STIs Flashcards
What organism causes candida?
Candida albicans
What are risk factors for candida?
Antibiotic use
COCP/pregnancy - raised oestrogen
Diabetes
Immunocompromised
What is the presentation of candida?
Thick white discharge (‘curd-like’)
Very itchy
How is candida diagnosed?
Clinically
High vaginal swab isf unsure
What is the treatment for candida?
Topical clotrimazole
Oral fluconazole
What organism causes bacterial vaginosis?
Gardenella vaginali or anaerobes - imbalance of flora
How is bacterial vaginosis diagnosed?
Clinically
High vaginal swab - clue cells on microscopy
Increased pH (>4.5)
What is the management for bacterial vaginosis?
Oral metronidazole
What organism causes pubic lice?
Phthirus pubis
What is the presentation of pubic lice?
Itchy pubic area
What is the management of pubic lice?
Malathion lotion
What are the sexually transmitted bacterial infections?
Chlamydia
Gonorrhoea
Syphilis
What are the sexually transmitted viral infections?
HPV
Herpes simplex
HIV
Heb B or C
What are the sexually transmitted parasitic infections?
Trichomonas vaginalis
Scabies
Crabs
What organism causes chlamydia?
Chlamydia trachomatis
What gram is chlamydia trachomatis?
Gram negative
What is the most common bacterial STI?
Chlamydia
Where in the body does chlamydia infect?
Endocervix
What is the presentation of chlamydia?
80% asymptomatic Male - urethritis - urethral milky discharge - dysuria - orchiditis/proctitis Female - mucopurulent cervicitis - dyspareunia - abnormal bleeding Abdominal Pain
What are signs of upper genital disease?
Suprapubic tenderness
Mucopurulent cervicitis and contact bleeding on bimanual examination
Dyspareunia
What are the complications of chlamydia?
Pelvic inflammatory disease
Neonatal conjunctivitis
Reiter’s syndrome
Fitz-Hugh-Curtis syndrome
What is Reiter’s syndrome?
Reactive arthritis
Triad of: uveitis, urethritis, arthitis
What is Fitz-Hugh-Curtis syndrome?
Adhesions and inflammation of he liver capsule
What investigations are done for chlamydia?
Male - first pass urine sample
Female - endocervical swab
Combined NAATs/PCR
What is the management for chlamydia?
Oral doxycycline (100mg BD 7 days) Second line - azithromycin Cover for PID if signs of upper genital disease - ceftriaxone, doxycycline and metronidazole
How should contacts of someone with chlamydia be managed?
Treat without need to test
What is lymphogranuloma venerium?
STI caused by chlamydia trachomatis types LGV 1, 2 and 3
Where is lymphogranuloma venerium most common?
Africa, India, SE asia
What are risk factors for lymphogranuloma venerium?
HIV positive MSM
What is the presentation of lymphogranuloma venerium?
Rectal symptoms and genital ulceration
Stage 1 - painless ulcerating papule on genetalia 7-21 days after exposure
Stage 2 - regional lymphadenopathy - fixed and painful with overlying erythema
Stage 3 - nodes become fluctuant and can rupture
How is lymphogranuloma venerium diagnosed?
Nucleic acid amplification for LGV serovar
What is the management for lymphogranuloma venerium?
Doxycycline or erythromycin
What is the complication of lymphogranuloma venerium?
Chronic infection can result in extensive scaring, abscess and sinus formation
What organism causes gonorrhoea?
Neisseria gonorrhoea
What is the description of the organism neisseria gonorrhoea?
Gram positive diplococci (kidney bean shaped)
Where does gonorrhoea infect?
Intracellular, infects the epithelium of the urogenital tract, rectum, pharynx and conjuntivae
What is the incubation period of gonorrhoea?
2-14 days
What is the presentation of gonorrhoea?
Purulent urethral discharge
Dysuria
Rectal infection - proctitis with pain, discharge and itch
Can be asymptomatic
What are the complications of gonorrhoea?
Infection of epididymis, prostate Bartholin's abscess Neonatal conjunctivitis Disseminated gonorrhoea Upper genital infection
What is the presentation of disseminated gonorrhoea?
Arthritis (monoarticular)
Papular or pustular rash with erythematous base
Fever and malaise
What is the investigation for gonorrhoea?
Male - first pass urine
Female - endocervical swab
Combined NAAT/PCR
What is the management for gonorrhoea?
IM ceftriaxone
Second line - cefixime and azithromycin (if IM injection contraindicated or refused)
What is the management for contacts of someone with gonorrhoea?
Treat with ceftriazone without need to test
What organism causes syphilis?
Treponema pallidum (a spirochete)
What is the incubation period for syphilis?
9-90 days
What are stages of presentation of syphilis?
Stage 1 (primary) - chancre (painless ulcer) - local lymphadenopathy - heals without treatment Stage 2 (secondary) - 4-10 weeks after appearance of primary lesion - copper palmar-plantar rash - snail track mouth ulcers - patchy alopecia - flu-like illness - generalised lymphadenopathy Stage 3 (latent) - no symptoms Stage 4 (tertiary) - neurosyphilis - Argyll-Robertson pupil (miotic - accomodates but doesn't react) - CVS effects - Cardiovascular - aortic aneurysm, aortic regurgitation - 4-20+ years after initial infection
How is syphilis diagnosed?
Swab of stage 1 or 2 lesion
Spirochetes on dark ground microscopy (PCR)
Serology specific tests fo diagnosis (IgM and IgG ELISA for screening, TPPA)
What is the management of syphilis?
Benzathine penicillin IM
For pen allergy - doxycycline or erythromycin
What strain of herpes simplex virus causes genital herpes?
HSV2 majority
Who is more severely affected by genital herpes?
Immunocompromised
What is the presentation of genital herpes?
Ulcers/blisters on external genitalia Painful Dysuria Local lymphadenopathy - tender Systemic symptoms - fever, myalgia, headache
What are the complications of genital herpes?
Neurological - aseptic meningitis, involvement of sacral plexus leading to retention of urine
How is genital herpes diagnosed?
Swab vesicles - PCR
What is the management of genital herpes?
Oral acyclovir + lidocaine topical
If lesions already crusting antivirals won’t do anything
Secondary bacterial infection - rest, analgesia, antipyretics
Supportive - saline bathing, analgesia
What is the risk of genital herpes in pregnancy?
Transplacental infection or infection via birth canal causing neonatal HSV
What is the management of genital herpes in pregnancy?
Acyclovir can b given in 1st or 2nd trimester depending on clinical condition
Acyclovir can be given during the last 4 weeks of pregnancy to prevent recurrence at term
Primary acquisition in 3rd trimester or term with high levels of viral shedding - c-section
Are condoms effective in preventing genital herpes?
May not be - lesions may occur outside areas covered
Which strains of HPV cause genital warts?
HPV 6 and 11
How is HPV spread?
Skin contact
What is the presentation of HPV?
Anogenital warts that are:
- white
- rough
- raised
- not painful
How is HPV diagnosed?
Clinically
What is the management of HPV?
Cryotherapy
Podophyllotoxin cream
Imiquimod cream
What organism causes trichomonas vaginalis?
Protozoal parasite
What is the presentation of trichomonas vaginalis?
Discharge - purulent, green, frothy, musty odour
Irritation and itch
Strawberry spots
Males are usually asymptomatic but may have urethritis
What are strawberry spots?
Multiple small haemorrhagic areas on the cervix
Sign of trichomonas vaginalis
How is trichomonas vaginalis diagnosed?
High vaginal swab for microscopy - motile trophozoites
No test for males
What is the management for trichomonas vaginalis?
Oral metronidazole
What is the lookback period for contact tracing for chlamydia?
Male urethral - 4 weeks
Endocervix, anal, oral - 6 months
What is the lookback period for contact tracing for gonorrhoea?
Male urethral - 2 weeks
Endocervix, anal, oral - 3 months
What is the lookback period for contact tracing for syphilis?
Primary - 90 days
Secondary - 2 years
What is the lookback period for contact tracing for trichomonas vaginalis?
4 weeks
What is the lookback period for contact tracing for PID?
6 months
What is the lookback period for contact tracing for HIV?
3 months
What conditions is contact tracing not needed for?
Genital warts
Genital herpes
Thrush
Bacterial vaginosis
