STIs Flashcards
What is chlamydia
Chlamyidia trachomatis is gram negative bacteria. Intracellular organism - enters and replicates within cells, ruptures and spreads
Whast % of men anad women are asymptomatic with chlamydia
50% men
75% women
What are the aims of the National chlamydia screening programme
Screen every sexually active person under 25 years of age for chlamydia annually or when they change their sexual partner
Retested postivei cases in 3 months to make sure havent contracted chlamydia again
What is someone screened for basic in a GUM
Chalmydia
Gonorrhea
Syphilis - bloods
HIV - bloods
Swabs used in sexual health testing
Charcoal swabs
Nucleic acid amplification test (NAAT)
Which infections are NAAT swabs used for
Chalmydia
Gonorrhea
What investgiations do charcoal swabs allow
Microscopy
Culture
Sesnitiveits
What is the medium of NAAT swabs called
Amies transport medium
What can charcoal swabs confimr
Bacterial vaginosis
Candidiases
Gonorrhea
Trichomonas vaginalis
Group B strep
Where does gonorrhea swab have to be from
endocervical swab
Where does tichomonas swab have to be from
Posterior fornix
What can be used for endocervical swabs and high vaginal swabs
Charcoal swabs
What do NAAT swabs test for
DNA or RNA of oranfism
What can a NAAT be perfomred on
Endocervical swab
Vulvovaginal swab
First catch urine sample
men - urine, urethral swab
Rectum, pharyngeal
When gonorrhea sus on NAAT test what further investigations do
Cahrcoal swab for microscopy, culture and sensitivities
Chlamydia presentation woman
Mostly asymptomatic
Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding (intermenstrual or postcoital)
Dyspareunia
Dysuria
How does chalmydia present in men
Urethral discharge or discomfort
Painful urination (dysuria)
Epidydymo-orchitis
Reactive arthritis
When is rectal chlamydia and lymphogranuloma venreum worth considering
Anorectal symptoms eg discomfort, discharge, bleeding and cahnge in bowel habits
Examination findings chlamydai
Pelvic or abdominal tenderness
Cercical motion tnederness - cervical excitation
Inflamed cervix - cervicitis
Purulent discharge
What swabs can be taken to diagnose chlamydia
- Vulvovaginal swab
- Endocervical swab
- First-catch urine sample (in women or men)
- Urethral swab in men
- Rectal swab (after anal sex)
- Pharyngeal swab (after oral sex)
First line management chalmydia
Doxycylcine 100mg twice a day for 7 dyas
First line management chalmydia
Doxycylcine 100mg twice a day for 7 dyas
Why has azithromycin become alternative medication for chlamydia
Mycoplasma genitalium resistance
Less effective for rectal chlamydia
What is doxycycline contraindicated in?
Pregnnacy
Breast feeding
Chalmydia treatments for pregnant or breast feeding women
- Azithromycin 1g stat then 500mg once a day for 2 days
- Erythromycin 500mg four times daily for 7 days
- Erythromycin 500mg twice daily for 14 days
- Amoxicillin 500mg three times daily for 7 days
When is a test of cure for chlamydia done
Rectal chlamydia
Pregnancy
Persisiting symptoms
Further management than medical for chlamydia
Refrain from sex for 7 dyas - reduce risk reinfection
Refer to GUM - contact racing and notifying sexual partners
Test for and treat any other STIs
Future protection advice
Safegurading issues
Complications from chlamydia
PID
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivirits
Lymphogranuloma venereum
Reactive arthritis
WHY
Pregnancy related coomplications chlamydia
Preterm
PROM
LBW
PP endometritis
Neonatal infection - conjunctivitis and pneumonia
What is lymphogranuloma venereum, who mostly gets it
Affects lymphoid tissue around site chlamydia
Men who have sex with men
What stages does LGV occur in
Primary - painless ulcer (primmary lesion)
Secondary - lymphadenitits - swelling, inflammation + pain of inguinal or femoral lymph nodes
Tertiary - Proctitiscolitis -> anal pain, change in habit, tenesmus, discharge
Treatemnet for LGV
Doxycycline 100mg twice daily for 21 days is the first-line treatment
Erythromycin, azithromycin and ofloxacin are alternatives.
How does chalmydial conjunctivitis present
Chronic erythema, irritationa nd discharge>2 weeks
Most are unilateral
How does chalmydial conjunctivitis present
Chronic erythema, irritationa nd discharge>2 weeks
Most are unilateral
What is gonorrhoea
Gram negative diplococcus bacteria infects mucous membranes with columnar epithelium - endocervix, urethra, rectum, conjunctiva and pharynx
Spreads via mucous secretions
How does gonorrhea present female
symptomatic 50% of women
Odourles spurulent discharge, green or yellow
Dysuria
Pelvic pain
How does gonorrhea present male
in 90% of men symptomatic
Odourless purulent discharge, green or yellow
Dysuria
Testicular pain or swelling - epididymo-orchitis
How else can gonorrhea present
Rectal - discomfort, discharge, may be asymptomatic
Pharyngeal - sore throat or asymptomatic
Prostatitis - perineal pain, urinary symptoms, prostate tenderness on exam
Conjunctivitis - erythema, purulent dischaege
How else can gonorrhea present
Rectal - discomfort, discharge, may be asymptomatic
Pharyngeal - sore throat or asymptomatic
Prostatitis - perineal pain, urinary symptoms, prostate tenderness on exam
Conjunctivitis - erythema, purulent dischaege
How disagnose gonorrhea
NATT - nendocervical, vulvovaginal or urethral swabs, first catch urine sample
Rectal and pharyngeal swabs -MSM, risk factors (sex in those areas), infections
Endocervical swab - charcoal
What need to do before starting anitbiotics for chlamydia
Endocervical charcoal swab for microscopy, culture and antibiotic sensitivities
Management of gonorrhoea
GUM clinic referr - coordinate test, treat and contact tracing
Medication depends on sensiticities
What is first line for uncomplicated fonorrhoea if sensitivities are known vs unknown
Single dose IM ceftriacone = 1g - unknown
Signle dose oral ciprofloxacin 500mg if snesiticeities KNOWN
Why do all patients with gonorrhea have a follow up test of cure
High levels of antibiotic resistance
When do test of cure gonorrhea
72 hours after treatment for culture
7 dyas after treatment - RNA NATT
14 days - DNA NATT
Complications of gonorrhea
PID
Chronic inflammatory pain
Infertility
Epidiymo-orchitis
Prostatitis
Conjuncitivits
Urethral strictures
Disseminated gonococcal infection
Skin lesions
Fitz-Hugh-Curtis syndrome
Septic arthritis
Endocarditis
What is gonorrhea ass with in neonate
Conjunctivitis (opthalmia neonatorum)
Contracted from mother in birth
Why is gonococcal conjunctivitis a medical emergency
Ass with sepsis, perforation of eye and blindness
What is disseminated gonococcal infection
Complciation of untreated gonorrhea, bacteria spread to skin and joints
Presentation of GDI
Various non specific skin lesions
Polyarthralgia - joint aches and pains
Migratory polyarthritis - arthritis moves between joints
Tenosynovitis
Systemic symptoms eg fever and fatigue
WHat is mycoplasma genitalum
Bacteria that causes non gonococcal urethrisit
What are there high lveles of resitstance to in gonorrhea
Ciprofloxacin
Azithromycin
Presnetation of mycoplasma genitalium
Urethritis
Epididymitis
Cerviciits
Endometritits
PID
Reactive arthritis
Preterm delivery in pregnancy
Tubal infertility
v similar to chlamydia and may be co-infection
Why are traditional culutreus not helpful in isolating MG
V slow growing organism
Use NAAT
Samples recomended for MG
First urine samples in morning - men
Vaginal swabs - can be self taken - women
What things need to do when positive for MG
Check for macrolide resistance
Test of cure after treatemnt
Uncomplicated MG genital infection 1st line
Doxycycline 100mg twice daily for 7 dyas then (not in pregnancy)
Axithromycin 1g stat then 500mg ince a dya for 2 dyas - UNLESS macrolide resisitace
What is an alternative/complicated infection treatment of MG
Moxiflacin
What is trichomonas
Protozoan - single celled organism w flagella (4 at front one at back)
Urethra in men + women, vagina aswell
What can trichomonas increase the risk of
Contracting HIV by damaging vaginal mucosa
Bacterial vaginaosis
Cervical cancer
Pelvic inflammatory disease
Pregnancy related complications eg preterm
Symptoms of trichomonas
50% none
Non specific if do
Vaginal dishcarge - frothy and yellow green + fishy
Itching
Dysurai
Dyspareunia
Balanitis (glans inflammation)
Examination of cervix appearance in trichomonas
Strawberry cervix - colpitis macularis
Cervicitis caused - tiny haemorrhages across surface
pH trichomonas
> 4,5
Diagnosis of trichomonas
Charcoal swab + microscopy from prost fornix vagina - behind cervix
Self taken vaginal swab also used
Urethral swab or first catch urine in men
Treatment of trichomonas
Metronidazole
Where does herpes become latent after initial infection
Sensory nerve ganglia
Cold sores - trigeminal nerve
Genital - sacral nerve
How is herpes simplex spread
Direct contact with affected mucous membranes or viral shedding in mucous secretions
Can be spread asymptomatically - more common in first 12 months infection
When does herpes present
Asymptomatic or develop months or years after when latent virus reactivated
Normally initial infection symptoms appear within 2 weeks, most severe, then recurrent are milder
Symptoms last 3 weeks primary infection
Signs and symptoms of genital herpes
Ulcers or blistering lesions
Neuro[athic pain - tingling, burning, shooting
Flu-like symptoms - fatigue, headahce
Dysuria
Inguinal lymphadenopathy
Diagnosis of gential herpes
Cna be clinical
Viral pCR confirm
Treatment for genital herpes
Aciclovir
Additional conservative treatments for herpes
Varciciclovir, famciclovir
Paracetemol
Topical lidocaine 2% gel
Clean w warm salt water
Vaseline
Additional oral fluids
Wear loose clothing
Avoid intercourse with symptoms
What is the main pregnancy risk with genital herpes infection
Neonatal herpes simplex virus infection contracted in labour and delivery
High morbidity and mortality
How are babies protected against HSV
Antibodies from mum after initial infection can cross placenta -> passive immunity
How treat primary genital herpes before 28 weeks gestation
Aciclovir during intial
Prophylactic aciclovir from 36 weeks gestation onwards - reduce risk genital lesions during labour and delivery
When is C section recommended for herpes in pregnant women
If symptomatic
If contracted after 28 weeks gestation
(not needed if contact before 28 weeks, its >6 weeks past infection and woman is asymptomatic)
How treat gential herpes contracted after 28 weeks gestation
Aciclovir and immediate prophyactive gollow ip
What risk does recurrent gnetial herpes in pregnancy present
low for passing on to neonate even if lesions present
Prophylactic aciclovir considered form 36 weeks to reduce symptoms for delivery
What is HIV + types + what does it target
RNA retrovirus
HIV I most common, 2 rare outside west africa
CD4-T helper cells
How HIV initially presents
Seroconversion flu like illness - within frew weeks infection
Then asymptomatic until progresses to immunodeficiecny -> AIDs defining illnesses and oportunistic infections
How is HIV spread
Unprotexted anal, vaginal or roal sezual activity
Mother to child at any stage of pregnancy, birth or breastfeeding - vertical
Mucous membrane, blood or open wound exposure to infected blood or bodily fluids eg needle sharing, injuries or blood splashed in eye
Examples of AIDs defining illnesses
Kaposis sarcoma
Pneumocysitis jirovecii oneumonia - PCP
Cytomegalovirus infection
Candidiasis - oesophageal, broncheal
Lymphomas
TB
Who should be tested for HIV
Anyone with any risk factors
Need verbal consent documented to test
Why need to repeat HIV antibody test in 3 months
Antibodies take 3 months to develop - may be negative on first test so need another if exposed to virus to confirm
Tests for HIV
Antibody - can order at home and slef ample
p24 antigen testing - earlier + result
PCR testing for HIV RNA levels - gives viral load
What is normal CD4 count
500-1200 cells/mm3
What CD4 count is considered end stage HIV
<200 cells/mm3
What does undetectable viral load mean
PCR - HIV RNA levels below labs recordable range eg 50-100 copies/ml
treat HIV
Antiretroviral therapy = ART
Offered to anyone irrespective of CD4 count or viral load
Starting regime HIV
two NRTIs eg tenofovir and emtrivitabine + thrid agent
What does hiv treatment aim for
Normal CD4 count
Undectable viral load
Treat physical health problems
What is HAART + classes
Highly active anti-retrovirus therapy
* Protease inhibitors (PIs)
* Integrase inhibitors (IIs)
* Nucleoside reverse transcriptase inhibitors (NRTIs)
* Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
* Entry inhibitors (EIs)
What extra is given to people with a CD4 under 200
Prophylactic co-trimaxazole (septrin) to prevent against PCP
What monitor HIV patients for
Cardiovascular risk factors and blood lipids - hgih risk of CVS disease
What is required yearly in women with HIV and why
Cervical smears
Risk of HPV and cervical cancer
What vaccines need and dont
Should be up to date
influenza, pneumococcal, hepatitis A and B, tetanus, diphtheria and polio vaccines.
Avoid live vaccines
What advice about reproductive helath given
Condoms for vaginal and anal sex and dams for oral sex even when both partners HIV +
If viral load undetectable transmission through unprotexted sex unhheard of although not impossible - parnters should be reguarly tested
How can conceive with HIV
If undetectable, naturally
Sperm washing
IVF
What viral load allows a normal vaginal delviery with HIV
<50 copies/ml
When is C section considered for delivery in HIV
Considered if >50
In all women >400 copies/ml
What is given if viral load unknown or >1000 in delivery
IV zidovudine
What is a low risk baby given prophylactivalyy if mothers HIV +
Zidovudine for 4 weeks
What is high risk baby given after birth if HIV + mother
Zidovudine, lamivudine and nevirapine for 4 weeks
What risk babies if mum HIV +
<50 = low
>50 = high
Viral load
Can you breastfeed with HIV
Highly unrecommended - HIV can be transmitted in breastfeeding even if viral load undetectable
WHat is the current PEP meds
ART - truvada (emtricitabine and tenofovir_ and raltegravir for 28 days
Howeffective is PEP
more effective earlier done
Needs done befpre 72 hours after incident
What do after PEP
Immediate test and test in 3 months to confirm negative
Abstain from unprotected sexual activity for 3 months until confirmed negative
What is syphilis caused by
Treponema pallidum - spirochete - enters mucous membranes and disseminates
21 day incubation
How is syphilis contracted
Oral,vaginal, anal sex
Vertical transmission
IV drug use
Blood transfusions and transplants
Stages of syphilis
Primary - painless ulcer (chancre) at OG site
Secondary - systemic (skin + MM)
Latenet stage - asymtpomatic
Tertiray - many years later -> organs, gumma development, CVS + neuro
Neurosyphilis - CNS infection
How long is secondary syphilis
3-12 weeks
Early vs late latent syphilis
become asymptomatic before 2 years is early
After is late
Primary syphilis presentation
Chancre - 3-8 week resolve
Local lymphadenopathy
Symptoms of secondary syphilis
Maculopapular rash
Condylomata lata
Low grade fever
Lymphadenopathy
Alopecua
Oral lesions
What are condylomata lata
Grey wart like lesions genitals and anus
Key features of tertiary syphilis
Depends on organs effected how presents
Gummatous lesions
Aortic aneursysms
Neurosyphilis
When does neurosyphilis occur
Can occur at any stage if reaches CNS
Presentation of neurosyphilis
Headahce
Altered behaviour
Dementia
Tabes dorsalis (lose coordination)
Ocular syphilis
Paralysis
Snesory impairment
What is tabes dorsalis
Demyelination affecting the spinal cord posterior columns
What is the typical pupil finding in neurosyphilis
Argyll-robertsion pipil
What is argyll robertson pupil
Constricted pupil accomodates when focusing on near object but doenst react to lught
Often irreguarly shaoed
Prostitutes pupil - syphilis + accomodates but doesnt react
Diagnosis of syphilhis
Antibody testing for T.pallidum
Dark field microscopy
PCR
Non specific but sensitive tests assess for active infection syphilis:
Rapid plasma ragin - RPR
venereal disease reaseach lab (VDRL)
Quantigy antibodies - greater chance active disease
Can be false positives
Management of syphilis
GUM follow up
Full screening for other STIs
Advice about avoiding sexual activity til treated
Contact tracing
Prevention further infections
Treatment for syphilis standard
Deep IM dose of benzathine benzylpenicillin
Alternatives for syphilis treatment
Ceftriazone
Amoxicillin
Doxycycline
