STI's Flashcards
Describe chlamydia?
Gram negative bacterium
Trasmission: Vaginal, orally, anal
Highest incidence: 20-24 years
What is the chlamydia presentation in a female?
post coital or intermenstrual bleeding
Lower abdo pain
Dyspareunia
Mucopurulent cervicititis
What is the chlamydia presentation in a male?
urethral discharge
Dysuria
Urethritis
Epidiymo-orchitis
How do you diagnose Chlamydia?
Test 14 days following exposure
NAAT - females (vulvovaginal swabs)
First void urine (males)
MSM and rectal swab if anal intercourse occured
How do you treat chlamydia?
Azithromycin 1G stat
Doxycycline 100mg BD x 1 week
Describe gonorrhoea?
Gram negative intracellular diplococcus
Where are the primary sites of a gonorrhoea infection?
Mucous membranes of urethra, endocervix, rectum and pharynx
What is the incubation period of urethral infections in a male?
2-5 days (short)
Whats more likely, male to female transmission or female to male transmission?
F-->M = 20% M-->F = 50-90%
How does gonorrhoea present in males?
Asymptomatic in
How does gonorrhoea present in females?
Asymptomatic in up to 50%
Dysuria
Pelvic pain
Pharngeal/rectal infections, mostly asymptomatic
What are lower genital tract complications of gonorrhoea?
Bartholinitis Tysonitis Periurethral abscess Epididymitis Urethral stricture
What are the upper genital tract complications of gonorrhoea?
Endometritis PID Hydrosalpinx Infertility Ectopic pregnancy Prostatitis
How do you diagnose gonorrhoea?
Microscopy- urethral (90-95% sensitivity) endocervical (37-50% sensitivity)
Culture
NAAT
What is the treatment for gonorrhoea?
IM ceftriaxone 500mg
Azithromycin 1g
What is the second line treatment for gonorrhoea?
Cefixime 400mg oral
What is the incubation period of genital herpes?
3-6 days
What is the duration of genital herpes primary infection?
14-21 days
What are the symptoms of genital herpes?
Blistering and ulceration of external genitalia Pain External dysuria Vaginal/urethral discharge Local lympohadenopathy Fever + myalgia
Describe recurrent episodes of genital herpes?
Common with HSV-2
Often misdiagnosed as thrush
Usually unilateral, small blisters and ulcers
Minimal systemic symptoms, resolves within 5-7 days
What is the management of genital herpes?
Swab base of ulcer for HSV PCR Aciclovir orallly Topical lidocaine 5% Saline bathing Analgesia
What is viral shedding?
Higher occurrence with HSV2 as opposed to HSV1
More frequent in first year of infection
How do you treat Human Papilloma virus (genital warts)
Podophyllotoxin (warticon)
Imiquimod (Aldara) - immune modifier
Cryotherapy
Electocautery
What organism causes Syphilis?
Treponema pallidum
How can syphilis be transmitted?
Sexual contact
Trans-placental/during birth
Blood transfusions
Non-sexual contact - healthcare workers
What is the incubation period of Primary Syphilis?
9-90 days (mean of 21
What is primary chancre?
Painless lesions
What else is seen with syphilis?
non-tender local lympohadenopathy
What is the incubation period of Secondary Syphilis?
6wks to 6 months
What are the features of secondary syphilis?
Skin lesions Mucous membrane lesions Generalised lymphadenopathy Pathcy alopecia Condylomata Lata (highly infectious lesion, exudes a serum teeming with treponemes)
How do you diagnose syphilis?
From lesions or infected lymph nodes
Dark field microscopy
PCR
Serology for antibody to pathogenic treponemes
What are non-treponemal serology tests?
VDRL - Venereal Disease Research Lab
RPR - Rapid Plasma Reagin
What are Treponemal tests?
TPPA - Treponemal Pallidum Particle Agglutination
ELISA/EIA - Enzyme Immunoassay (screening test)
INNO-LIA - Line immunoassay
FTA abs - Flourescent Treponemal Antibody absorbed
What is the treatment for early syphilis?
2.4 MU Benzathine penicillin x1
What is the treatment of late syphilis?
2.4 MU Benzathine penicillin x3
What follow up serology tests are there for syphilis?
Until PRP is negative or serofast:
- Titres should decrease fourfold by 3-6 months in early syphilis
- Serological relapse/reinfection if titres increase by fourfold
