STIs Flashcards
RFx for STIs?
- Sexually active 2 sexual partners last 12 months
- Homeless
- Substance abuse
What are the most common STIs in order of prevalence?
- Chlamydia
- Gonorrhoea
- HPV
- Genital herpes
What are the less common STIs?
- Hep B
- HIV
- Syphilis
- Trichomoniasis
What are non sexually transmitted genital tract infections?
- Vulvovaginal candidiasis
- Bacterial vaginosis
Features of sexual history?
- Age of first intercourse
- Sexual orientation
- Sexual activity / type
- Sexual activity during travel
- Total number of partners and duration of involvement
Features of STI history?
- Awareness
- Contraception
- Previous STIs and testing
- Partner communication regarding STIs
- Local symptoms
- Systemic symptoms
What are local symptoms of STI to elicit on Hx?
- Burning
- Itching
- Discharge
- Sores
- Vesicles
- Testicular pain
- Dysuria
- Abdo pain
What are systemic STI symptoms to elicit on Hx?
- Fever
- Lymphadenopathy
- Arthralgia
Screening for at risk individuals (even if asymptomatic?
-Chlamydia
-Gonorrhoea
-Hep B
-HIV
-Syphilis
Pap if non previous 12mo
Signs of gonorrhoea?
M: -urethral discharge, -unexplained pyuria, -dysuria -conjunctivitis F: -mucopurulent endocervical discharge -vaginal bleeding -dysuria -pelvic pain -dyspareunia with cervicitis. Can be asymptomatic; rectal involvement if anal sex.
Gonorrhoea Ix?
-M: urine PCR, urethral swab for Gram stain and culture
-F: urine PCR, endocervical swab for gram stain and culture, vaginal swab for wet mount (r/o trichomonas)
M/F: urine PCR
Rx gonorrhoea?
-Ceftriaxone 500mg IMI, stat in 2mL 1% lignocaine
PLUS
-Azithromycin 1g PO, stat
M complications gonorrhoea?
- Urethral strictures
- Epididymo-orchitis
- Infertility
- Disseminated disease (macular rash +/- necrotic pustules, septic arthritis)
- Increased risk HIV acquisition / transmission
F complications gonorrhoea?
- PID (dyspareunia, intermenstrual bleeding, post coital bleeding)
- Infertility
- Perinatal infection
- Disseminated disease (macular rash +/- necrotic pustules, septic arthritis)
- Increased risk HIV acquisition / transmission
Signs and symptoms of chlamydia?
70% asymptomatic
if symptoms, then similar to gonoccocal
Ix of chlamydia?
-NAAT (FPU / self collected swab)
Cause chlamydia?
Chlamydia trachomatis
Treatment uncomplicated genital or pharyngeal chlamydia infection?
-Azithromycin 1g PO stat
OR
-Doxycycline 100mg, PO BD 7/7
Non pharmacologic immediate management in treatment STI?
- Advise no sexual contact for 7 days after treatment is administered.
- Advise no sex with partners from the last 6 months until the partners have been tested and treated if necessary.
- Contact tracing.
- Provide patient with factsheet.
- Notify the state/territory health department.
Signs and symptoms of HPV?
Most are asymptomatic
M: cauliflower lesions (condylomata acuminata) on skin/mucosa of penile or anal area
F: cauliflower lesions and/or pre-neoplastic/neoplastic
lesions on cervix/vagina/vulva
ix of HPV?
None needed if simple condylomata
Potential biopsy of suspicious lesions
F: screening for cervical dysplasia through regular Pap smears
Treatment of HPV?
For condylomata: cryotherapy, electrocautery, laser excision, topical therapy (patient-applied or office-based)
For cervical dysplasia: colposcopy and possible excision, dependent on grade of lesion
Complications HPV?
M and F: anal cancer MSM and F who have receptive anal sex: rectal cancer
F: cervical/vaginal/vulvar cancer
Signs and symptoms of HSV I and II?
1° episode: painful vesicoulcerative genital lesions ± fever, tender lymphadenopathy, protracted course Recurrent episodes: less extensive lesions, shorter course, may have “trigger factors”
Ix HSV I and II?
Swab of vesicular content for culture, type-specific serologic testing for HSV-1 vs. HSV-2 antibodies and to determine 1o vs. recurrent episode
Rx HSV I and II?
- 1° episode:
- Acyclovir 200 mg PO 5x/d x 5-10 d
- Famciclovir 250 mg PO tid x 5 d
- Valacyclovir 1000 mg PO bid x 10 d - Recurrent Episode:
- Acyclovir 200 mg PO 5x/d x 5d or 800 mg PO tid x 2d
- Famciclovir 125 mg PO bid x 5 d
- Valacyclovir 500 mg PO bid x 3 d or 1000 mg POODx3d
Complications HSV I and II?
Genital pain, urethritis, cervicitis, aseptic meningitis, increased risk of acquiring and transmitting HIV
Signs and symptoms of syphilis?
- 1°: chancre (painless sore), regional lymphadenopathy
- 2°: rash and flu-like symptoms
- Latent Phase: asymptomatic
- 3°: neurologic, cardiovascular, and tissue complications
Ix of syphilis?
- Specimen collection from 1° and 2° lesions
- screen high risk individuals with serologic syphilis testing
- universal screening of pregnant women
Complications of syphilis?
- chronic neurologic and CV sequelae
- increased risk of acquiring and transmitting HIV
Incubation period primary syphilis?
Incubation period 10-90 days (average 3 weeks).
Signs and symptoms secondary syphilis?
The patient may present with
- constitutional symptoms such as fever, malaise, headache and lymphadenopathy
- The skin is involved in over 90% of cases
- The rash is usually generalised involving the trunk but may just affect the palms and soles
- The rash can be easily confused with drug eruptions, pityriasis rosea or guttate psoriasis
Rx syphilis (1/2/latent)
-Benzathine penicillin 1.8g IMI, stat
OR
-Procaine penicillin 1.5g IMI, for 10 days
Treatment of non infectious 3” syphilis?
Benzathine penicillin 1.8g IMI, weekly for 3 weeks
What is procaine reaction?
Procaine reaction is a rare reaction to procaine penicillin. It is characterised by a sensation of impending doom with hallucinations. The reaction is self-limiting and lasts about 30 minutes. The patient needs to be reassured and given general supportive measures.
What is Jarisch-Herxheimer reaction?
Jarisch-Herxheimer reaction is a common reaction to treatment in patients with primary and secondary syphilis. It occurs 6-12 hours after commencing treatment, and is an unpleasant reaction of varying severity with fever, headache, malaise, rigors and joint pains, and lasts for several hours. Symptoms are controlled with analgesics and rest. Patients should be alerted to the possibility of this reaction and reassured accordingly.
Non pharm immediate management of syphilis?
- Advise no sexual contact for 7 days after treatment is administered
- Advise no sex with partners from the last 3 months (primary syphilis) and 6 months (secondary syphilis) until the partners have been tested and treated if necessary.
- Contact tracing
- Provide patient with factsheet
- Notify the state/territory health department.
What does syphilis of the aorta involve?
- Intima of coronary arteries and may narrow coronary ostia leading to myocardial ischaemia.
- Destruction of medial muscle layers of aorta -> aortic dilation
Why does myocardial ischaemia occur in AR (as in syphilis)?
- Oxygen requirements are elevated secondary to LV dilation and elevated LV systolic wall tension
- Coronary blood flow normally during diastole when diastolic arterial pressure is subnormal > decreased coronary perfusion pressure
