STIs Flashcards
When do MSM need STI screening every 3 months rather than annually?
New partner or multiple sexual contacts
Group sex
Use of HIV pre-exposure prophylaxis (PrEP)
Use of recreational drugs during sex (chemsex).
Do condoms eliminate risk of getting herpes?
No they just reduce transmission
Does herpes affect fertility?
No
Can the herpes virus be passed on when asymptomatic?
Yes, the virus is usually passed on when there are no sx
Is genital herpes associated with increased risk of cancer?
No
What are the symptoms of Chlamydia?
Urethra – 50% asx; dysuria, penile urethral discharge
Endocervix – 75% asx; vaginal discharge, intermenstrual bleeding, post coital bleeding;
Conjunctivitis
What are the complications of Chlamydia?
Epididymitis or epididymo-orchitis
PID
Subfertility
Chronic pelvic pain
Ectopic pregnancy
Reactive arthritis
What are the indications for testing for Chlamydia?
- If signs and sx; sexual contacts of those with Chlamydia or other STIs
- Pregnancy
- Before TOP
- Before IUD insertion if at risk of STIs
- Suspected epididymo-orchitis
- Suspected PID
- Sexually active under 30
- MSM
- Hx sexual assault or intimate partner violence
- If sexual health check requested
- If asx and requesting testing wait at least 2 weeks
What is the treatment for Chlamydia?
Doxycycline 100mg PO BD for 7/7
Pregnancy/lactation Azithromycin 1g once
Review in 1/52
Do you need to test for cure for Chlamydia?
No test of cure unless pregnant or rectal sx (use NAAT)
Retesting a 3/12 is recommended to look for reinfection
Is Chalmydia a notifiable disease?
No
What are the symptoms of Gonorrhoea?
Urethral discharge (10% asx)
Dysuria
Endocervix – 80% asx
Vaginal discharge
Dyspareunia
Post coital bleeding
Intermenstrual bleeding
Anorectum – usually asx
Rectal discharge, irritation, painful defecation and disturbed bowel function
Conjunctivitis – may be sight threatening
What are the indications for testing for Gonorrhoea?
Sxc
Sexual contact of those with gonorrhoea or other STI’s
Before IUD insertion
Suspected epididymo-orchitis
Suspected PID
Sexually active and under 30 yrs
MSM
Hx sexual assault or intimate partner violence
Pt requesting a sexual health check but if asx wait 2/52
What are the complications of Gonorrhoea?
- PID
- Subfertility
- Ectopic pregnancy
- Chronic pelvic pain
- Adverse pregnancy outcomes including chorioamionitis, premature rupture of memebranes, neonatal conjunctivitis
- Rarely disseminated disease causing arthritis, skin lesions, endocarditis and meningitis
- Epididymitis or epididymo-orchitis
- Proctitis very rarely
How do you treat Gonorrhoea?
Ceftriaxone 500mg IM + Azithromycin 1g PO stat
Same in pregnancy but also require a test of cure 4/52 later and re-screen in the 3rd trimester
If co-infection with Chlamydia swap stat Azithromycin for Doxycyline 100mg PO BD for 7/7
Review in 1 week after treatment
Is Gonorrhoea a notifiable disease?
Yes
When do you need to test for cure if a patient has Gonorrhoea?
Pregnant or with rectal sx (NAAT)
- Retesting a 3/12 is recommended to look for reinfection
How do you test for hepatitis A?
Total HAV antibody. Differential testing for IgG and IgM only if suspected of having acute Hep A (jaundice and deranged LFTs)
Interpretation of Hep A results: HAV <20 means?
Susceptible – offer vaccination if high risk and patient willing to pay for vaccination
Interpretation of Hep A results: Total HAV >20 with no suspicion of acute hep A means?
Previous infection or vaccination
- Reassure; no further action required
Interpretation of Hep A results: Total HAV >20 and sxc or positive HAV IgM means?
Possible acute Hep A infection; request LFTs; supportive care and monitoring; avoid food handling and sexual contact until non infectious (from 2 weeks prior to infection until 1 week after jaundice begins)
Who do you notify if a patient tests positive for Hepatitis A?
Public health
Why is serological testing for Hepatitis B not recommended?
Results will be >10 for 1-2 months post vaccination then become undetectable by 7 years post vaccination despite immune memory remaining (no further vaccination required)
Who should you offer serological testing and vaccination for Hep B to?
Unless known to be immune, offer to:
MSM
Sex workers
People infected with HIV
IDU
Maori, Pacific, Asian born in NZ before 1988
Immigrants of any age from Pacific islands, Asian, Middle eastern, or African countries
People who have been incarcerated
Contacts of people with HBV
Following non consensual sex