STI Infections of the Genital Tract - STIs - an introduction Flashcards
what is a Sexually transmissible organism?
a virus, protozoan, insect or arthropod which can be spread by sexual contact (commensal or pathogen) – doesn’t have to be pathogenic
what is a sexually transmitted infection (STI)?
an infection by a pathogen which is sexually transmissible and which is unlikely to be transmitted by non-sexual means (gonorrhoeae)
what is a Sexually transmitted disease (STD)?
a disorder of structure or function caused by a sexually transmitted pathogen. (pelvic inflammatory disease or genital warts)
what are other official sexually transmitted organisms in the UK?
what are some controversies regarding weather something is an infection or a colonisation?
Characteristics and implications of STI:
theyre contagious
what is the implication?
sexual contact tracing
Characteristics and implications of STI:
asymptomatic most of the time
what is the implication?
cant eradicate just by treating the symptomatic
Characteristics and implications of STI:
unpredictable minority suffer significant complications
what is the implication?
early detection and treatment needed
Characteristics and implications of STI:
totally avoidable
what is the implication?
primary prevention is the goal
Many don’t know they have it as ____________ and then ____ it on
asymptomatic
pass
what Activity is required for transmission?
- Skin contact only – pubic lice, scabies, warts, herpes
- Group sex – hepatitis C
Why are STIs important?
- STDs cause morbidity and can even kill
- They’re a drain on resources
- They’re common
Why are STIs important?
- STDs cause morbidity and can even kill
what do they cause?
- Unpleasant symptoms – grouped into syndromes
- Psychological distress
- Can cause ulceration, lumps, genital discharge, non-genital discharge, rashes
- Systemic symptoms – fever, rash, lymphadenopathy, malaise, arthralgia and arthritis
- Late complications – cancer, adverse pregnancy outcomes from syphilis
Why are STIs important?
They’re a drain on resources
how do they drain resources?
- Managing infertility due to chlamydia: cost of IVF
- Cost of HIV medication/management of HIV related health conditions
- Taking time off work to get warts frozen
- A true difference in the number of cases
- A change in diagnoses but no actual difference in number of cases?
what is the best thing to reduce transmission?
vaccine
Change in number of diagnoses but no change in cases - why may this be?
- More people asking for tests
- More clinicians considering STIs and testing for them
- Better tests
Modelling and mapping the spread of STIs – sexual network analysis - what is it?
- Some people have sex with people like them and leads to high prevalence within a subpopulation but limited spread through wider community
- Lots of little cores can be seen linked in a network (picture on fornt of this card)
- Chains and random mixing: some cores are every big (e.g. heterosexual men and women) and random mixing leads to lower prevalence’s and wider dissemination along chains (picutre on this card)
What are the Principles of a consultation in someone with a possible STI
- A good history
- (partner notification)
- (HIV testing)
- Health promotion
what should be asked and tlaked about in the consultation?
- Standard history – PC, HPC, PM/SH
- Include gynae history
- Need to ask direct questions about symptoms e.g. discharge from penis/pain in abdomen?
- The sexual history is necessary for determining possible cause of symptoms, detecting high risk behaviour and advising on risk reduction, tracing contacts
- Assessment on long term sexual risk (men) – sexual contact with other men, injected drugs, medical treatment outside the UK, paid for sex
Partner notification (contact tracing) - how can this be done?
- Two ways – patient tells contact “client referral” or NHS tells contact “provider referral”
- Client referral is preferred for STIs
Offer/recommend further testing - why?
- Most STIs are risk factors for HIV acquisition and transmission
- If someone has one STI (e.g. chlamydia) they could have another (e.g. HIV)
health promotion - what should you promote?
- Condoms prevent transmission of some STIs
- Oral sex carries risks too
- Address hazardous drug use
- Vaccination
- HIV pre-exposure prophylaxis
Summary:
