STI Flashcards

1
Q

State 5 risk factors for STI contraction

A
  • young age (<20 years) - low age at 1st intercourse - coitarche
  • frequent partner change, high no. lifetime partners, concurrency (simultaneous partners)
  • sexual orientation
  • ethnicity for some STIs
  • use of non barrier contraception
  • residence in inner city/ deprivation
  • history of previous STI
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2
Q

What are the effects of having sex at an early age?

A
  • Poor subsequent sexual health status
  • higher numbers of sexual partners / partners change
  • greater numbers of concurrent partners
  • yet to develop skills and confidence to use condoms, negotiate safe sex,
  • more risk-taking behaviour/ experimentation
  • poor contraception awareness
  • Physiological changes increase susceptibility to pathology
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3
Q

What is tthe correlation between consent and age?

A

The earlier intercourse occurs, the more people express regret and rport being more/less willing than their partner

20% men
42% women wish they waited

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4
Q

Rx factors for young people having poor sexual health/ early coitarche

A
  • leaving home / not living with parents before 16 years
  • leaving school early
  • family disruption & disadvantage
  • lack of nurturing relationships
  • those whose main source of information on sex was not school / parents
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5
Q

Where do young people get sexual information from?

A
  • Parents
  • School
  • Books
  • Internet (porn)

Internet is free, unrestricted and UNCENSORED. Its unrealistic and raises expectations

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6
Q

State 5 negative aspects of porn

A
  • Unrealistic nature & expectations
  • Self-image / performance anxiety
  • Lack of censorship / boundaries – hardcore material becomes addictive / normalised
  • Ethical issues e.g. exploitation of women
  • Sexual consent blurred
  • Lack of condom use = reduced risk perception / perceived need to practice safe sex
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7
Q

What should we be telling young people about sex?

A
  • Don’t rush, avoid peer pressure
  • Use a condom with all new partners, continue until both screened
  • Sort out contraception
  • Avoid overlapping sexual relationships
  • Get screened for chlamydia/gonorrhoea when you have a new partner
  • MSM should have regular sexual health screens, including HIV, get vaccinated for hepatitis A/B and HPV & consider PrEP for HIV prevention
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8
Q

What is the definition of a “core group”

Why are these relevant?

A
  • sub-group of the population, high turnover
  • not a static entity
  • highly sexually active individuals
  • high prevalence of infection
  • reservoirs of infection
  • high frequency of transmission

Effective control at the population level based on targeting core groups

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9
Q

What is GMC guidelines regarding a genital examination?

A
  • OFFER a chaperone
  • Explain to patient why examination is necessary & what it will involve
  • Give patient privacy to undress & dress
  • Obtain patient’s permission before the examination - discontinue if patient asks you to
  • Keep discussion relevant - avoid unnecessary comments
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10
Q

How would you conduct a female genital examination?

A
  • Inspect pubic area, labia majora & minora & perianal area
  • Inspect & palpate inguinal region
  • Use leg rests - allow better visualisation
  • Speculum examination (use water as lubricant - gels can interfere with tests)
  • Bimanual examination (if indicated)
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11
Q

How would you conduct a male genital examination?

A
  • Inspect pubic area, inguinal region
  • Inspect scrotum & perianal area
  • Palpate scrotal contents – note presence of testes, any lumps/ tenderness
  • Inspect penis - record whether circumcised - if not inspect under foreskin
  • Particular attention to coronal sulcus, frenulum & meatus
  • Note presence of urethral discharge
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12
Q

What are pearly penile papules?

What is the female equivalent?

A
  • Normal variation in penis

- Vulval papules / papillomatosis

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13
Q

How can normal subaceous glands become pathological

A
  • Subaceuous glands can turn into subaceous cysts (these are not always pathological
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14
Q

How does psoriasis appear in the moist genital areas?

If you suspect psoriasis what else would you ask/check

A

Red

  • FHx,
  • Asthma
  • Check elbows
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15
Q

How does scabbies present?

Is scabbies exclusively a STI?

A

Pruritic papules (red spots on penis)

  • Lesions and burrows in finger webs and wrist

No

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16
Q

Consider the bacterial and protozoal category of STIs.

  • Give examples
  • How do they present?
  • Treatment?
A

Chlamydia, gonorrhoea, syphilis, trichomonas

  • more often florid symptoms
  • early presentation
  • rapid diagnosis
  • effective treatment available
  • curative
  • reservoirs can be controlled
17
Q

Consider the viral category of STIs.

  • Give examples
  • How do they present?
  • Treatment?
A

Herpes, warts, HIV, hepatitis

  • many unaware of infection –> delayed presentation
  • diagnostic tests may be unreliable
  • symptomatic treatment only
    often life-long
  • expanding reservoirs
18
Q

Presentation of gonorrhoea and chlamydia

A
  • Dysuria

- Discharge

19
Q

What does gonorrhoea discharge look like microscopically?

A
  • Gram negative intracelllular diplococci
20
Q

How fast will primary syphilis appear?

Presentation?

A

1-3 weeks after contact (9-90 days), red mark raised spot ulcer at the site of contact

Enlarged lymph nodes in the groin/neck, heals within 1-3 weeks (with or without treatment)

Not painful

21
Q

How fast will secondary syphilis appear?

Presentation?

A
  • 2-6 weeks after stage 1 (lasts 2-4 weeks)

Systemic dissemination - millions spirochaetes spread through-out the body
Flu-like illness, headache, lymphadenopathy
Mouth ulcers - “snail track” painless
Condylomata lata - white/grey lumps in moist areas
Arthritis
Rapid resolution with effective treatment
Particularly suspect if rash involves palms & soles

22
Q

Describe trichomonas vaginalis , its symptoms and causes

  • Diagnosis?
  • Treatment?
A

Single cell protozoan parasite
Infects vagina & urethra
Dysuria, discharge
Causes frothy discharge, “strawberry cervix”
Diagnosed by seeing motile organisms on microscopy

Responds well to metronidazole

23
Q

Genital warts causes?

Are increased cervical smears recommended in patients with genital warts?

A

HPV 6 and 11

No.

24
Q

State 2 symptoms of Herpes simplex

State 2 signs of Herpes simplex

What proportion of people are aware they have genital herpes?

Type 1 and type 2 herpes simplex cause…

A

Symptoms

  • painful ulceration, dysuria, vaginal discharge
  • systemic symptoms e.g. fever and myalgia (more common in 10)

Signs

  • blistering & ulceration (+/- cervix/rectum)
  • inguinal lymphadenopathy

20%

Genital herpes and cold sores. Not mutually exclusive

25
Q

Candida/thrush is a non- sexually transmitted infection

Organism?
Symptoms?
Treatment?

A
  • fungal
  • itching, discharge, swelling
    (papular rash in males)
  • topical antifungals
26
Q

Bacterial vaginosis is a non-sexually transmitted infection

Cause?
Symptoms?
Treatment?

A
  • Overgrowth of anaerobes/imbalance of vaginal flora usually as a result of voer-washing/bubble baths
  • Discharge/ fishy smell
  • Responds to metronidazole
27
Q

For the folllowing STIs, state a possible complication

1 - Chlamydia/gonorrhoea
2 - HPV/Warts
3 -Bacterial vaginosis
4 - Trichomonas vaginalis
5 - Syphilis
6 - Hepatitis B and C
7 - HIV
A

1 - PID, epididymitis, infertility, chronic pain, Reiter’s syndrome (urethritis, arthritis, conjunctivitis)

2 - cervical cancer, AIN, VIN, PIN

3 & 4 - miscarriage, early labour, low-birth wt

5- dementia, cardiac abnormalities

6 - cirrhosis, liver cancer

7- long term morbidity & mortality opportunistic infections, tumours, non-AIDS malignancies

MOST STIs INCREASE THE RISK OF HIV TRANSMISSION