STI

Question 1

What is the difference between an STI and an STD?

Answer 1

• STI = pathogen that causes infection through sexual contact
• STD = recognisable disease state that has developed from an infection

Question 2

How are STI’s transmitted from one person to another?

Answer 2

Sexual intercourse/intimate contact

Question 3

How do organisms pass from person to person?

Answer 3

Blood, semen, vaginal and other bodily fluids

Question 4

How can these infections be transmitted non-sexually?

Answer 4

• Mother to infant during pregnancy/childbirth
• Blood transfusions/shared needles

Question 5

List bacterial STI’s

Answer 5

• Neisseria gonorrhoea (gonorrhoea)
• Chlamydia trachomatis (chlamydia)
• Treponema pallidum (syphilis)

Question 6

List STI viruses

Answer 6

• HIV/AIDs
• Herpes simplex virus type 1 and type 2 (genital herpes)
• Human papillomavirus (HPV) - genital warts, cervical dysplasia, cancer

Question 7

List different parasitic and fungal infections

Answer 7

Parasites - pediculus humanus (lice), sarcoptes scabei (scabies)

Fungal - candida Albicans (thrush)

Question 8

List some long term complications of STI’s

Answer 8

• PID, ectopic pregnancy, infertility, infant infections and blindness, epidydimitis in men, CVD/neuro damage, cancers, arthritis

Question 9

List the 3 different levels of SHSs services

Answer 9

• Level 1 (asymptomatic) > GPs, some pharmacies, SRH services, online sexual health services
• Level 2 (symptomatic) > “ “
• Level 3 (complex/specialist) > GUM & SRH services

Question 10

List the at risk groups for STI

Answer 10

• Adolescents (15-24 years), MSM, people with multiple partners, alcohol/substance use, IV drug use

Question 11

List some safe sex advice

Answer 11

• Education
• Partner reduction
• Condom use
• Repeat testing (3 monthly if high risk)
• Vaccination
• PrEP

Question 12

What is the most common CDS

Answer 12

• C-card

Question 13

How do we manage STIs?

Answer 13

• Sexual history taking, screening, testing, treatment, contact tracing & notification, lifestyle advice and STI prevention

Question 14

What does chlamydia cause inflammation of in men and women?

Answer 14

Urethra (men)
Cervix and/or urethra (women)

Question 15

What are the risk factors of chlamydia?

Answer 15

• <25 years, new sexual partner, more than one sexual partner in the last year, lack of consistent condom use

Question 16

What type of test is done for chlamydia?

Answer 16

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

Question 17

What is the treatment for chlamydia?

Answer 17

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

Question 18

How long to avoid sexual intercourse and oral sex after treatment?

Answer 18

7 days

Question 19

What to do for partner notification and how long for previous partners to be notified?

Answer 19

• Refer to GUM clinic
  Symptomatic (all partners within 2 weeks)
  Asymptomatic (all partners preceding 3 months)

Question 20

How long after to offer repeat testing?

Answer 20

Under 25 years = 3-6 months after treatment
Over 25 years = if at high risk of re-infection

Question 21

What are the complications of gonorrhoea?

Answer 21

Men - epididymitis, prostatitis, infertility
Women - PID & dangers in pregnancy
Babies - blindness (conjuctivitis)

Question 22

Who should manage gonorrhoea patients?

Answer 22

Level 2/3 SHS

Question 23

What test is done to test for gonorrhoea?

Answer 23

NAAT

Question 24

How are men and women tested?

Answer 24

• Women (vulvovaginal swab)
• Men (first pass urine sample)

Question 25

What is required if NAAT is positive for gonorrhoea?

Answer 25

Culture to test for susceptibility and identify resistant strains

Question 26

Which is most resistant to common antibacterials?

Answer 26

Super gonorrhoea

Question 27

What is the treatment for gonorrhoea?

Answer 27

• 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

Question 28

What are the alternative treatments if people have allergies, needle phobia or other CI?

Answer 28

• Gentamicin 240mg IM as single dose + azithromycin 2g orally
• Cefixime 400mg orally as single dose + azithromycin 2g orally (if IM injection CI/refused)

Question 29

What is the treatment for disseminated gonorrhoea?

Answer 29

• 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

Question 30

What follow up advice should be given with gonorrhoea?

Answer 30

• 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