STI Flashcards
What bacteria causes chlamydia and is it gram positive or negative?
chlamydia trachomatis
gram negative
what is the most common STI in the UK and what is it a common cause of?
chlamydia
infertility
Risk factors for chlamydia
young
sexually active
multiple partners
What % of people with chlamydia are asymptomatic?
50% men
75% females
What does the National Chlamydia Screening programme entail?
everyone under 25 and sexually active to be screened annually for chalmydia or if partner changes
positive re-test 3 months
GUM clinic STI screening list
chalmydia
gonorrhoea
syphilis - blood
HIV - blood
2 types of swabs used
charcoal swabs
NAAT swabs
What do charcoal swabs allow for?
microscopy
culture
sensitivities
transport medium - charcoal swab
amies transport medium
keep microorganisms alive
What does microscopy entail?
gram staining
What can charcoal swabs be used for?
endocervical swabs
high vaginal swabs
What can charcoal swabs confirm?
bacterial vaginosis candidiasis gonorrhoea trichomonas vaginalis group B strep
What do NAAT detect?
DNA or RNA
What STIs use NAAT?
chlamydia
gonorrhoea
What can NAAT be performed on?
vulvovaginal swab
endocervical swab
first catch urine sample
What can NAAt be performed on - men
first catch urine
urethral swab
Rectal and pharyngeal NAAT swabs
chlamydia in rectum or throat
anal or oral sex
After gonorrhoea is demonstrated on NAAT what is done next?
endocervical charcoal swab
microscopy, culture, sensitivities
Who to consider chlamydia in - women
sexually active abnormal discharge pelvic pain abnormal vaginal bleeding painful sex painful urination
Who to consider chalmydia in - men
urethral discharge or discomfort
painful urination
epididymo-orchitis
reactive arthritis
Examination findings
Pelvic or abdominal tenderness
cervical motion tenderness
inflamed cervix
purulent discharge
First line treatment - uncomplicated chlamydia
doxycycline 100mg 2 daily for 7 days
When is doxycycline CI?
breastfeeding and pregnancy
treating chlamydia in pregnancy/breastfeeding
azithromycin 1g then 500mg for 2 days
erythromycin 500mg 4xdaily for 7 days
amoxicillin 500mg 3xdaily 7 days
When could a test of cure be done?
rectal chlamydia
pregnancy
symptoms persist
Factors to consider going forward
GUM - contact trace
look for other STIs
prevention
safeguarding - young people
Complications - chlamydia
PID chronic pelvic pain infertility ectopic pregnancy reactive arthritis epididymo-orchitis
Pregnancy related complications - chlamydia
preterm delivery
low birth weight
postpartum endometriosis
neonatal infection - conjunctivitis
What is lymphogranuloma venereum?
condition affecting lymphoid tissue around site of infection with chlamydia
MSM
3 stages of LGV
primary stage - painless ulcer
lymphadenitis
proctitis (tenesmus)
treating LGV
doxycycline 100mg 2xdaily for 21 days
Chlamydia conjunctivitis
chronic erythema, irritation and discharge more 2 weeks
unilateral
young adults and neonates with affected mothers
What bacteria causes syphilis?
treponema pallidum
What type of bacteria is treponema pallidum?
spirochete
spiral shaped bacteria
incubation period syphilis
21 days
How can syphilis be contracted?
oral, vaginal or anal sex vertical transmission IVDU blood transfusions transplants
Name different phases of syphilis
primary secondary latent tertiary neurosyphilis
primary syphilis
painless ulcer - chancre
local LN
secondary syphilis
systemic sx - skin and mucous membranes
maculopapular rash
condylomata lata
LN, fever, alopecia, oral lesions
latent syphilis
asymptomatic
within 2years of infection (early latent) and after 2 years is late latent
tertiary syphilis
many years after
development of gummas
aortic aneurysms
neurosyphilis
When can neurosyphilis occur?
any stage
What are gummas?
granulomatous lesions that affect skin, organs and bones
neurosyphilis symptoms
headache altered behaviour dementia tabes dorsalis ocular syphilis paralysis sensory impairment
tabes dorsalis
demylination of spinal cord posterior columns
specific pupil finding in neurosyphilis
Argyll-Robertson pupil
Argyll-Robertson pupil
constricted pupil that accommodates when focusing on near object but does not respond to light
diagnosing syphilis
antibody test - screening
rapid plasma regain and VDRL
dark field microscopy and PCR
Managing syphilis
screening other STIs
sexual activity advice until treated
contact tracing
treating syphilis
deep im dose of penicillin
Treating HPV
local cytotoxic therapy - 5FU
cryotherapy
surgical - laser, curettage
Treating HSv2/genital herpes
acyclovir
Treating HIV
Systemic ART
nucleoside reverse transcriptase inhibtor
integrase inhibitor, reverse transcriptase inhibitor, protease inhibitor
Treating hep B
ART - entecavir
interferon sc or im
Treating gonorrhoea
ceftriaxone im
azithromycin
symptoms gonorrhoea
urethritis, Bartholin gland cyst, salpingitis, PID
epididymitis
Treating candida albicans
local antimycotic agent - clotrimazole
fluconazole PO
Treating pubuc lice
permethrin 1% - insecticide
