STI Flashcards
How does Gonorrhoea present in Women?
Altered Vaginal Discharge
Lower Abdo Pain
Dysuria
Altered Menstrual Bleeding
How should you investigate suspected Gonorrhoea?
Vaginal or Endocervical Swab
Culture for sensitivity
How is Gonorrhoea managed?
Ceftriaxone IM
(If complicated add Doxycycline or Metronidazole)
Partner Tracing
Avoid Sexual Contact until treatment complete
Name three complications of Gonorrhoea in Pregnancy
Spontaneous Abortion
Premature Labour
Gonococcal Conjunctivitis
Give three general complications of Gonorrhoea
PID
Infertility
Ectopic Pregnancy
How does Chlamydia present in Women?
Dysparenuria
PCB/IMB
Increased Discharge
Or
Reiters Syndrome (Urethritis/Arthritis/Conjunctivitis)
How should you investigate suspected Chlamydia?
Vulvovaginal Swab and NAAT
How should you manage suspected Chlamydia?
100mg Doxycycline BD for one week
Partner Tracing
Give three complications of Chlamydia in Pregnancy
Premature Delivery
Neonatal Conjunctivitis
Pneumonia
Give three complications of Chlamydia
PID
Infertility
Ectopic Pregnancy
Name the four ways Syphilis can be transmitted
Sexual
Vertical
Blood Transfusions
Breaks in Skin
How does Primary Syphilis present?
Develops at site of inoculation less than 90 days after
Transforms from Macule to Papule to Painless Ulcer/Chancre
Highly Infectious
How does Secondary Syphilis present?
Usually 6 weeks after Primary Lesion
Polymorphic Rash affecting palms and soles
Systemic: Night time headaches, Malaise, Slight Fever
How does Tertiary Syphilis Present?
Neurological: Tapes Dorsalis (Sensory Ataxia and Pain), Dementia
Cardiovascular: Aortitis
Gummata: Inflammatory nodules that can occur in any organ
How would you investigate Syphilis?
Treponemal Enzyme Immunoassay for IgM, IgG or both
How would you manage Syphilis?
Benzathine Penicillin 2.4 Mega Units
What is Jarisch Herxheimer Reaction?
Reaction to Syphilis treatment
Febrile, Myalgia, Chills, Headaches
Describe the features of Congenital Syphilis
Saddle Nose
Rashes
Failure to gain weight
What are Genital Warts?
Benign epithelial growths caused by HPV 6 and 11
Give three risk factors for Genital Warts
Smoking
Multiple Sexual Partners
Immunosupression
How do Genital Warts present?
Painless lesions causing itching/bleeding/Dysparenuria
On moist hairy skin (soft and non keratinised) on dry skin (firm and keratinised)
How would you counsel patients on a Genital Warts diagnosis?
Explain long latent period and that the recurrence of warts does not mean infidelity
How would you manage Genital Warts?
May choose no treatment
Non Keratinised - Podophyllotoxin Cream
Keratinised - Imiquimod Cream
Trichomonas Vaginalis is spread almost exclusively through Sexual Intercourse, how does it present?
Often confused for Bacterial Vaginosis
Vaginal Discharge, Vulval Itching, Dysuria, Offensive Odour
Strawberry Cervix
How do you investigate Trichomonas Vaginalis?
High Vaginal Swab
How should Trichomonas Vaginalis be managed?
Avoid intercourse for at least one week
Single dose 2g Oral Metronidazole
What is Bacterial Vaginosis?
Overgrowth of predominantly anaerobic bacteria in Vagina (Gardnerella Vaginalis)
Outgrow Lactobacilli so pH increases
Give three risk factors and three protective factors for Bacterial Vaginosis
Risk Factors: Sexual Activity, IUCD, Douching
Protective Factors: COCP, Condoms, Circumcised Partner
How does Bacterial Vaginosis present?
Offensive fishy smelling discharge without irritation
Diagnosis of Bacterial Vaginosis is difficult in Primary Care so generally just treated empirically. How is it managed?
Asymptomatic don’t need treating unless pregnant
Avoid Douching
Oral Metronidazole 400-500mg BD for 5-7 days
How is Genital Herpes transmitted?
Through skin to skin contact during Vaginal/Oral/Anal Sex
Can lie dormant (in nearest nerve ganglion) and reoccur
What are the two different types of Genital Herpes?
HSV1 - Genital and Oral
HSV2 - Genital and Anal
What are the clinical features of Primary Genital Herpes?
Small red blisters that are very painful and can form open sores
Vaginal/Penile Discharge
Flu Like
What are the clinical features of Secondary Genital Herpes?
Shorter and less severe
Burning/Itching/Painful Red Blisters
How is Primary and Secondary Genital Herpes managed respectively?
1 - Acyclovir, Contact Tracing
2 - Painkillers, Petroleum Jelly, Ice Packs, Episodic Acyclovir
Describe the effect of Genital Herpes on Pregnancy
Baby is normally protected via placental antibodies , last trimester is more dangerous as antibodies not formed
What are the three types of Neonatal Herpes?
- SEM (Skin, Eyes, Mouth)
- DIS (Disseminated)
- CNS Herpes
Describe the pathophysiology of HIV
Penetrates CD4, empties contents, reverse transcriptase, combined with host DNA via integrase, maturation with protease
Define Seroconversion
Process of producing anti HIV antibodies during primary infection
Extremely infectious
Flu like symptoms
How does Symptomatic HIV present?
Weight Loss, High Temperature, Diarrhoea, Frequent Minor Opportunistic Infection
How should you investigate HIV?
ELISA - for salivary/serum antibodies, gives reliable results in 4-6 weeks
Contact Tracing
What is HAART?
Highly Active Anti-Retroviral Therapy
Aims to reduce load to virtually undetectable
Eg Nucleoside Reverse Transcriptase Inhibitors, Protease Inhibitors
When should PEP be given?
Within 72 hours of exposure
What is monitored in HIV?
CD4 count HIV viral load FBC U&Es Urinalysis
What is Vulvovaginal Candidiasis?
Fungal infection of lower reproductive tract with Candida Albicans
Give three risk factors for Vulvovaginal Candidiasis
Pregnancy
Diabetes
Immunosupression
Name three symptoms of Vulvovaginal Candidiasis
Pruritus Vulvae
Vaginal Discharge (white, curd like, non offensive)
Dysuria
How would Vulvovaginal Candidiasis present OE?
Erythema and Vulval Swelling
Satellite Lesions (Red Pustular with White Superficial Plaques)
Curd like discharge
How is Vulvovaginal Candidiasis managed?
1) Intravaginal Clotrimazole (oil based so may weaken condoms)
2) Oral Antifungal (Fluconazole/Itraconazole) (Not in Pregnancy)
Why does Pregnancy encourage Vulvovaginal Candidiasis?
Increased Oestrogen stimulates glycogen production (more favourable environment)
Encourages growth and sticking to vaginal walls
Define Pelvic Inflammatory Disease
Infection of the Upper Genital Tract affecting Uterus/Fallopian Tubes/Ovaries
How does PID present?
Lower Abdo Pain Deep Dysparenuria PCB Abnormal Discharge Fever
Give three differentials of PID
Ectopic Pregnancy
Ruptured Ovarian Cyst
Endometriosis
How would you investigate PID?
Endocervical Swabs (Chlamydia, Gonorrhoea) High Vaginal Swabs (TV and BV) Urine Dip Pregnancy Test Transvaginal USS
Describe the antibiotic therapy for PID
Oxaflocin
Doxycycline
Ceftriaxone
Metronidazole
All partners from last 6 months should be tested/treated
Give three complications of PID
Ectopic Pregnancy
Tubo- Ovarian Abscess
Fitz Hugh Curtis (Perihepatitis)
What should you treat needle phobic patients with for Gonorrhoea?
Cefixime and Azithromycin (PO)
Name the three features of Disseminated Gonococcal infection
Dermatitis
Migratory Arthritis
Tenosynovitis
Hen should you treat Chlamydia?
Before you get the results
When should you test for Chalmydia?
2 weeks after suspected exposure
Describe contact tracing for STIs
Female -all sexual partners in last 6 months
Males - all sexual partners in last 4 weeks
Name three similarities between BV and TV
pH<4.5
Foul smelling discharge
Both treated with Metronidazole
Name two differences between BV and TV
BV: Thin white watery discharge, Clue Cells on microscopy
TV: Yellow/Green frothy discharge, Protozoa on microscopy
How do you treat pregnant women with Genital Herpes?
> 28 weeks - caesarean
Recurrent during pregnancy - Prophylactic Aciclovir
How should you treat gonorrhoea in needle-phobic patients?
Single dose cefixime and azithromycin
What is disseminated gonoccal infection?
Tenosynovitis, Migratory Polyarthritis and Dermatitis
