STIs Flashcards
What is the most common STI in the UK?
Chlamydia
For Neisseria gonorrhoea state:
- Gram stain
- Shape
- What mucous membranes it infections
- How it spreads
- Gram -ve
- Diplococcus
- Mucous membranes with columnar epithelium e.g. endocervix, urethra, rectum, conjunctiva & pharynx
- Spread via mucous secretions from infected area
There is a high level of abx resistance to gonorrhoea; true or false?
True
Is gonorrhoea often symptomatic; discuss for both mena & women
- Men: 90% symptomatic
- Women: 50% symptomatic
*Gonorrhoea more likely to be symptomatic than chlamydia
Describe presentation of Neisseria gonorrhoea; include both male & female symptoms
Female
- Odourless discharge
- Discharge may be green or yellow
- Dysuria
- Pelvic pain
Male
- Odourless discharge
- Discharge may be green or yellow
- Dysuria
- Testicular pain and/or swelling (epididymo-orchitis)
May have:
- Rectal infection causing discomfort & discharge (often asymptomatic)
- Pharyngeal infection causing sore throat (often asymptomatic)
- Conjunctivititis
All pts with suspected gonorrhoea should be referred to GUM clinic for diagnosis and treatment. Discuss how gonorrhoea is diagnosed
*If pt won’t go to GUM clinic or unable to access can do in GP
-
Nucleic acid amplification test (NATT) to detect DNA or RNA of gonorrhoea
- Women: vulvovaginal swab
- Men: first-catch urine sample
- Endocervical charcoal swab or charcoal swab of discharge for microscopy, culture & sensitivity
- Rectal swab (in MSM, anal sex)
- Pharyngeal swab (oral sex)
Why do we do charcoal swabs aswell as NAATs?
NAATS only test if infection is present or not by looking for gonococcal RNA or DNA; do not tell us about sensitivities and resistance. This info is required to guide treatment
Discuss the conservative management of gonorrhoea
- Test contacts
- Test for (and treat) any other infections
- Abstain from sex for 7 days following treatment of all partners to reduce risk reinfection
- Advice about reducing infection risk in future
- Consider safeguarding issues & sexual abuse in children & young people
Discuss the pharmacological management of gonorrhoea
- Sensitivities unknown= single dose of IM ceftriaxone 1g
- Sensitivies known= oral ciprofloxacin 500mg
AND TEST CONTACTS!
*NOTE: regimes may vary dependent on local guidelines and complications
All pts treated for gonorrhoea should have a follow up “test of cure” due to high abx resistance. Tests can be cultures, NAAT for DNA and NAAT for RNA. When can you do each?
If asymptomatic do NAAT, if symptomatic do cultures. BASHH recommends test of cure at least:
- 72hrs post treatment if using a culture as test of cure
- RNA NAAT 7 days post treatment
- DNA NAAT 14 days post treatment
State some potential complications of gonorrhoea
- PID
- Infertility
- Prostatitis
- Conjunctivitis
- Urethral strictures
- Fitz-Hugh Curtis syndrome
- Septic arthritis
- Gonococcal conjunctivities in neonate (ophthalmia neonatorum)
What is a disseminated gonococcal infection?
GDI= complication untreated gonoccoal infection where bacteria spreads to skin & joints causing:
- Skin lesions
- Polyarthralgia
- Migratory polyarthritis
- Tenosynovitis
- Systemic symptoms e.g. fever, fatigue
For Chlamydia trachomatis, state:
- Gram stain
- Shape
- Intra- or extra-cellular
- Gram -ve
- Rod
- Intra-cellular
Is chlamydia often symptomatic; discuss for men & women
- Men: 50% symptomatic
- Women: 25% symptomatic
Majority of women with chlamydia are asymptomatic; if they do get symptoms, state some symptoms they can experience
- Vaginal discharge
- Pelvic pain
- Abnormal vaginal bleeding
- Dyspareunia
- Dysuria
50% of men with chlamydia are symptomatic; state some symptoms they may present with
- Urethral discharge
- Urethral discomfort
- Dysuria
- Epididymo-orchitis