STIs Flashcards
what four STIs are tested for in a regular STI screen?
chlamydia
gonorrhoea
HIV
syphilis
besides STIs, what other conditions should be considered in a female presenting with vaginal discharge?
BV
candida
thichomonas vaginalis
what is the ideal test for GC/CT in females?
vulvovaginal swab (VVS) for GC/CT NAAT
what is the ideal test for GC/CT in males?
first void urine NAAT
what other swabs may be performed for GC/CT depending on the sexual history?
throat swab
rectal swab
what does GC/CT mean?
gonorrhoea and chlamydia
how are HIV and syphilis tested for?
blood tests
what symptomatic sampling is done for chlamydia?
cervical microscopy
vaginal microscopy + pH
urethral microscopy
when is an Amies swab done?
recurrent or persistent discharge vaginitis of unknown cause pregnant postpartum post gynae surgery suspected PID
what can high white cell count at the cervix suggest?
PID
what is the management of chlamydia?
doxycycline 100mg BD for one week
OR
azithromycin 1G stat followed by 500mg daily for two days
how is PID due to chlamydia treated?
cerftriaxone 1G IM
doxycycline 100mg BD for two weeks
metronidazole 400mg BD for two weeks
what is the most commonly reported bacterial STI?
chlamydia
what percentage of chlamydia cases are asymptomatic?
female - 70-80%
male - 50%
what tissue is infected in chlamydia?
columnar epithelium at mucosal sites
how is chlamydia transmitted?
vaginal, oral or anal sex
what age group has the highest incidence of chlamydia?
20-24 year olds
what do chlamydia serovars A-B cause?
ocular infectious
what do chlamydia serovars D-K cause?
genital infection
what do chlamydia serovars L1-L3 cause?
lymphogranuloma venereum (LGV)
what are the symptoms of chlamydia?
milky urethral discharge
irregular vaginal bleeding
abdominal pai
dysuria
what are the signs of chlamydia?
urethritis
cervicitis
epididymo-orchitis
proctitis
what are some possible complications of chlamydia?
PID
ectopic pregnancy
reactive arthritis
conjunctivitis
when should females be tested for chlamydia?
14 days following exposure
in which group are cases of LGV mainly seen?
MSM
what are the symptoms of LGV?
rectal pain
discharge
bleeding
what are the four possible locations for gonorrhoea infection?
urethra
pharyngeal
rectal
endocervical
how does urethral gonorrhoea present?
discharge
dysuria
how does pharyngeal and rectal gonorrhoea present?
usually asymptomatic
how does endocervical gonorrhoea present?
discharge
irregular bleeding
external dysuria
what investigations can be done for gonorrhoea?
NAATs
microscopy
culture
what is the first line management of gonorrhoea?
cerftriaxone 1G IM
what is the second line management for gonorrhoea?
cefixime 400mg oral plus azithromycin 2G
when is second line treatment for gonorrhoea given?
if IM injection is contraindicated or refused
what needs to be done for all patients with gonorrhoea after treatment?
test of cure
what type of bacteria is gonorrhoea?
gram negative intracellular diplococcus
what are the primary sites of infection of gonorrhoea?
mucous membranes of the urethra, endocervix, rectum and pharynx
what is the incubation period for gonorrhoea in males?
2-5 days
what are some possible lower genital tract complications of gonorrhoea?
bartholinitis tysonitis periurethral abscess rectal abscess epididymitis urethral stricture
what are some possible upper genital tract complications of gonorrhoea?
endometritis PID hydrosalpinx infertility ectopic pregnancy prostatitis
what is mycoplasma genitalium associated with?
non gonococcal urethritis
PID
what test is done for mycoplasma genitalium?
NAAT test
what is the management for genital herpes?
oral acyclovir 400mg TDS x5/7
saline bathing
analgesia
what can be given for genital herpes if very painful?
topical lidocaine 5% ointment
what are the three possible presentations of genital herpes?
primary infection
non-primary first episode
recurrent infection
what is the incubation period for a primary infection of genital herpes?
3-6 days
how long does a primary infection with genital herpes last?
14-21 days
how does primary genital herpes infection present?
blistering + ulceration pain external dysuria discharge lymphadenopathy prodromal symptoms
which type of HSV is more commonly associated with recurrent episodes of genital herpes?
HSV 2
how do recurrent episodes of genital herpes present?
unilateral small blisters and ulcers
minimal systemic symptoms
how long do recurrent episodes of genital herpes last?
5-7 days
what causes syphilis?
treponema pallidum
how is syphilis transmitted?
sex (acquired)
trans-placental/during birth (congenital)
what are the five stages of syphilis?
primary secondary early latent late latent tertiary
what stages of syphilis are “early infectious”?
primary
secondary
early latent
what stages of syphilis are late non infectious?
late latet
tertiary
what is the incubation period for primary syphilis?
9-90 days
mean = 21
what is the lesion in primary syphilis called?
primary chancre
painless
where do lesions appear in primary syphilis?
at the site of inoculation
90% genital
what is the incubation period of secondary syphilis?
6 weeks - 6 months
what is the most highly infectious lesion in syphilis?
condylomata lata
how can syphils be detected?
dark field microscopy
PCR
serological testing
what is the treatment for early syphilis?
2.4 MU benzathine penicillin stat
what is the treatment for late syphilis?
2.4 MU benzathine penicillin weekly for three weeks
when should serological follow up be done for syphilis?
until PRP is negative or serofast
what is the most common viral STI in the UK?
HPV
what are the most oncogenic types of HPV?
16
18
what is the incubation period of HPV?
3 weeks - 9 months
what type of HPV causes the majority of anogenital warts?
6
11
what are the four treatment options for HPV?
podophyllotoxin
imiquimod
cryotherapy
electrocautery
