STI Flashcards
With which presenting symptoms should you consider taking a sexual history/performing a sexual health screen?
- Vaginitis
- Urethritis
- Epididymo-orchitis
- Pelvic inflammatory disease
- Proctitis
- Ulcer/lumps on genitals
- Possible syphilis
- Possible HIV seroconversion
What are the symptoms of vaginitis?
- Change in discharge (colour, consistency, volume)
- Dysuria
- Change in menstrual bleeding
What are the symptoms of vaginitis?
- Change in discharge (colour, consistency, volume)
- Dysuria
- Change in menstrual bleeding
What are the symptoms of urethritis
- Penile discomfort
- Dysuria
- Meatal discomfort
- In women it rarely causes any symptoms
What are the symptoms of epididymo-orchitis
Swollen, painful testicle
What are the symptoms of pelvic inflammatory disease?
- Pelvic pain
- Fever
- Change in discharge
- Dyspareunia
What are the symptoms of proctitis?
- Rectal discharge
- Rectal pain
- Bleeding
What is tested for on a standard sexual health screen?
- Chlamydia and gonorrhoea (naat test)
* Syphilis and HIV (blood test)
Where are the swabs obtained for a sexual health screen?
- Women: self taken vulvovaginal swab
- men: urine
- Men with male sexual partners: urine, throat and self taken rectal swab
Which groups are at a higher risk of gonorrhoea?
- Men who have sex with men
- Afro-carribean
- Urban areas with deprivation
- Women <25 years
What is gonorrhoea caused by?
Gram negative diplococcus N. gonorrhoeae
Where does N.gonorrhoeae infect?
mucous membranes of: •Urethra •Endocervix •Rectum •Pharynx •Conjunctiva
How does gonorrhoea spread?
Inoculation through secretions from one mucous membrane to another
What are the symptoms of gonorrhoea in men?
- Urethral discharge (yellow green)
* Dysuria
What are the symptoms of gonorrhoea in women?
- Change in discharge
- Abdominal/pelvic pain
- Dysuria
- Altered bleeding is rare
What are the symptoms of rectal gonorrhoea
Usually asymptomatic but can get anal discharge, pain or discomfort
Describe the diagnosis of gonorrhoea
- NAAT testing - urine in male, self taken vaginal swab in women (takes up to a week)
- Urethral sample microscopy - looking for gram negative diplococci, if positive treat straight away, if negative await NAAT testing don’t rule out
With Gonorrhoea, who should you treat?
- Those with a positive test result
- Clinical suspicion in certain cases (e.g. when no on the day microscopy is available)
- Recurrent or ongoing sexual contact with gonorrhoea
What should you give to treat gonorrhoea?
- Ceftriaxone 1g IM (or ciprofloxacin if sensitive)
* Repeat test after 2 weeks to ensure cure
What are the complications of gonorrhoea?
- Epididymo-orchitis
- Prostatitis
- Pelvic inflammatory disease
- Disseminated gonococcal infection (rare in the UK, usually affects the skin and joints)
- Resistance (48.6% is restart to at least one antibiotic)
What is the most common bacterial STI in the UK?
Chlamydia
What are the risk factors for a chlamydia infection?
- <25 years old
- New sexual partner or >1 partner
- Inconsistent condom use
What are the signs of a penile chlamydia infection?
- Majority are asymptomatic
- Discharge/dysuria/meatal discomfort
- Normally the discharge is clear/white
What are the symptoms of vaginal chlamydia infection?
- Most asymptomatic
- Intermenstrual bleeding/ Post coital bleeding
- Cervicitis or contact bleeding
- Change in discharge
- Pelvic pain
What are the symptoms of a rectal chlamydia infection?
- Usually asymptomatic
- Can present with proctitis (rectal pain, PR discharge/bleeding, tenesmus, constipation)
- Lymphogranuloma venereum (chlamydia attacks the lymph nodes) subtype often presents as proctitis
What is the diagnosis of chlamydia?
- NAAT testing
* Same sample as gonorrhoea
What is the treatment of chlamydia?
Doxycycline 100mg BD 7/7 (weeks Course)
What are the complications of chlamydia?
- Pelvic inflammatory disease
* Epididymo-orchitis
What are the complications of pelvic inflammatory disease?
- Tubal infertility (1-20%)
- Ectopic pregnancy
- Fitz-hugh-curtis syndrome
How is mycoplasma genitalium infection diagnosed?
NAAT (urine/self taken swab)
What are the symptoms of a mycoplasma genitalium infection?
- Some people get symptoms of urethritis/PID
* Some asymptomatic
Who is treated for mycoplasma genitalium infection?
Only those with symptoms or partners of those with symptoms (to stop the chain of infection)
What is trichomonas vaginalis?
Protozoan with flagella
What are the symptoms of a vaginal trichomonas vaginalis infection?
- Often asymptomatic
- Frothy yellow discharge with intense itch
- ‘Strawberry cervix’ in 2%
What are the symptoms of a penile trichomonas vaginalis infection?
- Usually asymptomatic
* Can have urethritis
How is trichomonas vaginalis diagnosed?
Microscopy/culture
How is trichomonas vaginalis infection treated?
Metraonidazole
What causes syphilis?
A gram negative spirochete bacterium called treponema palladium
Describe the transmission of syphilis
- Normally transmitted sexually
* Can be transmitted vertically
What is it called if someone is asymptomatic but tests positive for syphilis?
Latent syphilis
What is the classical presentation of primary syphilis?
- Chancre
- Usually single and painless ulcer, clear fluid
- May be on the genitals, peri anal, in the mouth
- 9-90 days
What is the classical presentations of secondary syphilis?
- usually a generalised rash affecting the palms and sole
- Muco-cutaneous lesions, condylomata lata, lymphadenopathy and fever
- Occurs in 25%, 3 months- 2 years
What is the classical presentation of tertiary syphilis?
• Neurosyphilis: - variation of neurological symptoms •Cardiovascular syphilis - Aortic valve disease, aortic aneurysm, aortitis •Gummatous syphilis
What is the diagnosis of syphilis?
• If there is a chancre: dark ground microscopy/viral PCR swab
•bloods for antibody
- 3 month window period
- stays positive even after treatment completed
• Rapid plasma reagin
- quantitative marker
What is the treatment of syphilis?
Benzathine penicillin
What causes anogenital warts?
Human papilloma virus (HPV), most commonly types 6 and 11
What are the symptoms of anogenital warts?
Normally only itch, aesthetics usually main problem
What is the advice given to those with anogenital warts?
- Reassure high prevalence and benign
- No requirement for partner notification but condoms reduce transmission
- Many people clear virus
- Smoking/hair removal slows down the ability to self clear
What is the treatment of anogenital warts?
- Cryotherapy
- Topical treatments: podophyllotoxin/imiquimod
- Surgical excision (rarely required)
How is herpes simplex virus diagnosed?
Viral PCR swab
What advice should be given to those with HSV?
- Reassure, high prevalence
- Possible future recurrence
- Condoms reduce transmission
What are the complications of herpes?
- CNS infection, balanitis, proctitis, urinary retention (only if sig swelling)
- If first episode is in pregnancy there is a risk of neonatal infection
What is the treatment of herpes?
- Aciclovir
- Can give long term if frequent recurrences
- A lukewarm bath with some salt can help to alleviate some of the symptoms
What are the symptoms of scabies?
- Itch, especially at night
* rash
What causes scabies?
Hypersensitivity reaction triggered by mite excrement
Where are the classical burrows in scabies?
- Web spaces
- Wrist
- Elbows
- Nipples
How is scabies diagnosed?
On clinical appearance
What is the treatment of scabies?
- Permethrin 5% or malathion 0.5%
- Wash off after 24 hours
- Wash contaminated clothes at 50 degrees celsius
Explain phthirus pubis infection
- Transmitted by close bodily contact
- Lives on coarse body hair
- It needs hair to stay alive
- Incidence is decreasing
What is the treatment of phthirus pubis infection?
Malathion 0.5% or permethrin 1% cream
