STI Flashcards
Gonorrhoea
- Gonorrhoea is most commonly diagnosed in men who have sex with men, young (heterosexual) Aboriginal and Torres Strait Islander people
- travellers returning from high prevalence areas overseas.
- Neisseria gonorrhoeae, (Gram-negative)
- IP 2-7 days
Gonorrhoe - Clinical presentation
- often asymptomatic
- Penile urethral discharge
- Dysuria
- Vaginal discharge
- Dyspareunia with cervicitis
- Conjunctivitis: purulent, sight-threatening
- Anorectal symptoms: discharge, irritation, painful defecation, disturbed bowel function
Gonorrhoe - Complication
- Epididymo-orchitis (uncommon): painful, red swollen testicle/s
- Prostatitis (very rarely)
- Pelvic inflammatory disease (PID): dyspareunia, intermenstrual bleeding, post-coital bleeding, discharge
- Bartholin gland abscess
- Disseminated disease (rarely):
macular rash that may include necrotic pustules
septic arthritis - Meningitis or endocarditis (rarely)
Gonorrhoe - Diagnostic
- First pass urine (FPU) - NAAT
- Penile urethral swab ( just if discharge)
- Clinician-collected endocervical swab -best
- Clinician-collected endocervical swab (men)
- Pharyngeal swab (men)
Gonorrhoe - Treatment uncomplicated
- Ceftriaxone 500 mg IMI, stat. in 2 mL 1% lignocaine+ Azithromycin 1 g PO, stat.
same treatment in pregnancy
- test 2 weeks after
- Contact tracing 2month
Gonorrhoe - Treatment Conjunctivitis
- Ceftriaxone 1 g IMI, stat. in 2 mL 1% lignocaine+
Azithromycin 1 g PO, stat.
Gonorrhoe - other MX
- no sexual contact for 7 days
- Partner notification and testing ( 2 month back)
- Notify health department
- Testing for other STIs
Chlamydia
- most commonly
- Those < 30 years are at greatest risk.
- Frequently asymptomatic.
- Simple to test and treat
- IP 5days to 12weeks
Chlamydia trachomatis
Chlamydia - Symptoms
85%-90% have no symptoms
- Dysuria
- Penile urethral discharge
- Vaginal discharge
- Testicular pain
- Pelvic Pain
- Intermenstrual bleeding
- Postcoital bleeding
- Pain with sex - dyspareunia
- Anorectal symptoms
Clamydia - complications
- Epididymo-orchitis
- Pelvic inflammatory disease (PID)
- Infertility
- Pregnancy - Ectopic pregnancy, Premature rupture of the membranes, preterm delivery, and low-birthweight infants
- Reactive arthritis: arthritis, sometimes with concurrent rash and gastrointestinal symptoms
- Cervicitis
- Conjunctivitis
- Perihepatitis
Clamydia - Diagnostic
- First pass urin ( NAAT)
- Endocervical swab
- Anorectal swab
- Pharyngeal swab
NAAT highly sensitive
Chlamydia - Treatment
**For uncomlicated genital or pharyngial
** Doxycylin 100 mg for 7 days
* Alternative Azithromycin 1g, immed.
**Anorectal asymptomatic
** Doxycylin 100 mg for 7 days
* Alternative Azithromycin 1g, immedi repeat in 12-24 hrs
**Anorectal symptomatic
** Doxycylin 100 mg for 21 days
* Alternative Azithromycin 1g, stat repeat in 12-24 hrs
Chlamydia - further MX
- No sexual contact for 7 days or until symptoms resolved
- Contact tracing and testing 6 month
- notify health department
Pregnancy : Azythromycin 1g immed
Retest in 3 month
Syphillis
- high prevalence : homosexual, Abor/torres
- in pregnancy - congenital syphylis ( urgent specialist advice
Treponema Palidum
Syphillis- Clinic
- 50% asymptomatic
- mimic many other conditions , consider testing in all pat with unexplained symptoms
- 3 stages
early infectious
late latent
tertiary or late symptomatic
Syphylis - early
- primary and secondary and early latent infection
Syphylis - Primary
- genital, anal, oral ulcer (chancre)
- enlarge LN, rubbery non tender
- mostly painless
- Incubation 10-90 days
- high infectious
Syphylis - secondary
- more than 6 weeks after infection
- systemic signs and symptoms
- fever, malaise, headache and Lymphadenopathy
- rash( 90%) trunk, palms and soles
- Incubation averrage 6 Weeks
- highly infectious
- psoriatic rahes/warty lesion
Syphylis - early latent
- <2 years
- positive syphilis serology with no clinical symptoms
- high infectious
Syphylis - late
- > 2years
- absence of any symptoms
- no longer infectious to sexual partners but transmitted during pregnancy
syphylis - Tertiary
- development of complication:
Skin lessions ( gumma)
Cardiovascular
neurological (visual changes, tinnitus, deafness, cranial nerve palsies, meningitis), require intravenous treatment.)
Syphylis - congenital
- severe multi-organ disease with very high mortality and morbidity in both in-utero and neonatal periods
Syphylis - Diagnostic
- Blood Serolgy ( antibody: RPR and TpHa)
- Swab of ulcer (NAAT/PCR)
- Test in pat with HIV
- In remote Australia include donovanosis Pcr
Syphilis Treatment early stage
- Benzathine benzylpenicillin 2.4 MU (1.8 g) IMI, Stat, given as 2 injections containing 1.2 MU
Syphilis Treatment Late/ unclear stage
- Benzathine benzylpenicillin 2.4 MU (1.8 g) IMI, given as 2 injections containing 1.2 MU (0.9 g)
weekly for 3 weeks
Jarisch-Herxheimer reaction
- common reaction to treatment in patients with primary and secondary syphilis
- 6-12 hours after commencing treatment
- fever, headache, malaise, rigors and joint pains, and lasts for several hours
- analgesics and rest
- Patients should be alerted to the possibility of this reaction and reassured accordingly.
Syphilis - further Mx
- no sexual contact for 7 days or symptoms resolve
- Contact tracing 3 month/6month/12month
- Notify health department
Discharge
Bacterial vaginosis: thin, grey-white, offensive and fishy odour
Candidiasis: thick, white, non-offensive
Chlamydia and M. genitalium: minimal discharge or purulent (cervicitis)
Gonorrhoea: purulent (cervicitis)
* Trichomoniasis: offensive green and yellow, scanty to profuse and frothy (vaginitis)
Donovaosis granuloma inguinale
- Indigenous
- sores , destructive infection
- NAAT
- Azithromycin or Doxycyclin for 4 weeks
Bacterial vaginosis
- Garnerella
- Amsel test : ph>4.5, Clue cells, Amin test pos
- thin, grey-white, offensive and fishy odour
- mc cause of Vaginitis
- oral metronidazol or tinizole
- Clindamycin in pregnancy
- no need to treat partner
Candidiases
- thick, white, non-offensive
- pruritus /Brick like vagina/dysuria
- Clotrimazole vag tabl and cream
- Nystatin for recurent
- fluconazol ( not in preg)
Trichimoniasis
- offensive green and yellow, scanty to profuse and frothy (vaginitis)
- Inv PCR
- Strawberry cervix
- Metronidazol or tinidazol
- treat partner
HIV - investigation
- Elisa- antibody screning
- Western blot - to confirm Elisa
- Immune function - CD4 cell count
- Viral load - treatment response
HIV acute seroconvertion
- within 6 weeks, flue like symptoms
- Headache, malaise, photophobia
- fever night sweats, anorexia, sore throat, diarrhoe, lymphadenopathy
Resemble ebv inifection( monospot test)
HIV - Clinic
- Fever
- weight loss
- respiratory: Pneumocystis Jerovicii Pneumonia/Tb reactivation
- GI : diarrhoe
- Neuro GBS HIV encephalopathy, Cryptococcal meningitis
- Kaposy sarcoma, Herpes
- Sti, candidiasis
- Ulcer
What is its significance in HIV?
- As the antibodies take about 2-8 weeks to
present in the blood stream, the window
period varies between 3 - 12 weeks in
case of HIV.
What is the window period?
time between the initial infection and a positive test
results.
PrEP - Pre-exposure prophylaxis
Perform a risk assessment to determine
the risk of HIV INFECTION:
* men who have sex with men - MSM
* transgender and gender diverse people
* heterosexual people
* people who inject drugs
3 months is the key word
Before prescribing HIV PrEP
Perform baseline testing:
* HIV,
* Hepatitis B and C virus
* Sexually transmitted infections
* RFT - LFT
* Pregnancy
USE:
Tenofovir + Emtricitabine (Truvada) orally, daily.
When do you start Antiretroviral therapy
- Reduces morbidity and mortality regardless of CD4 cell count, so it is recommended for all people with HIV infection.
- For patients without opportunistic or co-infections, start antiretroviral
therapy as soon as possible. - Once started, treatment should be continued indefinitely without
interruption, unless oral therapy cannot be taken, or severe toxicity develops.
Guidelines before starting antiretroviral therapy in Australia:
HIV antibody - antigen
* CD4 cell count
* Plasma HIV RNA (viral load)
* HIV genotypic resistance as soon as possible after diagnosis
* Hepatitis B and C virus serology
* FBE – RFT – LFT
* FBS and serum lipids
* Serum cryptococcal antigen if CD4 cell count is less than 100 cells/ microlitre
* Tests to exclude opportunistic and co-infections if the patient is symptomatic.
Pregnancy and HIV
- Risk of transmission: 15 to 25%
- Antiretroviral therapy given to the mother during pregnancy
and to the infant post delivery - Caesarean section delivery
- Exclusive formula feeding.
HIV antiviral therapy
Dolutegravir + abacavir + lamivudine= Triumeq
* Tenofovir alafenamide + emtricitabine + bictegravir = Biktarvy
* Tenofovir alafenamide + emtricitabine +elvitegravir + cobicistat = Genvoya
HIV Infant management
- 4-week course of oral zidovudine prophylaxis for all HIV-exposed infants
- Started ORALLY or IV as soon after birth as possible, within 6 hours of delivery
DX of HIV in Infant
During pregnancy, the foetus passively acquires maternal HIV
antibodies across the placenta – so Elisa/WB will be (+)
- It can take up to 12 to 18 months for an infant to clear these
maternal antibodies.
HIV post- exposure prophylaxis
LOW RISK:
* Zidovudine + Lamivudine 12 hourly for 4 weeks
HIGH RISK: (ASAP)
* Zidovudine + Lamivudine + Indinavir within 8 hrs for 6 weeks
MONITORING at 0,4,6,12,24 and 52 weeks.
