STIs Flashcards
anogenital warts
caused by HPV from direct skin to skin contact with apparent or subclinical lesions and contact with genital secretions
micro-abrasions in the recipients skin allow viral access to the basal cells of the epithelium
most HPV infections are asymptomatic
symptoms and signs of anogenital warts
warty growths in and around anogenital skin or mouth
little discomfort, sometimes itchy
distorted urinary stream or bleeding with urethral lesions
rectal bleeding with anal lesions
cervical lesions should have cervical screening
complications of HPV
penile, anal, oropharynx, vulvar, vaginal, cervical malignancy with oncogenic HPV genotypes
treatment options for genital warts
patient applied topical paint or cream until resolution
clinical intiated cryotherapy weekly
treatment is cometic not curative
are genital warts a notifiable condition
no
chlamydia
caused by chlamydia trachomatiis
often asymptomatic
may cause dysuria, penile urethral discharge, vaginal discharge, testicular pain, pelvic pain
complications of chlamydia
epiididymo-orchitis
PID
infertility
pregnancy
reactive arthritis
cervicitis
conjunctivitis
perihepatitis
testing for chlamydia
nucleeic acid amplification test from
clinician collected endocervical swab is best if the patient is examined, or self collected vaginal swab
anorectal swab in any patient with anorectal symptoms and all men who have sex with men
pharyngeal swab in all men who have sex with men
FPU in people who do not have a vagina or if vaginal swab cannot be taken
NAAT
nucleic acid amplification test
highly sensitive, only recommended test for chlamydia
concurrent gonorrhea testing should accompany chlamydia testing
uncomplicated genital or pharyngeal infection of chlamydia
doxycycline 100mg PO 7 days or azithromycin 1mg PO stat
anorectal infection chlamydia treatment
doxycycline 100mg PO 7 days if asymptomatic, but 21 days if symptomatic
or azithromycin 1mg PO stat and repeat in 12-24 hours
when to use azithromycin to treat chlamydia
if adherance is likely to be poor
advice following chlamydia
no sexual contact for 7 days or until course is completed and symptoms have cleared, whichever is later
no sex with partners from the last six months until they have all ben testd nd treated
is chlamydia notifyable
yes
chlamydia in pregnanct people
azithromycin 1g PO stat
rectal co-infection with chlamydia and gonorhhea
treatment should be given for both infections ie. ceftriaxone 500mg IMI stat PLUS doxycycline 100mg PO BD 7 days but 21 days if symptomatic
test of cure for chlamydiaa
by NAAT no earlier thaan 4 weeks after tretment for pregnanct poeple or people with anorectal infection treated with azithromycin
donovanosis
rare cause of genital ulceration
consider in patients rturning from areas where disease is endemic
donovanosis is caused by
klebsiella granulomatis
clinicial presentation of donovanosis
relatively painless anogenital ulceration which may be ulcerative, proliferative or both
secondary anaerobic bacterial infection may result in offensive odour is association wiith the primary lesions
complications of donovanosis
extra genital disease is common and may occur via auto-inoculation, contagious spread or haematogenous spread
untreated u,cers may lead to lymphatic destruction with subsequent pseudo-elephantiasis of genitalia
neoplastic trasformation is possible
vertical transmission to neonote during vaginal delivery is possible
increase in HIV transmission risk
diagnosis of donovanosis
dry swab or punch bopsy for NAAT or histology
treatment for donovanosis
azithhromycin or doxycycline
notify the state
ectoparasite infections
most common are scabies and pubic lice
pubic lice = pediculosis pubis or crabs
scabiees aare associated with crowded living and sleeping conditions and institutional outbreaks
clinical presentation of ectoparasite infection
pubic or genital itch
scabies will have genital papulonodule
crabs will have debris in underwear
scabies complications
complications uncommon and mostly in crusted scabies
fever in children
pain on mopvement
sleep disturbance
secondary infection
pubic lice complications
fever, lethargy, irritability
diagnosis for pubic lice
direct visualisation +/- magnification of crab or eggs
diagnosis of scabies
clinical diagnosis
dermatoscope can aid
characteristic nodule and silvery skin burrows sometimes seen
treatment fro scabies
permethrin cream applied to dry skin with extra attention to hands and genitalia and leeave on for 8 hours
repeat in 1 week to improve success rate
treatment for pubic lice
apply pyrethrin and piperonyl butoxide topiical foam to pubic and other hhair infested with lice and wash off after 10 minutes
repeat treatment in one week
crusted scabies
occurs when the mite population is very high due to poor host immune response, such as people with HIV infection and people living in remote aboriginal communities.
treatment advice for scabies
patient and recent partners should complete treatment
avoid close body contact
isolate clothes, towel and bedlinen from previous 3 days and launder
symptoms and signs may not clear for 2 weeks
antihistamines, calamine lotion and topical steroid may be helpful
treatment advice for pubic lice
isolate clothes, towel and bedlinen from previous 3 days and launder
shaving pubic hair is not required
compared with head lice, resistance to permethrin treatment is pubic lice has not been demonstrated
herpes
caused by herpes simplex viruses types 1 and 2
primary episodes may be severe with extensive anogenital ulceration and systemiic features of viraemia
recurrent genital fissures, ertyhema with itching and swelling
cervicitis, proctitis and tenesmus
herpes CNS involvement
meningitis, transverse myelitis or sacral radiculopathy
diagnosis of herpes
swab of base of ulcer or deroofed vessicle
HSV NAAT
treatment for herpes
valaciclovir
aciclovir
other treatment:
- regular analgesia
- topical lignocaine to reduce pain from erosions
- urinating in a bath or shower
- neuropathic bladder requires urgent catheterisation and referral
- avoid immediate contact with partners until symptoms have resolved
- routine sexual health screening
- use of barriers ie. waterproof dressings
