Sexually transmitted infections Flashcards
Who gets STIs?
ANYONE having sex… BUT the risk groups are:
- Young age (<20 years) - The lower the age at 1st intercourse, the greater the risks of sexual health infections. ‘coitarche’- The first sexual intercourse.
- Frequent partner change, high no. lifetime partners, concurrency (simultaneous partners)
- Sexual orientation
- Ethnicity for some STIs
- Residence in inner city/ deprivation
- Use of non barrier contraception
- History of previous STI
Young people
- Early age sexual intercourse is associated with poor subsequent sexual health.
- Behaviourally more vulnerable to STI acquisition
- higher numbers of sexual partners / partners change
- greater numbers of concurrent partners
- yet to develop skills and confidence to use condoms, negotiate safe sex
- more risk-taking behaviour/ experimentation
- poor awareness contraception
What is the stricture in the image
Answer: normal cervix. Cervical ectropion – transformation zone – changing from columnar epithelium to squamous epithelium.
Chlamydia and gonorrhoea infect columnar epithelium
cervical ectropion, or cervical ectopy, is when the soft cells (glandular cells) that line the inside of the cervical canal spread to the outer surface of your cervix. The outside of your cervix normally has hard cells (epithelial cells).
The rate of gonorrhoea in BME people is 4x that of the general population
For trichomoniasis, the rate in BME people is 9x that of the general population. WHY?
Its because of Sexual networks & core groups
Definition of a “core group”
- sub-group of the population – high turnover of STI
- not a static entity
- highly sexually active individuals
- high prevalence of infection
- reservoirs of infection
- high frequency of transmission
Effective control at the population level based on targeting core groups
Pearly penile
Pearly penile papules, also known as hirsutoid papillomas, are small, skin-colored bumps that form around the head of the penis. A papule is a raised, pimple-like growth on the skin that does not produce pus. While these tiny bumps may seem alarming, they are harmless and will tend to fade in appearance as you age
Fordyce spots
Fordyce spots are whitish-yellow bumps that can occur on the edge of your lips or inside your cheeks. Less often, they can appear on your penis or scrotum if you’re male or your labia if you’re female. The spots, also called Fordyce granules or Fordyce glands, are enlarged oil glands.
Fordyce spots are not a sexually transmitted infection. They are not infectious. These skin abnormalities are not a health concern but should be checked by a doctor if they start changing
Vulval papules / papillomatosis
Vestibular papillomatosis is characterized by small, shiny, skin-colored growths on a woman’s vulva, which is the outer part of the vagina. The growths, or papillae, occur in a line or as symmetrical patches on the labia minora — smaller inner folds.
This is not a sexually transmitted Infection .
-They are not pathological
Other conditions presenting with genital signs; Malignant melanoma
Other conditions presenting with genital signs; Psoriasis
Tinea cruris – dermatophyte (fungal) infection
Pruritic papules…
STI’s can be divided into
Bacterial/protozoal vs. viral STIs
Bacterial / protozoal STI
Chlamydia, gonorrhoea, syphilis, Trichomonas vaginalis.
- more often florid symptoms
- early presentation
- rapid diagnosis/accurate test that is easily done
- effective treatment available
- curative
reservoirs can be controlled once treated .
Viral STI’s
Herpes, warts, HIV, hepatitis.
- many unaware of infection
- delayed presentation
- diagnostic tests may be unreliable
- symptomatic treatment only
- often life-long
expanding reservoirs
Discharge 2o to gonorrhoea / chlamydia
The incubation period is 2 to 30 days with most symptoms occurring between 4–6 days after being infected.
- This is gonorrhoea.
- we would do contact tracing for at least 6 months.
- there is a point of care test where you put the discharge under a microscope and you can see the bacteria.
Gonorrhoea: caused by intracellular gram negative diplo-cocci
(Neg because they are red, cocci because they are round).
Primary syphilis
- 1-3 weeks after contact (9-90 days), red mark = raised spot = ulcer at the site of contact
- Enlarged lymph nodes in the groin/neck
- Heals within 1-3 weeks (with or without treatment)
-it doesn’t cause many symptoms but lots of signs. the rash isn’t itchy, the wounds aren’t painful. the red sit is the sit of the infection and that’s how the bacteria enters the body. they will then travel through the lymph nodes and spread throughout the body to cause a secondary syphilis.
Secondary syphilis
•2-6 weeks after 10 stage - lasts for 2-4 weeks
- Systemic dissemination - millions spirochaetes
- Flu-like illness, headache, lymphadenopathy
- Mouth ulcers - “snail track” painless
- Condylomata lata (white/grey lumps in moist areas)
- Arthritis
- Rapid resolution with effective treatment
•Particularly suspect if rash involves palms & soles
-This will ideally get better on its own, but it will go even quicker with some penicillin. however, in some people, the inflammation will continue in the latent stage and they will progress to tertiary syp[hilis. which may present with aortic regurgitation, dementia, posterior column disruption etc.
Differential diagnosis
pityriasis rosea (no herald patch),
psoriasis
HIV
Trichomonas vaginalis
- Single cell protozoan parasite
- Infects vagina & urethra
- Dysuria, discharge
- Causes frothy discharge, “strawberry cervix”
- Diagnosed by seeing motile organisms on microscopy
- Responds well to metronidazole
- can affect both sexes
- Can be describe/remebered as Frosty discharge with a strawberry cervix.
Genital warts
-Extremely common, human papilloma virus (HPV)
-Type 6 & 11 in 90% are those that cause external gential warts . Genital warts are benign growths which occur in the genital area.
-Vs types 16 & 18, 31, 33 etc (all the other ones higher than this). are the one we worry about more because they can cause (cervical cancer) , neoplasia , etc.
- not everyone that has had HPV had developed warts
- The HPV vaccine cover 6, 11, 16, 18 and they actually give some cross-reaction to some of the other numbers.
- There is also a Nonno Vaillant vaccine which we don’t use in the UK yet that covers all the other numbers and really reduces cervical cancers and all the rarer oropharyngeal cancers.
Notes: Number of anogenital warts diagnoses by sexual risk: England, 2015-2019
Overall, there was an 11% decrease in the number of anogenital warts diagnoses between 2018 and 2019. The number of diagnoses has steadily decreased for both groups in the years leading up to 2018 (generally a 6-8% decline per year), with a steeper decline between 2018 and 2019 (12% and 13% decline among heterosexual men and women). This is because of the HPV vaccine.
Molluscum contagiosum
- A viral infection.
- Common in kids but not sexually transmitted in kids. transmitted from swimming pools, and usually widespread in kids.
- whereas in adult, they are only on the upper thigh and the anterior abdominal wall in adult and in fact if they are more widespread or above the neck, we see that as a sign of severe immunosuppression and you will need to rule put HIV.
Herpes simplex type 1 & 2
Symptoms
- painful ulceration, dysuria (external, as the urine touches the broken skin, it hurts), vaginal discharge
- If it’s their first episode, they might have systemic symptoms e.g. fever and myalgia (more common in the first occurrence).
- recurrences generally less severe
Signs
- blistering & ulceration (+/- cervix/rectum)
- painful inguinal lymphadenopathy
- heals after 5-14 days
- The virus which has entered the system through the skin is neurotrophic, it travels up the nerve that supplies that bit of skin al the ay to the nerve root ganglion where it resides latently. when the immune system them takes a hit in the future, it comes back out again, down the nerve and back to that same bit of skin. when it comes back it can cause something called the Pro Drome which is pins and needle, paraesthesia, pain before the skin becomes abnormal. If you get all these before the skin breaks down, you can take a high dose of Aciclovir 3 times a day for 2 days and this can cause the outbreak altogether.
- it gets really bad the first infections and the second one doesn’t get as bad.
- with herpes, you can transmit it via a mouth sore/saliva and then have symptoms in your vagina/penis and have genital herpes.
Non-sexually transmitted infections
Candida / thrush
- fungal
- itching, discharge, swelling
- papular rash in males
- topical antifungals
Bacterial vaginosis
- discharge / “fishy” odour
- imbalance of vaginal flora
- overgrowth of anaerobes
- often result of over-washing / bubble baths etc.
- responds to metronidazole
Complications of Chlamydia / gonorrhoea
PID, epididymitis (inflammation of the epididymis), infertility, chronic pain, seronegative arthritis +/- urethritis and conjunctivitis.
Complications HPV / warts
cervical cancer, anal/vulval/penile intraepithelial neoplasia (AIN/VIN/PIN).
Trichomonas vaginalis and Trichomonas vaginalis Complications
miscarriage, early labour, low-birth weight
Syphilis complications
dementia, cardiac abnormalities etc
Hepatitis B, hepatitis C
cirrhosis, liver cancer through the chronic inflammation
HIV
opportunistic infections (immunosuppression), lymphoma, non-AIDS malignancies.
Most STIs increase the risk of HIV transmission
