Sexually Transmitted Infections Flashcards
What is PID?
Infective inflammation of endometrium, uterus, fallopian tubes (salpingitis), ovaries + peritoneum
What are the clinical features of PID?
May be asymptomatic Deep dyspareunia Menstrual abnormalities Post-coital bleeding Dysuria Abnormal discharge - purulent/smelly
If severe:
- fever
- nausea + vomiting
How is PID diagnosed?
Which additional investigations should be done?
Endocervical swabs (for chlamydia + gonorrhoea) High vaginal swab (for trichomonas vaginalis + bacterial vaginosis)
Additional:
- full STI screen
- urine dipstick +/- MSU (exclude UTI)
- pregnancy test
- transvaginal USS
- laparoscopy (if very severe + diagnostic uncertainty)
What is the treatment for PID?
Broad spectrum antibiotics:
- doxycycline, ceftriaxone + metronidazole
- OR ofloxacin + metronidazole
When might a patient require admission for PID?
If pregnant, especially if risk of ectopic
Severe symptoms: N&V, fever
Signs of pelvic peritonitis
Unresponsive to antibiotics, need for IV therapy
What are the complications of PID?
Ectopic pregnancy (scarring) Infertility Tubo-ovarian abscess Chronic pelvic pain Fitz-Hugh Curtis syndrome (perihepatitis --> RUQ pain)
What are the different subtypes of chlamydia?
Chlamydia trachomatis:
- types A-C –> ocular infection
- types D-k –> genitourinary infection
- types L1-L3 –> lymphogranuloma venereum (LGV)
What is LGV?
Chlamydia infection in men who have sex with men –> proctitis
- rectal pain, discharge + bleeding
What are the symptoms and signs of chlamydia in women?
Many asymptomatic Dysuria Abnormal discharge Intermenstrual or post-coital bleeding Deep dyspareunia Lower abdominal pain
Signs:
- cervicitis +/- contact bleeding
- mucopurulent discharge
- pelvic tenderness
- cervical excitation
What are the features of chlamydia in men?
Urethritis –> dysuria + urethral discharge
Epididymo-orchitis –> testicular pain
How is chlamydia diagnosed?
NAAT –> nucleic acid amplification test, 14 days post-exposure
- women: vulvo-vaginal swab
- men: first catch urine sample
If indicated - swabs from rectum, eye + throat
What is the treatment for chlamydia?
Doxycycline 100mg twice daily for 7 days
or Azithromycin 1g stat followed by 500mg daily for 2 days
What advice should be given regarding sexual intercourse following chlamydia diagnosis?
Avoid sex (including oral) until they and/or their partner have completed treatment
What are the complications of chlamydia infection?
PID Ectopic Infertility Conjunctivitis Sexually acquired reactive arthritis/Reiter's syndrome Transmission to neonate Fitz-Hugh Curtis syndrome
What causes gonorrhoea?
Neisseria gonorrhoea - gram negative diplococcus
How does gonorrhoea present and how is it diagnosed?
Very similar to chlamydia
NAAT - screening test
Microscopy if symptomatic
Culture if micro +ve
How is gonorrhoea treated?
Single dose IM cefriaxone 1g
- if symptoms suggestive, treat without waiting for test result
Usually treat for chlamydia at same time
TEST OF CURE FOR ALL PATIENTS
What are the complications of gonorrhoea?
PID Epididymo-orchitis Prostatitis Disseminated gonococcal infection --> joint pain + skin lesions Gonococcal meningitis
What causes syphilis?
Treponema pallidum - spirochete gram negative bacteria
What happens in primary syphilis?
Chancre - painless ulcer on genital site
What happens in secondary syphilis?
3 months post infection:
- rash on hands and soles
- fever
- malaise
- arthralgia
- weight loss
- headaches
- condylomata lata (warts in moist areas)
- painless lymphadenopathy
- silvery grey mucous membrane lesions
What happens after secondary syphilis?
Enter asymptomatic latent phase Tertiary syphilis can present may years after initial infection: - gummatous syphilis (granulomas) - neurosyphilis - cardiovascular syphilis
How is syphilis diagnosed?
Demonstration of bacteria from lesions or infected lymph nodes: - Dark Field Microscopy - PCR Serological testing: - antibody to pathogenic treponemes
What is the treatment for syphilis?
Benzathine penicillin IM
