STIs Flashcards
Which patients should you offer performing a sexual screen for?
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
What is included in a standard sexual health screen?
- chlamydia + gonorrhoea (naat test)
- syphilis + HIV (blood test - big edta bottle)
What groups are more at risk of gonorrhoea?
- MSM
- Afro-Carribean
- urban areas with deprivation
- women <25
Describe the features of gonorrhoea
- 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
Describe the signs and symptoms of gonorrhoea
- 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
Who is given treatment for gonorrhoea and what is given?
- 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
What are the possible complications of gonorrhoea?
- epidimyo-orchitis: testicular pain/swelling/tenderness
- prostatitis
- PID
- disseminated gonoccoccal infection (rare - affects skin + joints)
- resistance to antibiotics
What are the risk factors of chlamydia?
- <25 years old
- new sexual partner or >1 partner in a year
- inconsistent condom use
Describe the signs and symptoms of chlamydia
- 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
What is the treatment for chlamydia?
Doxycycline 100mg twice a day for a week
Describe the possible complications associated with chlamydia
- PID: fever, pain, pelvic pain, dyspareunia/ tubal infertility/ ectopics/ Fitz-Hugh-Curtis syndrome
- epididymo-orchitis: male infertility
Describe the features of mycoplasma genitalium
- 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
Describe the signs and symptoms of trichomonas vaginalis
- often asymptomatic
- vaginal: frothy yellow discharge + intense itch (marker), strawberry cervix
- penile: urethritis
How is trichomonas vaginalis detected and treated?
- detection is through microscopy/culture
- treatment = metronidazole
Describe the features of syphilis
- treponema pallidum
- gram negative spirochete
- transmitted sexually (can vertically too)
- more common MSM
- asymptomatic positive test = latent syphilis
What is the clinical presentation of primary syphilis?
- chancre (single, painless ulcer that leaks clear fluid) at the site of inoculation
- 9-90 days after infection
Describe the clinical presentation of secondary syphilis
- 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
Describe the clinical presentation of tertiary syphilis
- neurosyphilis (variation of neurological symptoms including cognitive)
- cardiovascular syphilis (aortic valve disease, aortic aneurysm, aortitis)
- gummatous syphilis
Describe the diagnosis and treatment of syphilis
- 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
Describe the features of ano-genital warts
- caused by HPV
- more common types cause warts = 6 + 11
- quadrivalent vaccine (6, 11, 16 + 18)
- asymptomatic transmission possible
- itch + aesthetic problems
Describe the diagnosis and management of ano-genital warts
- 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
Describe features of HSV
- 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
Describe the advice and management for HSV
- high prevalence
- possible future recurrence
- condoms reduce transmission
Treatment: aciclovir (can be given long term if frequent recurrences)
Describe the features of scabies
- 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
Describe the treatment of scabies
- permethrin 5% or malathion 0.5%
- wash off after 24hrs
- wash contaminated clothes at 50 degrees
Describe the features of phthirus pubis
- transmitted by close bodily contact
- live on coarse body hair (differs from head lice)
- incidence decreasing (hair removal?)
What is the treatment for phthirus pubis?
Malathion 0.5% or permethrin 1% cream
