STI's Flashcards
Bacterial Vaginosis (BV) symptoms
Symptoms:
· Fishy odour
Thin, white, pale grey or Green discharge
Not an STI. Imbalance in the normal bacteria found in the vagina
Having BV makes STI easier
Lactobacilli keeps the vaginal fluid acidic and fewer anaerobe bacteria
BV- fewer lactobacilli, more anaerobic bacteria, PH becomes for alkaline
Causes: (which upset the balance) · Having sex with multiple partners · Douching/vaginal washes/deodorants · Oral sex · Smoking
BV investigation
BV treatment
Examination:
· HVS
· Internal exam
· Sample of vaginal fluid to lab
· Microscope findings: less lactobacilli, clue cells, increased mixed organisms
postive wiff test- potassium hydroxide gives a fish odour
Treatment
· Metronidazole 5-7 days
· Metronidazole gel, clindamycin cream
· Probiotic lactobacilli, lactic acid, live yoghurt can help prevent
· Use of aqueous cream for the genital area
BV in pregnancy:
Safe to take tx in 1st trimester. Can increase risk of premature deliver. BV can increase risk of bacterial infection spreading from vagina or cervix into womb during a surgical abortion which can lead to PID
Syphilis symptoms
A curable STI caused by bacterium treponema pallidum which can infect any part of the body (almost)
caused by treponema pallidum
stages 1-3
Symptoms:
primary: presence of a chance (ulcer)
widespread rash rough and red. specifically on palms
secondary (208 weeks): multi system syndrome (malaise, fever, myalgia, rash, fatigue)
tertiary: end organ amage
diagnosis- treponemal and cardiolipin serology testing
1st line therapy: IM benzathine benzylpenicillin 2.4 million units (in buttocks)
· Ulcers on genitals or in mouth, skin rashes, swollen lymph glands
· Skin rash
· Swollen lymph glands (groin, neck)
· Can be asymptomatic and only discovered on blood tests
How is it passed on: · Unprotected sex · Touching ulcers/weeping rashes · Blood transfusion · Infected mother to baby
Syphilis investigation and treatment
investigation: blood test?
treatment:
· Penicillin injection into the muscle of buttock (number of injections depends on how long you have been infected)
· Some people develop a high temp and feel unwell (headache, aching muscles) within 12 hrs of treatment which is called the Jarisch Herxheimer reaction (JHR) but it resolves in a few hours + paracetamol. This reaction is a reaction to endotoxin products released when microorganisms die
· Blood test to prove cured
Epididymo-orchitis symptoms
- what is it?
- causes
- symptoms
Condition affecting men - pain and swelling inside the scrotum due to infection in the epididymis or testicle (orchitiis) or both.
causes:
- STI e.g chlamydia/gonorrhoea (<35 y/o)
- UTI - infection spread from the bladder which can occur after surgical procedures eg cystoscopy or catherization
- (rare) gut bacterial infection from inseritive anal intercourse
- Mumps, tuberculosis
Symptoms: · Rapid pain and swelling in one/both testicles · Discharge from urethra · Pain on passing urine · Generally unwell with fever
Epididymo-orchitis treatment
Treatment: · Need to rule out testicular torsion · Antibiotics, painkillers and rest (weeks-months to settle) · Wear a scrotal support Complications · pain and swelling (long term) · Abscess · Shrinkage of the testicle · Loss of fertility
Herpes Simplex Virus (HSV)
Genital herpes is caused by 2 viruses called herpes simplex types 1 and types 2
(both can cause blisters and ulcers) On the face they are known as cold sores. On the genitals they are called genital herpes
Symptoms: (occur between 2 days- 2 weeks of infection)
· Flu like symptoms
· Swollen glands/groin
· Tiny bumps on the skin which turn to blistes/ulcers
· Ulcers slowly start to heal
After infecting the cells the virus travels up the nerve where it cannot be attacked by the immune system
HSV treatment and investigation
Type specific PCR.
A swab from the sore. type I or II
Treatment: analgesia, lidocaine acyclovir, saline bathing, tropical petroleum jelly.
. If you have had the sores for more than six days the treatment is unlikely to help. lidocaine
HSV in pregnancy
if untreated- higher risk of premature rupture of membranes
painful vesicle which ruptures and becomes ulcerated
associated with vaginal inflammation
lesions appear 2-12 days after infection and last around 20 days.
aciclovir speeds healing process and stops viral shedding.
aciclovir is not licenced in prengancy but is considered to be safe.
- if +ve for 1’ herpes infection in 1st of 2nd trimester= treat wtih oral aciclovir
- if herpes encephalitis= admission an dI V aciclovir 400mg x3 per day for 5 days
offer treatment dose aciclovir 3 times per day from 36 week- birth. normal vaginal delivery.
*if infected in 3d trimester, treat with aciclovir and C section offered. hiher rate of neonatal transmission
if refuse to have C-section and delivered aginally, IV aciclovir infusion for mother during labour and for neonate immediately.
Nisseria Gonorrhoea
Curable STI which infects the cervix, urethra, uterus, fallopian tubes, ovaries, testicles, rectum, throat and sometimes eyes
DIPLOCOCCI (OOOs)
Symptoms: (2-5 days of catching infection)
· Discharge from tip of penis. Burning when passing urine.
· Women usually asymptomatic. Infection starts in the cervix. Bleeding between periods/after sex, lower abdominal pain (sex), cystitis (burning pain whilst passing urine) increased vaginal discharge
- low abdominal pain and intermenstural and post coital bleeding.
- green dischsarge
Gonorrhoea invesitgation, treatment
Examination/Test: NAAT A swab from the cervix during internal examination (symptomatic) Self taken swab entrance of the vagina (Asymptomatic) Throat, rectum, eye Microscope findings:
Treatment: ‘Guilty As Charged’
1g Azithromycin PO, 1g Ceftriaxone IM
Complications:
Infertility if spreads to reproductive organs- PID
In men can spread to testicles- epididymo-orchitis
Can cause septicaemia, reactive arthritis
Chalmydia trachomatasis
A curable STI caused by chlamydia trachomatis. Can infect the urethra, the uterus, the cervix, the fallopian tubes, testicles, rectum, throat and eyes.
Usually asymptomatic
Symptoms:
- Usually asymptomatic
- intermenstrual bleeding/post-coital bleeding, l
- ower abdominal pain,
- dyspareunia, burning when urinating, -
- change in colour and amount qq of vaginal discharge.
Men might experience discharge from tip of penis and burning feeling when passing urine.
Chlamydia - investigation
Testing: NAAT
Gram -ve intracellular
Women:
· If asymptomatic. Swab from inside the vagina
· If symptomatic: swab during an internal vaginal examination (vulvovaginal)
Men:
· If asymptomatic: Urine sample
· If symptomatic e.g discharge: swab from tip of penis and urine sample NAAT
Chlamydia - treatment
“CAD”
azithromycin 1g
doxycycline 100mg PO B 7/7
Complications:
· Epididymorchitis
· PID
· SARA: pain and swelling in joints such as the ankles or knees. Sexually acquired reactive arthropathic and more common in men
- reactive arthritis, conjunctivitis, infertility and ectopic pregnancy
Pregnancy: conjunctivitis, inflammation of the lungs (pneumonia). Pregnant women should be retested at least four weeks after finishing their chlamydia treatment
Trichomoniasis Vaginalis
A curable STI caused by a protozoan, Trichomonas Vaginalis (TV) tiny germs similar to bacteria. Can infect the vagina, urethra, underneath the foreskin.
Symptoms:
itchy and burning, strawberry cervix. grey/green and frothy
fish-smelling yellow vaginal discharge.
· Women: change in vaginal discharge, vulvar itching, pain on passing urine (Cystitis) Green frothy smelling discharge, strawberry cervix, vulvovaginitis, pain in vagina during sex
Men: discharge from tip of penis, pain on passing urine, soreness of the foreskin
Trichomoniasis Vaginalis
- investigation
- treatment
Examination/Tests:
HSV women- wet saline mount = ovoid mobile parasites. or after 48 hours of anaerobic culture.
urine test men (culture)
· Women: Swabs from upper vagina during internal examination. Urine sample (not to have passed urine in 1 hr) WET PREP (saline)
· Men: swab from the tip of penis
· POC test? Rapid antigen detection test
· Under the microscope: motile (moving?) protozoan
- PH 4.5
motile protozoaan
Treatment:
metronidazole 400-500mg twice daily for seven days or 2g as a single dose.
treat partners to prevent re-infection
Non gonnoccocal urethritis symptoms
Inflammation of man’s urethra when gonorrhoea is not the cause
Most causes of NGU are STIs (chlamydia), other causes is trauma
Symptoms:
· Men: discharge from tip of penis, pain on passing urine, discomfort, itching at tip of penis or inside urethra
Women: usually asymptomatic. If it’s chlamydia might experience intermenstrual bleeding, post coital bleeding, lower abdominal pain, abnormal vaginal discharge, pain/burning when passing urine
