STIs Flashcards
what is trichomonas vaginalis caused by?
what is elicited in the history?
- anaerobic protozoan
- asymptomatic (especially in men)
- profuse, offensive greenish/grey, frothy discharge
- vaginal and vulval irritation
- superficial dyspareunia
- dysuria
what would you see on examination of trichomonas?
- erythematous punctuate appearance cervix (strawberry cervix)
- vaginal discharge and vulval erythema
what are the diagnostic investigations for trichomonas? (3)
- vaginal pH >5.0
- HVS for direct microscopy and culture in a trichomonas medium
- trichomonads are seen on saline wet-mount (pathognomonic)
what STIs can be detected in a high vaginal swab?
endocervical swab?
blood tests?
- BV, candida albicans
- chlamydia and gonorrhoea
- blood tests for HIV, syphilis and hepatitis B (abundance of leukocytes)
what is the treatment for trichomonas?
what complications are there?
- metronidazole (200mg PO)
- PID
- premature delivery, PROM etc
- SEs of Tx (flushing, headache, nausea, etc)
what is the most common adverse side effect of chlamydia?
what percentage of people are asymptomatic ?
- PID (accounts for 50% of cases of PID)
- 60-80%
what are symptoms in males and females of chlamydia?
- vulval irritation
- superficial/ deep dyspareunia
- dysuria and frequency
- vaginal discharge
- PCB, IMB
- abdo pain, fever
male:
- urethritis
- unilateral testicular pain
- dysuria
what may be seen on examination in chlamydia?
- copious mucous vaginal discharge
- pain
- induration
- speculum shows cervicitis, friable contact bleeding.
- PID, adnexal tenderness, cervical motion tenderness, abdo tenderness
what investigations would you do for chlamydia in males, then females?
males:
- first void urine (NAATs)
- swab urethra from discharge (CT and GN)
- MSU if UTI
females:
- endocervical swab (NAATs)
- VVS (NAATs, red)
- HVS (TV, BS, candida, gonorrhoea)
- urine dip and MSU
what is the management of chlamydia?
- azithromycin stat
- doxycycline
- erythromycin
- avoid intercourse for 7 days after completion treatment, contact tracing.
what are the complications of chlamydia?
neonatal complications?
- PID
- seronegative arthritis
- Reiters syndrome
- fitz- hugh- curtis syndrome
- pregnancy problems
- neonatal pneumonia
- ophthalmitis, pneumonia
what can PID cause?
- tubal infertility, Acute PID results in tubal blockage in 15% of cases following 1st episode, 40% following 2nd
what percentage of men and women are symptomatic following gonorrhoea infection?
what is the incubation period?
- 50% of women, 90% of men
- 2-10 days
what are the symptoms of gonorrhoea in women?
men?
- purulent, offensive vaginal discharge
- deep dyspareunia
- IMB, PCB, menorrhagia
men:
- urethral dysfunction (discharge, dysuria)
- epididymal tenderness/ swelling
- balanitis
what are the complications of gonorrhoea?
- local spread: bartolinitis, skenitis
- ascending spread:
salpingitis, fever, malaise, rash - septicaemia, infection of rectum, fits Hugh-curtis syndrome
what can be found on pelvic exam?
- white/ yellow purulent discharge
- abscess (urethral or bartholins)
- uterine tenderness, adnexal tenderness, cervical excitation
what would gonorrhoea look like under microscope?
what investigations would you do?
- gram -ve diplococci
- EC swab (NAATs)
- VVS (NAATs)
- urethral, rectal and pharyngeal swabs
- microscopy and culture of swab will identify n.gonorrhoea and antibiotic sensitivity
what is the management of gonorrhoea?
- ceftriaxone 500mg and azithromycin 1g
what are the neonatal complications of gonorrhoea?
- neonatal ophthalmia (presents 2-7 days after birth with severe bilateral conjunctivitis, chemosis and lid oedema
what is more common HSV1 or 2?
what would you obtain from a history
- equally as common
- extensive sore genital ulceration
- can be systemic “flu-like”
- dysuria
- discharge
- neuropathic pain in buttocks/ genitals
what do the lesions look like in hsv?
- vesicles that burst leaving superficial tender ulceration with erythematous halo and grey/white exudate
how do recurrent infections compare with initial infections in HSV?
what might be a trigger for reactivation?
- shorter and less severe, last 3-5 days, cause unilateral lesions
- trauma, stress, menstruation
what is the difference in reactivation between HSV 1 and 2?
- HSV 2 has 4-6 outbreaks a year
- HSV 1 limited to once per annum
when are you most infectious in HSV?
what prodromal symptom may alert you of it coming on?
- during viral shedding and symptoms
- neuralgia pain down legs and buttocks
what investigations would you perform?
- swab ulcer vesicular fluid for PCR (HSV and syphilis)
- STI screen (NAAT’s urine, bloods HIV and Hep B, syphilis)
what is the management of HSV?
- primary episodes 400mg TDS for 5 days
- topical/ oral analgesia
- recurrent episodes are self limiting, use saline baths and analgesia
what do you do if a mother gets herpes in 1st/2nd trimester?
what do you do in 3rd trimester acquisition?
- daily suppressive acyclovir from 36 weeks
- 1st episode associated with first trimester miscarriage
- takes 6 weeks for pregnant women to develop Ab’s in response to HSV and protect neonate
- offer C section if present delivery or within 6 weeks of birth
- Give IV acyclovir
