STI overview Flashcards
How are sexual health clinics organised?
Sexual health clinics are comissioned by local authorities.
In the majority of area this bid is won by NHS services
However in some areas private companies won the bid
All services private or NHS are free to access (even if do not qualify for NHS treatment).
What is the deal with sexual health clinics and confidentiality to rest of medical world?
Confidential
Can give a false name is they want to
IT system is not linked to hospital or community records
What is an index patient in an SHC?
The patient diagnosed with the STI
What are the different methods for informing patient sexual partners after the patient has been diagnosed with an STI?
Patient self contact - check this by seeing if entered SHC
Provider referral - SHC makes contact with patients consent, level of information shared must be agreed on
Contract - patient given a certain amount of time to inform partners if they can, then gives consent for provider referall
In a provider referall for a sexual health clinc what information will the recipient be given?
- NOT be given the patients name
- With patient consent may be given the name of the STI
- Will be contacted by their local SHC regardless of where the patient entered the system
How do patients access the sexual health clinic?
80% self referall by phone or online
Recommendations from other health professionals or friends
Formal referalls from doctor
For patient with complex needs such as lots of medication or co-morbidities it is useful to request contact with GP for health records
If patient younger than 13yrs will be referred to paediatrics
All patients are then triaged equally
What will a sexual health clinic normally see you for?
Screening, prevention and treatment of STIs
Recurrent vaginal discharge
Recurrent genital itching
genital bumps, rashes/
Emergency and on-going contraceptives
Some services may see…
- pelvic, testicular or genital chronic pain
- sexual dysfunction
- chronic HIV care
- care of trans individual before, during and after genital reassignment surgery
What other members of the MDT may sexual health clinics work with?
Public Health
Infectious diseases
Gynecologists
What groups of people tend to have a higher prevalence of STIs?
Under 25yrs
Biological male who have sex with a biological male
How often is STI testing recommended?
Why?
Every three months
All STIs can be asymptomatic
- recommend more often if irregular sexual partner
What are the trends in chlamydia diagnosis patterns?
Most common in under 30s
Large peak in early 20s
More common in females
What are the trends in syphilis diagnosis over time?
Becoming more common
Signficantly more common and higher numbers in males
What are the main sources of sexual education?
Schools
Peers/friends
What are the key points in a sexual history?
Reason for attendance - symptoms and duration is relevant
Sexual contacts - regular and casual, information about any STIs they have, the gender of these contacts
Sexual practise - condom, oral/anal etc
Past history of STIs
Recent antibiotics and allergies
Medical and gynaecological history
What are the most common presenting complaints in a sexual health clinic?
Urethral discharge
Pain when urinating
Vaginal discharge
Genital ulcers/sores
Lumps
What is the GMC guidance for intimate examinations?
Offer chaperones for all exams
Obtain consent before examination
Keep discussion relevant
Explain why the exam is relevant and what it involves
Give patient privacy to dress and undress
What happens during a genital exam?
Only done if required
Undress below the waist and given something for modesty
Examine from mons pubis to natal cleft including the inguinal region
Females often in lithotomy position, may have a speculum exam and a bimanual exam (laterally palpate the lateral fornices)
What is involved in a typical STI check for men?
Urine test
Rectal and throat swabs in having sex with another man
Blood test for HIV and syphilis
Based on any symptoms may require a physical examination
Often ask patient to take their own swabs - often collect more than a health care professional would
What are the typical STI checks for women?
Blood test for HIV and syphilis
Based on symptoms may require a physical exam
Vaginal swab - often self taken
What is often done to the blood sample to identify an STI?
PCR test
Antigen test
What guidelines are used in sexual health clinics?
The British Association of Sexual Health and HIC guidelines
What STIs are becoming less common?
Suggest why?
Genital warts - HPV vaccination
Pubic Lice - shaving
New HIV diagnosis
What is the link between vaccination and gential warts?
HPV vaccination to prevent genital warts
HPV type 6 and 11 cause genital warts
Gardasil vaccine protects aginst 6,11 and 16,18.
16,18 are associated with cancer
Who is offered the HPV vaccine?
Girls in school-age 12-13yrs vaccinated since 2008
Boys vaccinated in schools 12-13yrs from 2019
Men under 45yrs who have sex with men can be vaccinated for free in any SHC
Can pay privately
Why have rates of new HIV diagnosis fell?
Use of pre-exposure prophylaxis (daily) to stop catching
Change in guidelines means all HIV patients receive treatment regardless of their immune function, effective treatment for six months + reduces viral load to unifectious amounts
What STIs are becoming more common?
Gonorrhoea
Syphilis
herpes
trichomonas
Chlamydia
What is Gonorrhoea?
What are its symptoms?
A bacterial infection
A superdrug that is developing antibiotic resistance
Symptoms: discharge, pain urinating, pelvic and testicular infection, conjunctivitis
May cause sepsis and arthiritis
What are the treatments of gonorrhoea?
Partner informing is essential
Cure needs researching
Currently use high dose cephlasporins
What does gonorrhoea look like on a gram stain?
Gram negative
intracellular diplococci
What is chlamydia trachomatis?
What are its symptoms and causes?
Most common bacterial STI in UK
Very transmissable
Can be asymptomatic
May have discharge, pain urinating, irregular bleeding in women, pain with sex, testicular swelling nd conjuctivitis
How is chlamyidia diagnosed?
Can not be seen under a light microscope
May be viewed under an electron microscope
Diagnosed by a NAAT test on vaginal or urine swab
How is chlamydia treated?
Antibiotic - clarithromycin
Do not recommend single dose as this does not treat rectal infection and can lead to antibiotic resistance in other STIs
Often given arithmromycin over a few days
What is the cause of syphilis and what are its symptoms?
Bacterial infection caused by a spirochete called treponema pallidum
Spread during sexual intercourse or via birth canal to give congential cases
What are the treatments for syphilis?
High dose penicillin
Untreated causes serious health problems and 15% mortality
What is the early stage of syphylis?
Caught under 2 yrs
Latent: positive tests with no symptoms
Primary: ulcer - painless but can occur anywhere where there has been contact with genitals, enlarged groin lymph nodes
Secondary: whole body infection, multiple organs can be affected, typically shows as a rash on the palms and soles of feet
What is the later stage of syphylis?
Latent : positive test but with no signs or symptoms
Cardiovascular symptoms
Neurological symptoms
Gummatous - soft tumour like growth of tissue inside the organ
What are he symptoms of early second stage syphylis?
Rash - typically on the palms and soles of the feet
patchy alopecia
hepatitis
Splenomegaly
meningitis
Cranial nerve palsy
Anterior uveitis
Glomerulonephritis
Generalised lymphadenopathy
How does syphylis affect pregnancy?
Can lead to premature or neonatal death
Congential syphilis may occur
Most common in primary/secondar syphylis then in early latent then secondary latent.
What are the symptoms on congenital syphylis?
Under 2yrs
Rash
Fever
Rhinitis
Meningitis
Heptosplenomegaly
Jaundice
Pneumonititis
Nephrotic syndtomr
Failure to thrive
What are the symptoms of congenital syphylis in children over 2yrs?
Interstitial keratitis - blood vessels grow into the cornea, can cause vision loss
Deafness
Neurosyphilis
Bilateral painless effusions
Paroxysmal cold haemoglobinuria
Dental malformations
Craniofacial malformations
What is mycoplasma genitalium?
A new STI
Smallest bacteria ever found
Diagnosed by NAAT test
Not all clinics have access to testing
Concerns over rising antibiotic resistance
Who is tested for mycoplamsa genitalium?
STI
Suspected pelvic infection in women
Male urethritis
Contacts of index patients
1 in 10 tested are positive
What is trichomoniasis?
Most common STI worldwide
Causes discharge and vaginal soreness
Associated with miscarriages
What is the cause and symptoms of genital herpes?
treatment
Caused by HSV
Primary infection causes flu like symptoms
Painful lymph nodes and tingling in the genital area, bum or legs
Genital blisteros or ulcers
Can get recurrent sores
No cure - aciclivir can reduce the recurrent sores
Life long infection - negative impact on mental health
What are some common complications of STIs?
INcrease risk of HIV acquisition
Pelvic inflammatory disease
Infected testicles
Arthiritis
Encephalitis
Neonatal infection
Depression and anxiety
Sexual and relationship breakdown
What are some common causes of pelvic inflammatory disease?
Chlamydia
Gonorrhoea
Mycoplasms
What are the symptoms of pelvic inflammatory disease?
Pelvic pain (worse with sex)
New onset heavy and painful periods
Vaginal discharge
Chronic long term pain and fertility problems
