STIs Flashcards
How are infections transmitted during sex?
- Direct inoculation (HSV)
- Trauma (HCV)
- IVDU (HIV, HCV)
- Fomites (sex toys - gonorrhoea)
- Ingestion (shigella, Hep A)
- Sexual/genital secretions
Risk factors for STIs
- <25 years old
- change sexual partner
- no condom use
- MSM
- Past history of STI
- Large Urban areas
- social deprivation
- Black ethnicity
Where can STIs affect?
Anywhere along the GI tract
Rectal Gonorrhoea
- transmission
- symptoms
- complications
Gram negative intracellular diplococci
Transmission - direct contact of mucosal surfaces
Symptoms
5-10 days incubation Low abdo pain diarrhoea rectal bleeding anal discharge tenesmus urethral/vaginal discharge
Complications
abscess formation
increased susceptibility of HIV
genital gonorrhoea (due to proximity)
Rectal Chlamydia
Chlamydia trachomatis
Transmission - direct contact of mucosal surfaces
Symptoms -
milder than gonorrhoea
anal discomfort/itch
anal discharge
Syphilis
- Primary
- Secondary
- Ulcer
Can mimic many other diseases. MULTI SYSTEM DISEASE
Transmission
spread through close contact with an infected sore.
- IV drug users
Primary Syphilis -
solitary painless ulcer
Secondary Syphilis
- mucosal patches and ulcers (mouth, anogenital, rectal)
- condylomata lata (warts)
- Hepatitis
- Systemic inflammation
- Ulcers are quite firm, feels like there is a button underneath
Herpes Simplex Virus
Transmission - ano-genital or oro-anal
Usually HSV2
Usually peri-anal mucosa but may extend into rectum
Symptoms
- pain
- ulcers
- painful defecation
- bleeding
- mucous
- viraemic
HPV
Transmission - ano-genital/ oro-anal
Anal Warts
can extend to rectum
anal cancers in homosexual men and HIV positives
Lymphogranuloma Venereum (LGV)
Primary - ulcer
Perianal abscesses
Friable rectal mucosa, large ulcers, contact bleeding
Bloody diarrhoea
severe anorectal pain
Secondary (3 to 6 months) - inguinal syndrome; and-rectal syndrome
Tertiary
- strictures
- fistulae
- genital elephantiasis
anyone diagnosed with LGV should be tested for HIV, Hep C, syphilis
associated with group sex; drug use; syphilis, Hep C
GALT (Gut-associated Lymphoid Tissue)
- Largest immune compartment in the body
- mucosal lymphocytes in rectum, foreskin, cervico-vagina
-Dense clustering of lymphocytes - easy cell to cell transmission
HIGH SUSCEPTIBILITY TO HIV INFECTION
Investigations in STIs
- Proctoscopy (rectal)
- Gram staining from discharge/swab (x3)
- Gonorrhoea NAAT
- Culture
- Rectal biopsy
Management of rectal gonorrhoea
Ceftriaxone 500mg
Doxycycline
Public health interventions
Management of Rectal Chlamydia
Azithromycin
Doxycycline
STI testing
Public health interventions
Syphilis management
Benzathene penicillin
Public health interventions
Follow up serology
LGV management
Doxycycline 100mg for 3 weeks
