Sexually transmitted infections & GI tract Flashcards
what is sex?
= contact between the penis and the vulva or the penis and the anus involving penetration, however slight; contact between the mouth and penis, vulva, or anus; or penetration of the anal or genital opening of another person by a hand, finger, or other object.
how are infections transmitted during sex?
- sexual/genital secretions
- direct inoculation, skin on skin e.g. Herpes
- trauma, e.g. Hepatitis C virus
- IVDU = injection drug user e.g. HIV, HCV
- fomites = an innate object e.g. gonorrhoea
- ingestion, e.g. shigella, campylobacter
True or false.
Anal sex is a pre-requisite for a rectal STI?
= FALSE
anal sex is NOT a pre-requisite for a rectal STI
how can rectal STIs arise?
- Passive transfer of vaginal secretions (chlamydia, gonorrhoea)
- Oro-anal contact/“rimming” (gonorrhoea, herpes)
- On sex toys or fingers (gonorrhoea, chlamydia)
- Systemic/haematogenous spread (syphilis)
- Local spread (herpes, warts)
what are risk factors for STIs?
- <25year olds
- changing sexual partner
- no Condom use
- men who have sex with men (MSM)
- past history/contact of STI
- large urban areas
- social deprivation
- black ethnicity
where can STIs present?
= anywhere in GI tract from mouth to anus
what is procto-colitis?
inflammation of rectum and colon
how would you advice someone with a STI?
- not to have sex until end of antibiotics
- inform other people that need to know
- safe sex advice
- substance use
what causes rectal gonorrhoea?
= neisseria gonorrhoea
gram negative cocci
how is gonorrhoea transmitted?
= direct contact of mucosal surfaces with infected secretions
- for proctitis; anal sex, transmucosal spread, fomit
what are symptoms of gonorrhoea?
- short incubation period (5-10days)
- lower abdominal pain, diarrhoea, rectal bleeding, anal discharge, tenesmus
- associated symptoms (urethral/vaginal discharge, dysuria)
- may be asymptomatic
what investigation would you do for gonorrhoea?
= protocscopy
what would you find on a protocscopy of gonorrhoea?
= inflamed mucosae
= purulent exudate
what are complications of gonorrhoea?
- abscess formation
- increased susceptibility/transmissibility of HIV
what causes the spread of rectal chlamydia?
= chlamydia trachomatis (serovars D-K)
how is rectal chlamydia transmitted?
= same as gonorrhoea
= direct contact of mucosal surfaces with infected secretions
- for proctitis; anal sex, transmucosal spread, fomit
what percentage of chlamydia in male sex with men is solely found in rectum?
= 50%
what are symptoms of chlamydia?
- 70% asymptomatic
- milder than gonorrhoea
- anal discomfort/itch, discharge
- associated symptoms
what would you find on a proctoscopy of rectal chlamydia?
= less severe
how would you diagnose chlyamdia?
= gram stain rectal swab
- CT (and GC)
- PCR (all sites)
how would you treat rectal chlamydia?
= doxycycline (7/7day course)
- better clearance at rectal sites
- test cure
- comprehensive STI testing
- public health intervention
Yes or no.
Can you culture chlamydia?
= no
- but you can culture gonorrhoea
in summary, what diagnosis/testing would you do fo chlamydia and gonorrhoea?
- gram stain of discharges
- chlamydia and gonorrhoea PCR
- gonorrhoea cultures
- STI testing of all sexual sites
what is lymphogranuloma venereum associated with?
= chlamydia
who often gets lymphogranuloma venereum?
- male sex with men
- often HIV
what is lymphogranuloma venereum associated with?
- group sex
- drug use
- syphilis
- hepatitis C
describe the clinical features of lymphogranuloma venereum?
Primary (3-30days)
- ulcer
Secondary (3-6/12)
- inguinal syndrome
- ano-rectal syndrome
Tertiary
- strictures
- fistulae
- genital elephantiasis
who should you test for, for LGV?
- MSM with haemorrhagic proctitis
- HIV+ MSM with positive rectal chlamydia
- Suspicious ulcers in MSM
- Failed chlamydia test of cure
- Contact of LGV
Anyone diagnosed with LGV should be tested for HIV, hepatitis C, syphilis….
describe the two types of syphilis?
Primary syphilis
- solitary painless ulcers
Secondary syphilis
- mucosal patches & ulcers
- mouth, anogenital, rectal
- condylomata lata (wart like lesions on genitelia)
- systemic inflammation
- hepatitis
- procto-colitis
how is herpes simplex virus transmitted?
= ano-genital or oro-anal
= usually HSV 2 (in HSV proctitis)
= usually per-anal mucosa but may extend into rectum
what are symptoms of herpes simplex virus?
- PAIN
- ulcers
- painful defaecation
- bleeding
- mucus
- viraemic symptoms (in primary infections)
how is the human papllomavirus transmitted?
= ano-genital, oro-anal
wart virus
describe the types of HPV?
- HPV 6, 11, 16, 18
what does the human papilloma virus usually cause?
= anal warts
- can extend to the rectum
- increasing prevalence of AIN and anal cancers (MSM and HIV+ people)
- HPV vaccination for MSM available
what is the largest immune compartment in the body?
= gut associated lymphoid tissue (GALT)
what is the gut therefore, highly susceptible to?
= HIV infections
what are some clinical consequences of loss of gut associated lymphoid tissue?
- unknown
- HIV enteropathies
- opportunistic infection (e.g. cryptosporidiosis)
- persistent immune activation = microbial translocation
- accelerated immune-senescence
