STI's - an introduction Flashcards by Sophie C

What is a commensal micro-organism

A micro-organism that derives food or other benefits from another organism without hurting or helping it.

Pathogen

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What is a Pathogen

micro-organism that can cause disease

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different types of infection

No symptoms sub-clinical

Symptoms clinical

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give examples of sexually transmissible organisms - how do they spread

A virus, bacteria, protozoan, insect or arthropod which can be spread by sexual contact

Commensal
pathogen

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Sexually transmitted infection (STI) - is caused by?

give 2 examples

pathogen spreading through sex

Neisseria gonorrhoeae
HPV type 6

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Sexually transmitted disease (STD) - what is this?

Give 2 examples

A disorder of structure or function caused by a sexually transmitted pathogen

Pelvic inflammatory disease
Genital warts

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Venereal Diseases (3)

Syphilis (Treponema pallidum pallidum)
Gonorrhoea (Neisseria gonorhoeae)
Chancroid (Haemophilus ducreyi)

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Bacteria infections (3) - organisms

Chlamydia trachomatis
Klebsiella granulomatis
Mycoplasma genitalium

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Virus infections (4)

HSV
HIV
HPV
Molluscum contagiosum virus

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parasite organisms (3)

Pthirus pubis
Sarcoptes scabei
Trichomonas vaginalis

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most common infections that are controversial?

Mycoplasma hominis
Ureaplasma urealyticum
Bacterial vaginosis
Genital candidosis

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Features STI’s share? (4)

They are all infectious/contagious
Asymptomatic most of the time
Unpredictable minority suffer significant complications
Totally avoidable

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implications/management of STI’s? (4)

Sexual contact tracing

Can’t eradicate just by treating the symptomatic

Early detection and treatment needed
Primary prevention is the goal

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Most likely to cause STI’s - list of sexual contact (8)

Group sex
Anal sex 
Vaginal sex
Oral sex - cunnilingus
Oral sex - fellatio
Touching someone else’s genitals with your genitals.
Mutual masturbation
‘Pants on’ cuddling

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Skin contact only conditions (4)

pubic lice (Pthirus pubis)
Scabies (Sarcoptes scabeii)
Warts (human papilloma virus types 6 &amp;11)
Herpes (Herpes Simplex Virus types 1 &amp; 2)

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Common group sex condition

hep c

Why are STIs important? (3)

STDs cause morbidity and can even kill.
Unpleasant symptoms – grouped in to syndromes
Psychological distress

Ulceration often seen in (2)

secondary syphillis

herpes sv

lumps often seen in?

genital wards

malloscum contagiosum

genital discharge

Gonorrhoea

chlamydia

Non-genital discharge

chlamydia in the eyes

- Gonorrhoea in the eyes

rashes can occur with (

scabies
syphillis
HIV
crab lice

Systemic symptoms (5)

Fever
Rash
Lymphadenopathy
Malaise
Arthralgia and arthritis

Late complications of chlamydia?

Infertility

late complications of sti's?

Cancer. 250,000+ deaths globally from cervical cancer - HPV | 300,000 adverse pregnancy outcomes from syphilis per year.

R0=cD - applies to?

every disease - the reproductive number | if R> 1, epidemic is sustained

Rate of acquiring new partners? (5)

``` increased numbers of partners/person increased concurrent partners more people having anal sex more men reporting sex with men (also increased condom usage). ```

cores meaning

likely to have sex with someone like them | - leads to high prevalence within a subpopulation (core) but limited spread through the wider community.

chains and random mixing?

Some ‘cores’ are very big – eg heterosexual men and women. Random mixing leads to lower prevalence but wider dissemination along ‘chains’. Most people have few sexual contacts over a given period of time and so chains are quite short

Principles of a consultation in someone with a possible STI? the 4 elements

a good history partner notification HIV testing health promotion

important things to ask in consultation?

Presenting complaint History of presenting complaint PM/SHx DHx Include a gynae history. Need to ask direct questions about symptoms Eg “discharge from the penis/pain in abdomen?”

The sexual history

- Determining possible cause of symptoms - Detecting high-risk behaviour and advising on risk reduction. - Tracing contacts

sexual history questions? (9)

- When did you last have sexual contact? - Casual contact vs ‘regular’ partner? - How long were you going out with them for? - Were they male or female? - Asking about nature of sex act sometimes useful anxiety about a specific incident - If it’s going to alter where you swab from eg MSM - Did you use condoms? - Other contraception used - Nationality of contact

Assessment of longer-term sexual risks (men) (7)

``` Have you ever had sexual contact with another man? Have you ever injected drugs? Sexual contact with anyone who’s injected drugs? someone from outside the UK? (clarify) Medical treatment outside UK? (clarify) Paid for sex or been paid? ```

Partner notification (‘contact tracing’) - what are the 2 ways of doing this?

Patient tells contacts “client referral” | NHS tells contact “provider referral”

Offer/recommend further testing -why/when may you do this?

- Most STIs are risk factors for HIV acquisition and transmission. - If someone has one STI (eg chlamydia) they could have another (eg HIV)

Health promotion for STI's? (5)

``` - Condoms prevent transmission of some STIs - Eg HIV, chlamydia, gonorrhoea - Not so good at preventing transmission of other STIs; eg herpes and warts - Oral sex carries risks too Not as great as vaginal or anal sex fellatio more than cunnilingus Address hazardous drug use. Vaccination HIV pre-exposure prophylaxis ```