STIs 2 Flashcards
gonorrhea
reduced susceptibility to first line treatment is emerging in urban australia
caused by neisseria gonorhhoae
clinical presentation of gonorrhea
anal and pharyngeal infections are usually asymptomatic
penile urethral gonorrhea is usually symptomatic
causes penile urethral discharge, dysuria, vaginal discharge, dyspareunia with cervicitis, conjunctivitis, anorectal symptoms
complications of gonorrhea
epidydimo-orcitis (uncommon)
prostatitis
PID
bartholin gland abscess
disseminated disease (rarely)
meningitis or endocarditis (raarely)
diagnosis for gonorrhea
always collect samples when treating to contribute to antimicrobial reesistance surveillence but never delay treatment while waiting for these culture results
first pass urine NAAT - less sensitive
penile urethral swab
clinician collected or self collected vaginal swab
for men who have sex with men, always aalso collect an anal and pharyngeal swab
gonoccoccal culture
high specificity and allows for antibiotic susceptibility testing
much less sensitive than NAAT
clinicians must specify ‘gonococcal culture’ rather than general culture
treatment for uncomplicated genital and anorectal infection gonorrhea
ceftriaxone 500mg stat
PLUS
azithromycin 1g PO stat
is gonorrhea notifiable
yes
other management for gonorrhea
no sexual contact for 7 days after treatment is commenced, or until the course is complete and symptoms resolved, whichever is later
no sex with partners from the last 2 months until they have all been tested and treated
recommend partner notification
provide patient fact sheet
notify the state
test of cure for gonorrhea
TOC by NAAT should be performed 2 weeks after treatment is completed
hepatitis A
acute infection of the liver
usually from contaminated food and water but faecal-oral transmission can occur during sex, especially in men who have sex with men
care is supporrtive, infection confers lifelong immunity
people at risk of hep A
men who haave sex with men
people who inject drugs
aboriginal and torres strait islander people
people in custodial settings
sex workers
symptoms of hep A
acute hepatitis: lethargy, nausea, fever, anorexia, jaundice, pale stools and dark urine
usually aysmpomatic in children, more severe illness in elderly and pregnant people
usually resolves in one month
tests for hep A
AST, ALT, bilirubin - raised in acute hep
Anti-HAV IgM - raised in acute illness and persists for 3-6 months
anti-HAV Ig- total - previous infection or vaccination
is hep A notifiable
yes
hepatitis B
anyone with positive hep B surface antigen (HBsAg) needs ongoing monitoring and needs to be considered for treatment
infection causes acute hepatitis, which may progress to chronic infection
hep B clinical presentation
asymptomatic infection is common
acute hepatitis - rght upper quadrant pain, lethargy, nausea, fever, anorexia for a few days then jaundice
is hep B notifiable
yes
interpreting Hep B serology
positive HBsAg - acute or chronic infection
positive anti-HBc - current or past infection
positive ant-HBs - immunity due to past infection or vaccination
how to tell the difference between acute or chronic hep B
acute hep B will have highh titre of anti-HBc IgM
HIV
treated with anti-retroviral therapy rehardless of CD4+ T cell count
people who achieve and maintain an undetectable HIV viral load cannot sexually transmit the virus
symptoms of HIV
acute infection - fever, rash, lymphadenopathy, pharyngitis, myalgia, diarrhoea
immune deficiency - multiple symptoms related to declining CD4 T cell couth such as oral thrush, diarrhea, weight loss, skin infections, herpes zoster
PEP
post exposure prophylaxs can be offered 72 hours after potential HIV exposure
PrEP
prevention option for HIv negative people
lymphogranuloma venerum is caused by
chlamydia trachomatis
ssymptoms of lymphogranuloma venereum
primary: small ulcer/nodule on penis/vulva/anus
secondary: inguino-femoral lympph node swelling
tertiary: chronic proctitis, fistulae, strictures, genital oedema, scarring
proctitis is cahacterised by
rectal ppain, bleedings, rectal discahrge, tenesmus and changed bowel habit
diagnosis of LGV
rectal swab: chlamydia NAAT, if positive then LGV specific NAAT
treatment of LGV
doxycycline 100mg BD for 21 days
test of cure for LGV
should be perfomed 3 weeks after treatment completion
mycoplasma genitalium
often asymptomatic
may cause dysuriaa, urethral discharge, urethral discomfort, PID and cervicitis
complications of mycoplasma genitalium
PID
possible role in tubal factor infertility
diagnosis of mycoplasma genitalium
FPU, anorectal swab, vaginal swab, endocervical swab and send for NAAT
throat swabs not recommended as pharyngeal infection is uncommon
clinical indications for mycoplasma genitaalium testing
acute, persistaant non-gonococcaal urethritis
cervicitis
PID
post coital bleeding
treatment of mycoplasma genitlaium
doxycycline and azithromycin
OR if suspected to be macrolide resistant
doxycycline and moxifloxacin
if PID: moxifloxacin
is m genitalium notifiable
no
syphilis
high prevelance in MWHSWM
caaused by treponema pallidum
clinical presentation of syphilis
50% will hve no symptoms
primary: genital, anal or oral ulcer
realtievly painless with well defined border and firm base
seconadary syphilis
secondary: systemic illness with fever, malaise, headache, rash and lymphadenopathy
alopecia, mucous patches and condyloma lata
neurological signs of visual changes, tinnitus, deafness and cranial nerve palsies
early latent syphilis
latent stage
postive serology with no symptoms
late latent syphilis
infection of more than 2 years
no longer infectious to sexual partners
still able to be transmitted in pregnancy
tertiary syphilis
complicaations include destructive skin lesions (gammas), cardiovascularr and neurological disease
diagnosis of syphilis
blood serology, swab of ulcer using PCR swab
treatment for sypphilis
benzathine benzylpenicillin IMI stat
garish-herxheimer reaction is a common reaction to treatment 6-12 hours after commencing treatment and consists of fever, headache, malaise, rigors and joint pains. treated with analgesics and rest
is syphilis notifiable
yes
trichomoniasis
more common in older people
uncommon cause of vaginal discharge or penile urethritis in urban settings
caused by trichomonas vaginalis
trrichomonas clinical presentation
urethritis
urethral discharge
dysuria
maloderous vaginal dischagre - typically profuse and frothy
vulval itch/soreness
cervicitis
diagnosis of trichomonas
high vaginal swab or firsst pass urine NAAT
treatment of trichomoniasis
metronidazole
only notifiable in NT
