STI Flashcards
What is the difference between an STI and an STD?
- STI = pathogen that causes infection through sexual contact
- STD = recognisable disease state that has developed from an infection
How are STI’s transmitted from one person to another?
Sexual intercourse/intimate contact
How do organisms pass from person to person?
Blood, semen, vaginal and other bodily fluids
How can these infections be transmitted non-sexually?
- Mother to infant during pregnancy/childbirth
- Blood transfusions/shared needles
List bacterial STI’s
- Neisseria gonorrhoea (gonorrhoea)
- Chlamydia trachomatis (chlamydia)
- Treponema pallidum (syphilis)
List STI viruses
- HIV/AIDs
- Herpes simplex virus type 1 and type 2 (genital herpes)
- Human papillomavirus (HPV) - genital warts, cervical dysplasia, cancer
List different parasitic and fungal infections
Parasites - pediculus humanus (lice), sarcoptes scabei (scabies)
Fungal - candida Albicans (thrush)
List some long term complications of STI’s
- PID, ectopic pregnancy, infertility, infant infections and blindness, epidydimitis in men, CVD/neuro damage, cancers, arthritis
List the 3 different levels of SHSs services
- Level 1 (asymptomatic) > GPs, some pharmacies, SRH services, online sexual health services
- Level 2 (symptomatic) > “ “
- Level 3 (complex/specialist) > GUM & SRH services
List the at risk groups for STI
- Adolescents (15-24 years), MSM, people with multiple partners, alcohol/substance use, IV drug use
List some safe sex advice
- Education
- Partner reduction
- Condom use
- Repeat testing (3 monthly if high risk)
- Vaccination
- PrEP
What is the most common CDS
- C-card
How do we manage STIs?
- Sexual history taking, screening, testing, treatment, contact tracing & notification, lifestyle advice and STI prevention
What does chlamydia cause inflammation of in men and women?
Urethra (men)
Cervix and/or urethra (women)
What are the risk factors of chlamydia?
- <25 years, new sexual partner, more than one sexual partner in the last year, lack of consistent condom use
What type of test is done for chlamydia?
Nucleic acid amplification tests (NAATs)
Women - vulvovaginal swab (first line) or alternatively first catch urine sample/endocervical swab
Men - first catch urine sample (first line)
Repeat at 14 days
What is the treatment for chlamydia?
First-line
- Doxycycline 100mg BD for 7 days
CI in pregnancy/BF, GI side effects, photosensitivity
- Alternatives if Doxycycline CI
Azithromycin 1g as single dose, then 500mg OD for 2 days
Erithromycin 500mg BD for 10-14 days
Ofloxacin 200mg BD for 7 days
Amoxicillin 500mg TDS for 7 days
Doxycycline and ofloxacin CI in pregnancy
How long to avoid sexual intercourse and oral sex after treatment?
7 days
What to do for partner notification and how long for previous partners to be notified?
- Refer to GUM clinic
Symptomatic (all partners within 2 weeks)
Asymptomatic (all partners preceding 3 months)
How long after to offer repeat testing?
Under 25 years = 3-6 months after treatment
Over 25 years = if at high risk of re-infection
What are the complications of gonorrhoea?
Men - epididymitis, prostatitis, infertility
Women - PID & dangers in pregnancy
Babies - blindness (conjuctivitis)
Who should manage gonorrhoea patients?
Level 2/3 SHS
What test is done to test for gonorrhoea?
NAAT
How are men and women tested?
- Women (vulvovaginal swab)
- Men (first pass urine sample)
What is required if NAAT is positive for gonorrhoea?
Culture to test for susceptibility and identify resistant strains
Which is most resistant to common antibacterials?
Super gonorrhoea
What is the treatment for gonorrhoea?
- When antimicrobial susceptibility is not known
Ceftriaxone 1g (IM) injection as single dose (pen allergy), safe in pregnancy/BF - When antimicrobial susceptibility is known
Ciprofloxacin 500mg as single dose - Pregnancy/BF (NOT ciprofloxacin)
Ceftriaxone 1g IM or Azithromycin 2g orally as single dose
What are the alternative treatments if people have allergies, needle phobia or other CI?
- Gentamicin 240mg IM as single dose + azithromycin 2g orally
- Cefixime 400mg orally as single dose + azithromycin 2g orally (if IM injection CI/refused)
What is the treatment for disseminated gonorrhoea?
- Ceftriaxone 1g IM or IV every 24 hours
- Cefotaxime 1g IV every 8 hours
24-48 hours after symptoms improve switch to
- Cefixime 400mg BD or Ciprofloxacin 500mg BD
What follow up advice should be given with gonorrhoea?
- Avoid sexual intercourse until treatment completed (or 7 days after treatment with azithromycin)
- Follow up 1 week after to confirm adherence to treatment, adverse reactions, partner notified, safe sex advice
- Test 2 weeks after treatment completes
- Notify any cases of ceftriaxone resistance
