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MBChB3 > STIs > Flashcards

STIs Flashcards

1
Q

Which patients should you offer performing a sexual screen for?

A

Anyone presenting with:
- vaginitis (change in discharge, dysuria, change in menstrual bleeding)
- urethritis (penile discharge, dysuria, meatal discomfort)
- epididymo-orchitis (swollen, painful testicle)
- PID (pelvic pain, fever, change in discharge, dyspareunia)
- proctitis (rectal discharge/pain/bleeding)
- possible syphilis (esp rash on hands/feet)
- possible HIV seroconversion

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2
Q

What is included in a standard sexual health screen?

A
  • chlamydia + gonorrhoea (naat test)
  • syphilis + HIV (blood test - big edta bottle)
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3
Q

What groups are more at risk of gonorrhoea?

A
  • MSM
  • Afro-Carribean
  • urban areas with deprivation
  • women <25
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4
Q

Describe the features of gonorrhoea

A
  • bacterial
  • caused by gram negative diplococcus N. Gonorrhoeae
  • infects mucous membranes of urethra, endocervix, rectum, pharynx + conjunctiva
  • inoculations are through secretions from one mucous membrane to another
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5
Q

Describe the signs and symptoms of gonorrhoea

A
  • penile urethra (90% symptomatic soon after inf.): urethral discharge (yellow) + dysuria
  • vaginal: change in discharge, abdo/pelvic pain, dysuria, altered bleeding (rare)
  • pharynx: asymptomatic
  • rectum: asymptomatic, anal discharge, pain, discomfort
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6
Q

Who is given treatment for gonorrhoea and what is given?

A
  • people with a positive test result
  • under clinical suspicion (really severe symptoms)
  • recent/ongoing sexual contact with someone with gonorrhoea

Ceftriaxone 1g IM (or ciprofloxacin)
* test repeated after 2 weeks to ensure cure

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7
Q

What are the possible complications of gonorrhoea?

A
  • epidimyo-orchitis: testicular pain/swelling/tenderness
  • prostatitis
  • PID
  • disseminated gonoccoccal infection (rare - affects skin + joints)
  • resistance to antibiotics
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8
Q

What are the risk factors of chlamydia?

A
  • <25 years old
  • new sexual partner or >1 partner in a year
  • inconsistent condom use
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9
Q

Describe the signs and symptoms of chlamydia

A
  • penile urethra: asymptomatic, discharge (clear/white), meatal discomfort
  • vaginal: intermenstrual/PC bleeding, cervicitis, change in discharge, pelvic pain
  • pharynx: asymptomatic
  • rectum: asymptomatic, proctitis, PR discharge, bleeding, tenesmus, constipation, LGV
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10
Q

What is the treatment for chlamydia?

A

Doxycycline 100mg twice a day for a week

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11
Q

Describe the possible complications associated with chlamydia

A
  • PID: fever, pain, pelvic pain, dyspareunia/ tubal infertility/ ectopics/ Fitz-Hugh-Curtis syndrome
  • epididymo-orchitis: male infertility
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12
Q

Describe the features of mycoplasma genitalium

A
  • bacterial infection
  • some people get symptoms of urethritis/PID
  • treatment only administered if symptoms/partner has symptoms (highly resistant to antibiotics)
  • detected through naat testing
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13
Q

Describe the signs and symptoms of trichomonas vaginalis

A
  • often asymptomatic
  • vaginal: frothy yellow discharge + intense itch (marker), strawberry cervix
  • penile: urethritis
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14
Q

How is trichomonas vaginalis detected and treated?

A
  • detection is through microscopy/culture
  • treatment = metronidazole
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15
Q

Describe the features of syphilis

A
  • treponema pallidum
  • gram negative spirochete
  • transmitted sexually (can vertically too)
  • more common MSM
  • asymptomatic positive test = latent syphilis
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16
Q

What is the clinical presentation of primary syphilis?

A
  • chancre (single, painless ulcer that leaks clear fluid) at the site of inoculation
  • 9-90 days after infection
17
Q

Describe the clinical presentation of secondary syphilis

A
  • generalised rash on palms and soles
  • muco-cutaneous lesion, condylomata lata/lymphadenopathy and fever
  • patchy alopecia, anterior uveitis, meningitis, cranial nerve palsies, hearing loss, hepatitis, arthritis, glomerulonephritis (all less common)
  • 3 months-2 years
18
Q

Describe the clinical presentation of tertiary syphilis

A
  • neurosyphilis (variation of neurological symptoms including cognitive)
  • cardiovascular syphilis (aortic valve disease, aortic aneurysm, aortitis)
  • gummatous syphilis
19
Q

Describe the diagnosis and treatment of syphilis

A
  • dark ground microscopy + viral PCR (chancre swab)
  • bloods for antibody testing (3 month period - stays positive after treatment completion)
  • rapid plasma reagin (quantitative marker)
  • treatment = benzathine penicillin
20
Q

Describe the features of ano-genital warts

A
  • caused by HPV
  • more common types cause warts = 6 + 11
  • quadrivalent vaccine (6, 11, 16 + 18)
  • asymptomatic transmission possible
  • itch + aesthetic problems
21
Q

Describe the diagnosis and management of ano-genital warts

A
  • reassure high prevalence and benign
  • no require for partner notif (but advise condoms reduce transmission)
  • many people clear virus
  • smoking + hair removal increase risk

Treatment = cryotherapy, topical treatments (podophyllotoxin/imiquimod), surgical excision

22
Q

Describe features of HSV

A
  • 2 types
  • often symptomatic with first presentation (further episodes show reduction in severity)
  • detected with viral PCR swab
  • complications: CNS infection, balantitis, proctitis, urinary retention, risk of neonatal infection if pregnant
23
Q

Describe the advice and management for HSV

A
  • high prevalence
  • possible future recurrence
  • condoms reduce transmission

Treatment: aciclovir (can be given long term if frequent recurrences)

24
Q

Describe the features of scabies

A
  • itches (particularly at night)
  • caused by mite excrement which triggers a hypersensitivity reaction
  • burrows in web-spaces, wrist, elbows + nipples
  • diagnosis made on clinical appearance
25
Q

Describe the treatment of scabies

A
  • permethrin 5% or malathion 0.5%
  • wash off after 24hrs
  • wash contaminated clothes at 50 degrees
26
Q

Describe the features of phthirus pubis

A
  • transmitted by close bodily contact
  • live on coarse body hair (differs from head lice)
  • incidence decreasing (hair removal?)
27
Q

What is the treatment for phthirus pubis?

A

Malathion 0.5% or permethrin 1% cream

MBChB3 (100 decks)

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