STI/ sexual health Flashcards
Features of Chlamydia in women vs men?
Features:
asymptomatic in around 70% of women and 50% of men
women: cervicitis (discharge, bleeding), dysuria
men: urethral discharge, dysuria
Complications of Chlamydia?
epididymitis
pelvic inflammatory disease
endometritis
increased incidence of ectopic pregnancies
infertility
reactive arthritis
perihepatitis (Fitz-Hugh-Curtis syndrome)- complication of PID causing liver inflammation/ adhesions
Investigation for Chlamydia?
Swabs for NAAT
Women: vulvovaginal and urine sample
Men: urine sample (first-line)
and urethral swab
First-void sample
Testing should be done 2-weeks after possible exposure
Management for Chlamydia?
First line: Oral doxycycline- 7 days
-Azithromycin if doxy contraindicated (pregnancy)- azithromycin, erythromycin or amoxicillin
-Patients should be offered GUM service/ RN for initial partner notification
-Contact tracing- treat then test
-Abstinence until treatment complete
Syphilis causative organism?
Stages disease + symptoms
Incubation period?
Spirochaete Treponema pallidum
Primary features:
chancre - painless ulcer at the site of sexual contact
local non-tender lymphadenopathy
Secondary features: occurs 6-10 weeks after primary infection
systemic symptoms: fevers, lymphadenopathy
rash on trunk, palms and soles
buccal ‘snail track’ ulcers (30%)
condylomata lata (painless, warty lesions on the genitalia)
Tertiary features:
gummas (granulomatous lesions of the skin and bones)
ascending aortic aneurysms
general paralysis of the insane
Investigations for Syphilis?
Dark field microscopy- directly observe T. pallidum in samples from primary lesions or secondary rash. NOT for oral lesions
PCR- oral lesions
Serological test (EIA, CLIA)- detect treponemal IgG/ IgA (most sensitive for secondary, early latent and late latent stages)
Screen for other STIs and CSF examination for tertiary syphilis to see extent of CNS involvement
Management for Syphilis?
Primary, secondary, and early latent syphilis: A single dose of IM penicillin G (benzathine benzylpenicillin) is the first-line therapy.
Tertiary and late latent syphilis or syphilis of unknown duration: Requires a longer course of IM penicillin G for 2-3 weeks.
Neurosyphilis: Treated with IV penicillin G for 10-14 days.
Patients allergic to penicillin may be given doxycycline or tetracycline.
Jarisch-Herxheimer reaction may occur on treatment initiation- acute febrile illness resolving within 24-hours, give antipyretics + reassurance
What cells are seen on microscopy in BV?
Amsel’s diagnostic criteria?- 4 points
Clue cells
Amsel’s criteria 3/4 should be present:
-thin, white homogenous discharge
-clue cells on microscopy
-vaginal pH > 4.5
-positive whiff test (addition of potassium hydroxide results in fishy odour)
Management for BV?
Asymptomatic- no treatment required
Symptomatic- oral metronidazole for 5-7 days (can be used in pregnancy)
Gonorrhoea causiatve organism?
Features in men vs women?
Gram-negative diplococcus Neisseria gonorrhoeae
-males: urethral discharge, dysuria
-females: cervicitis leading to vaginal discharge, bleeding
Investigations for Gonorrhoea?
Self-taken vulvovaginal swab- women Self-obtained first pass urine- men
Self-obtained rectal swab
Clinician-obtained endocervical or penile swab
Microscopy
NAAT
Culture
Management for Gonorrhoea?
Ceftriaxone IM- first-line
Alternative: IM gentamicin or oral cefixime, both with azithromycin orally.
Ciprofloxacin should only be considered when sensitivities are known and there are no suitable alternative antibiotics.
Causative organisms in PID?
Chlamydia trachomatis: the most common cause
Neisseria gonorrhoeae
Mycoplasma genitalium
Mycoplasma hominis
Investigations for PID?
pregnancy test- exclude ectopic
high-vaginal swab
Chlamydia/ Gonorrhoea screen
Management for PID?
First-line:
stat IM ceftriaxone + followed by 14 days of oral doxycycline + oral metronidazole
Second-line:
oral ofloxacin + oral metronidazole
Complications of PID?
Perihepatitis (Fitz-Hugh Curtis Syndrome)
Infertility
Chronic pelvic pain
Ectopic pregnancy
Features of of Trichomonas vaginalis?
Investigation and what it shows?
offensive, yellow/green, frothy discharge
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis
Investigation:
-microscopy of a wet mount shows motile trophozoites
NAAT
High-vaginal swab
Management for Trichamonas vaginalis?
Oral metronidazole 400-500mg TDS for 5-7 days
OR single dose of 2g orally
Abstinence until treatment done and both partners treated at the same time
Predisposing factors for vaginal candidiasis?
DM
HIV
Pregnancy
Drugs- steroids, Abx
Management for thrush?
-Oral fluconazole 150mg as a single dose first-line
-Clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated
-If there are vulval symptoms- topical imidazole in addition to an oral or intravaginal antifungal
-If pregnant, then only local treatments (cream or pessaries) may be used - oral treatments are contraindicated
Investigations for genital herpes?
Hx
Exam
Swabs of ulcer for NAAT- most effective
HSV serology- only if recurrent
Management for genital herpes?
Conservative:
-saline bathing
-analgesia
-topical anaesthetic agents- lidocaine
Medical:
-oral aciclovir started within 5 days of sx onset
Pregnancy:
-elective c-section if attack occurs >28 weeks
-should be treated with suppressive therapy
What is Lichen sclerosus?
Features/ Sx?
Investigations?
Management?
Complications?
Inflammatory condition affecting the genitalia, more common in elderly females.
Leads to atrophy and white plaques
Sx:
-white plaques that may scar
-itching
-pain on urination/ intercourse
Investigations:
-clinical diagnosis but can take biopsy if atypical features
Management:
-topical steroids/emollients
Complications:
-risk of vulval cancer
Causes of genital warts?
HPV 6 and 11
