STIs Flashcards
How is regular sex good for you?
Fitter
Lower rates of depressive symptoms
Better cardiovascular health
When is sex bad for you?
Non-consensual sex Exploitative sex Sexual dysfunction (physically or mentally) Unwanted conception Infections
What type of sex do people in the UK have?
Vaginal sex
Increase in oral and anal sex over the past few years
Is there an increase in same-sex experiences in the population?
Women -yes (from 2% to 8%)
Men - yes (from 4% to 5%)
How has there been changes in sexual lives over time?
Average age of first sexual intercourse has decreased
Average age of first live-in relationship has increased
Average age of first child has increased
Increase in same-sex relationship
Increase in multiple partners
Increase in casual sex
Increase in sexual activity with strangers
Give some reasons as to why younger people have higher STI diagnoses than older people.
Older people are more likely to have a long term partner
Younger people are more likely to have multiple partners, casual sex and sex with strangers. They are also more likely to be less educated
Which gender are more commonly affected by STIs?
Women
Which gender is more likely to be affected by gonorrhoea?
Men - spread easily though men who have sex with men than any other population
Geographically, where are there most likely to be higher STI rates?
In large cities (especially London)
Which personal factors increases the risk of an STI?
Partner choice
Multiple partners - sexual partners can form a network and an STI can easily pass from person to person
No condom use
Why should a patient be diagnosed and given treatment on the day they arrive at the clinic?
Otherwise they might leave diagnosed and go and have sex with someone and pass on the infection.
What are the basic principles of STI managment?
Diagnosis before treatment Screen for accompanying STIs Simple treatment regimens Follow-up after treatment Partner notification Non-judgemental patient support, counselling and education
Why are simple treatment regimens important?
Some people don’t think they need treatment, so if the regimen is complication
Why is a follow up after treatment needed?
To check that the treatment has been effective and the infection has been cleared properly so there is no more spread.
What is the most likely causative organism of urethral discharge?
Gonorrhoea (perhaps Chlamydia)
- but gonorrhoea has a thicker dischrage
When someone comes in with an STI, what do you need to know?
Last time they has any kind of sex
Who it was with - gender, long-term/casual partner and location
Types of sex - oral, condom use, sex toys, receptive anal sex
What would you expect to see on a microscope slide from a Gonorrhoea swab?
Gram negative
Intracellular
Diplococci
Presence of may neutrophils
How would the cell sample for Gonorrhoea be obtained?
Urethral gram film
- take a sample of urethral discharge
What is the name of the test for Gonorrhoea?
NAAT test - nucleic acid amplification test (uses PCR methods)
How would a sample for a NAAT test be collected?
Male urine - highly sensitive
Female vulvovaginal swab (Self taken is fine as sensitivity remains the same whether taken high or low in the vagina)
What more unusual places can be swabbed for an NAAT test?
Rectal swab (depending on the sexual history) Throat swabs - only men as women would also have it in the vagina if they have it in the throat
What is disseminated gonorrhoea?
Gonorrhoea outside the genitals, throat and rectum
Very rare
Form little nodules on the skin (hard to see on dark skin)
Affects bony joints and tendons
Why is examining the proportion of each ST found in each gender important?
This suggests which STIs are likely to be heterosexually or homosexually acquired
What is the standard management of male urethral discharge?
Ceftriaxone 500mg IM
Azithromycin 1g stat
Partner notification
What are the symptoms of Chlamydia trachomatis?
Asymptomatic
Infection can lead to tubal damage, and cause PID in 16% of women
- pain during sex
- vaginal discharge after sex
How is chlamydia currently treated?
A single dose of azithromycin (1g oral stat) cures in 90% of cases
- no check up for infection as it is normally effective
What are treatment options other than Azithromycin?
Doxycyline 100mg BD for one week
- not used as much due to compliance issues
- given for 3 weeks in LGV infections
What is Lymohogranuloma venereum?
LGV - subtype of Chlamydia - lymphotropic chlamydia This is a type of bacteria that attacks the lymph nodes Most commonly infects the rectum Can infects all mucosal sites
What are the symptoms of LGV in the rectum?
Severe proctitis causing constipation, rectal bleeding and tensemus
Inguinal bulbos come to the surface and look like fissures
How does Syphilis present?
In very unusual ways - any strangely presenting patient is probably syphilis
Chancre
Rash
What is the natural history of Syphilis?
Exposure Primary lesion (chancre - 3 weeks) Secondary lesion (rash - 8-16 weeks) Latent syphilis (Positive serology but no symptoms) Tertiary syphilis (10-40 years) - Gumma - Cardiovascular - Neurological
What is a Chancre?
Little organisms entering through an abrasion in the skin
Can present anywhere
- commonly on the penis
Which community is Syphilis passed most easily through?
Men who have sex with men
Easily transmitted through oral sex, but can travel through vaginal and anal
Why does a rash occur in secondary syphilis?
Triponines pass through the skin and are spreading though the body.
Rash is hard to see dark skin
Describe the secondary syphilis stage.
High infectious, with strongly positive blood test serology
Not all patients have a secondary stage
Rash
Can easily be confused with other medical condtions
What are some of the non-gential related problems that arise in late syphilis?
Can get into the bone - bone pain
Ophthalmic complications - can pop small blood vessels in the eye
Hearing loss
What is the treatment for Syphilis?
Penicillin
- Two IM injections
- not very good evidence that it works
Name the viral STIs.
HIV
Hepatitis B and C
HPV - warts
What is the treatment for genital warts?
Warts are usually benign
- topical solutions (imiquimod)
Which population does anogenital warts affect most?
Young women
Which type of herpes simplex virus is associated with the genitals?
Both Types 1 and 2
- increase in type 1 in the genitals due to increased oral sex (mouth to genital transmission)
Describe the treatment for herpes simplex.
New episode
- Aciclovir 400mg 3 times a day for 5 days
Recurrence episode
- Aciclovir 400mg 3 times a day for 2 days
Name some of the less common STIs.
Trichomonas vaginalis
Mycoplasma genitalium
Donovanosis
Chancroid
