STIs Flashcards
What is the most common bacterial STI?
Chlamydia
Profuse mucopurulent discharge from the penis and painful urination are most commonly symptoms of what STI?
Gonorrhoea
During which stage of syphilis does a chancre develop?
Primary
Which STI can lead to pelvic inflammatory disease in women?
Chlamydia
Which STI is known as the great imitator?
Syphilis
At what age is the HPV vaccine recommended for females?
11-13yo
Which type of genital HSV has a higher level of viral shedding?
Type 2
What type of organism is chlamydia?
Gram -ve bacteria
How is chlamydia transmitted?
Vaginal
Oral
Anal
What age group has the highest incidence of chlamydia?
20-24yo (M+F)
By how much does an episode of PID increase the risk of ectopic pregnancy by?
10x
What risk of tubal factor infertility does an episode of PID carry?
15-20%
How does chlamydia present in females?
Post coital or intermenstrual bleeding
Lower abdo pain
Dyspareunia
Mucopurulent cervicitis
How does chlamydia present in males?
Urethral discharge
Dysuria
Urethritis
Epididymo-orchitis
What are some complications of chlamydia?
PID (50% of cases)
Tubal damage
Chronic pelvic pain
Transmission to neonate
Adult conjunctivitis
Sexually acquired reactive arthritis/Reiter’s syndrome
Fitz-Hugh-Curtis Syndrome (perihepatitis)
How is chlamydia diagnosed?
Test 14 days following exposure
NAAT- females (vulvovaginal swab), males (first void urine)
MSM (rectal swab if receptive anal intercourse)
How is chlamydia treated?
Azithromycin 1g stat
Doxycycline 100mg BD x 1wk
What type of organism is gonorrhoea?
Gram -ve intracellular diplococcus
Where are the primary sites of infection of gonorrhoea?
Mucous membranes of: urethra endocervix rectum pharynx
What is the incubation period of urethral gonorrhoea infection in men?
Short: 2-5 days
What is the transmission risk of gonorrhoea from an infected woman to male partner?
20%
What is the transmission risk of gonorrhoea from an infected man to female partner?
50-90%
How does gonorrhoea present in males?
Asymptomatic in =<10%
Urethral discharge >80%
Dysuria
Pharyngeal/rectal infections mostly asymptomatic
How does gonorrhoea present in females?
Asymptomatic (up to 50%)
Increased/altered vaginal discharge (40%)
Dysuria
Pelvic pain (<5%)
Pharyngeal/rectal infections mostly asymptomatic
What are the lower genital tract complications of gonorrhoea?
Bartholinitis Tysonitis Periurethral abscess Rectal abscess Epididymitis Urethral stricture
What are the upper genital tract complications of gonorrhoea?
Endometritis PID Hydrosalpinx Infertility Ectopic pregnancy Prostatitis
How is gonorrhoea diagnosed through microscopy?
Urethral 90-95% sensitivity
Endocervical 37-50% sensitivity
How is gonorrhoea diagnosed through culture?
> 95% sensitivity (male urethra)
80-92% sensitivity (female endocx)
How is gonorrhoea diagnosed through NAATs?
> 96% sensitivity (both symptomatic + asymptomatic)
What is the first line treatment of gonorrhoea?
Ceftriaxone 500mg IM
What is the second line treatment of gonorrhoea?
Ceftriaxone 400mg oral (only if IM contraindicated or refused)
What is the co-treatment of gonorrhoea?
Azithromycin 1g (regardless of chlamydia result) given at same time as gonorrhoea treatment Test of cure in all patients
What is the incubation and duration of the primary infection of genital herpes?
Incubation 3-6 days
Duration 14-21 days
What are the symptoms and signs of the primary infection of genital herpes?
Blistering and ulceration of the external genitalia Pain External dysuria Vaginal or urethral discharge Local lymphadenopathy Fever and myalgia (prodrome)
Which HSV, 1 or 2, has more recurrent episodes?
2
What are the recurrent episodes of HSV often misdiagnosed as?
Thrush
Describe recurrent episodes of HSV
Usually unilateral, small blisters and ulcers
Minimal systemic symptoms, resolves within 5-7 days
How should HSV recurrent episodes be managed?
Swab ulcer base for HSV PCR Oral Aciclovir Consider topical Lidocaine 5% ointment if v. painful Saline bathing Analgesia
When is viral shedding more common?
HSV 2
More frequent in first year of infection
More in individuals with frequent recurrences
Reduced by suppressive therapy
What is the most common viral STI?
HPV
What are some of the associated clinical sequelae with different HPV genotypes?
Latent infection
Anogenital warts
Palmar and plantar warts
Cellular dysplasia/intraepithelial neoplasia
What is the incubation period of HPV?
3 weeks to 9 months
Where is subclinical disease common in HPV?
All anogenital sites
Is transmission of more than one type common in HPV?
Yes
What types of HPV cause >90% of anogenital warts?
6 and 11
What is the treatment for HPV anogenital warts?
Podophyllotoxin (Warticon)
Imiquimod (Aldara)
Cryotherapy
Electrocautery
Describe podophyllotoxin in wart treatment
Cytotoxic
Not licensed for extra genital warts (but widely used)
Describe imiquimod in wart treatment?
Immune modifier
Can be used on all anogenital warts
Other than 11-13yo girls, who currently gets the HPV vaccine?
MSM
People living with HIV
How is syphilis usually transmitted?
Sexual contact
Trans-placental/during birth
Blood transfusions
Non-sexual contact - healthcare workers
How is syphilis classified?
Congenital
Acquired
What stages of acquired syphilis can lead to an infectious state?
Primary
Secondary
Early Latent
What is the incubation period of primary syphilis?
9-90 days (mean 21)
Where do the lesions of primary syphilis appear?
Site of inoculation
What are the sites of inoculation of primary syphilis?
Genital 90%
Extra Genital 10%
What is the incubation period of secondary syphilis?
6wks to 6/12
What are some clinical features of secondary syphilis?
Skin (macular, follicular or pustular rash on palms + soles)
Lesions of mucous membranes
Generalised lymphadenopathy
Patchy alopecia
Condylomata Lata (most infectious lesion in syphilis)
How is syphilis diagnosed?
Demonstration of Treponema Pallidum (lesions, infected LNs): dark field microscopy, PCR
Serological testing- detects antibody
What are some non-treponemal serological tests?
VDRL (Venereal Disease Research Laboratory)
RPR (Rapid Plasma Reagin)
What are some treponemal tests?
TPPA (Treponemal Pallidum Particle Agglutination)
ELISA/EIA (Enzyme Immunoassay) SCREENING TEST
INNO-LIA (Line immunoassay)
FTA abs (Fluorescent Treponemal Antibody absorbed)
What is the treatment for early syphilis?
2.4 MU Benzathine penicillin x 1
What is the treatment for late syphilis?
2.4 MU Benzathine penicillin x 3
What is the serological follow up for syphilis?
Until RPR is -ve of serofast:
Titres should decrease fourfold by 3-6 months in early syphilis
There is serological relapse/reinfection if titres increase by fourfold
What is the look back period for chlamydia?
Male urethral 4 weeks, any other 6 months
What is the look back period for gonorrhoea?
Male urethral 2 weeks, any other 3 months
What is the look back period for non-specific urethritis?
4 weeks
What is the look back period for trichomonas vaginalis?
4 week
What is the look back period for epididymitis?
As CT/GC or if -ve, 6 months
What is the look back period for HIV?
3 months before -ve test, or before most likely time of infection
What is the look back period for syphilis?
Primary 90 days
Seconary 2 years
Other 3 months before most recent -ve test
What is partner notification not required for?
Warts
Herpes
Vaginal thrush
Bacterial vaginosis
What constitutes rape?
Penetration of the vagina, anus or mouth by the penis without consent
What invalidates sexual consent?
Incapacitated by alcohol or drugs
Incarcerated
Violence or threat of violence
Describe female sterilisation
Permanent Laparoscopic Fallopian tubes cut/tied/blocked No reliance on hormones Similar efficacy to Mirena IUS
Are there any non-contraceptive benefits to female sterilisation?
No
Describe the use of diaphragms as contraception
Silicon diaphragm Use with spermicidal gel Use within 4 hours of insertion, stays in 6 hours after sex Fitted by medic, user dependent Does not prevent infections
Who can use Caya diaphragms?
Users of the 65-80mm diaphragm
No medical fitting necessary
