STIs Flashcards
What is the treatment for Chlamydia?
Doxycycline 100mg BD for 1 week
OR
Azithromycin 1mg oral stat
What is the treatment for Gonorrhoea?
Ceftriaxone 500mg STAT IM &
Doxycycline 100mg BD 1week/ Azithromycin 1mg oral STAT
What is the treatment for PID?
Doxycycline 100mg BD 1week
& Metronidazole 400mg oral BD 1 week &
Ceftriaxone 500mg IM STAT
What is the treatment for Trichomoniasis?
Metronidazole 400mg BD 5days
alt: 2mg oral STAT
Which STIs are notifiable diseases?
Hep A, B & C
What are major complications of STIs (& which ones)?
- SARA= Chlamydia
- DGI= Gonorrhoea
What is SARA & how is it managed?
Sexual acquired reactive arthritis
Abx, NSAIDs, topical steroids for skin, contact tracing
What are RF for SARA/Reiter’s?
Psoriasis
Ankylosing spondylitis
Male
What 3 things make up Reiter’s syndrome?
Balanitis/urethritis (may see circinate balanitis- erythematous lesions on the penis)
Conjunctivitis
Arthritis
In GUM clinics, what measures are in place to protect confidentiality?
- Caldicott guardians
- Use of number rather than name
- No routine communication with GPs
- No requirement to give name/address/GP details
- Trace contacts without identifying index case
Do you have to tell a patient you are going to break confidentiality/disclose information?
Only disclose if harms likely to arise from non-disclosure are greater than possible harm both to patient and public trust in doctors that may arise from disclosure`
What organism causes chlamydia?
Chlamydia Trachomatis
What are the signs & symptoms of Chlamydia?
70% W & 50% M asymptomatic Cervical motion tenderness Pelvic pain/tenderness Dysuria Purulent discharge PCB/IMB Deep dyspareunia Epididymo-orchitis
How is Chlamydia investigated?
NAAT swabs
M: FCU & urethral swab
W: Endocervical/vulvovaginal swab
What are the causes of Gonorrhoea?
Exposure to cervical exudates during birth
N. Gonorrhoeae
What are the signs & symptoms of gonorrhoea?
Babys: Infection (Conjunctivitis) 2-5days after birth
M: Mucopurulent urethral discharge, dysuria
F: 50% asymptomatic, inc/altered vaginal discharge, dysuria, IMB, dyspareunia
Rectal: Anal discharge, acute proctitis, (peri)anal pain, tenesmus, rectal bleeding
How long does it take from infection to symptoms in Gonorrhoea?
10days
How is gonorrhoea investigated?
No earlier than 3days after sex with infected partner NAAT swabs Swab for cultures FPU for men Endocervical swab for women
What causes Syphilis?
Treponema Pallidum
What are the signs & symptoms of Syphilis?
CHANCRE- non-tender ulcers
Lymphadenopathy
Diffuse rash macules & papules
Neuro: Ataxia, Charcot’s joints
What are the signs of congenital syphilis?
Mental retardation Saddle nose Sabar teeth Rhinitis Hepatosplenomegaly
How is Syphilis investigated?
Serology: 10mL clotting sample for syphilis screen
Virology swab fro active lesions for PCR
Darkfield microscopy: Visualisation of bacteria= immediate treatment
How is Syphilis treated?
Partner notification
Benzathine Benzylpenicillin 1.8g IM Single dose
Congenital: IV aqueous Benzylpenicillin
Neuro: Benzylpenicillin Sodium 10.8g/day IV/4hourly & Prednisolone 40mg orally for 3 days
24hours before Penicillin
What are the cause of genital warts?
HPV 6 & 11
What is the incubation time of genital warts?
3months
How are genital warts treated?
No treatment
Self applied: Podophyllotoxin
Specialist: Tricholoracetic acid
Ablative methods: Cryotherapy, excision, electrocautery
What do you need to warn women about when using Podophyllotoxin?
Teratogenic
What is the prognosis for genital warts?
No cure
Goal is to eliminate visible lesions
Left alone 10-30% resolve on their own
What causes genital herpes?
HSV-2
What are the signs & symptoms of genital herpes?
Multiple painful bilateral blisters
Local oedema
Tingling/neuropathic pain in genital area/lower back/legs/buttocks
How is herpes investigated?
Swab from base of a lesion for viral culture
PCR
Vulvovaginal swab
How is genital herpes treated?
Commence within 5days of start of episode
Acyclovir 400mg TDS for 5-10days
Analgesia
Salt water bathing
What is bacterial vaginosis?
Inflammation caused by overgrowth of natural vaginal bacteria upsetting the natural balance
What bacteria can cause vaginosis?
Gardnerella vaginalis
Prevotella spp
Mycoplasma
Mobiluncus
What is the Amsel criteria diagnostic for & what are the components?
For bacterial vaginosis >3 of the following: - Homogenous discharge - pH >4.5 - Fishy odour Microscopy showing vaginal epithelial cells coated with large no. of bacilli
Other investigations: High vaginal swab
How is bacterial vaginosis treated?
Metronidazole 400mg BD for 5-7days
What parasite causes public lice?
Pthyris Pubis
What are the signs & symptoms of pubic lice?
Itchy red papules
Blue macule visible at feeding sites (thighs/lower abode)
Scatterings of minute dark-brown specks (louse excreta) on skin & underwear
What is the management for pubic lice?
Partner notification in the past 3 months
2 applications of Malathion 0.5% aqueous lotion/ Permethrin 5% dermal cream
7 days apart
What is scabies?
Infestation with the ectoparasite Sarcoptes scabiei, a mite that burrows through the human stratum corneum.
What are the signs & symptoms of scabies?
ITCH!
Blue spots
Perifollicultits
Track/burrow marks
What is crusted scabies a sign of?
Immunodeficiency
How is scabies investigated?
Skin scrapping
Ink burrow test: Ink tracks into burrow marks
What is the management for scabies?
Within 24hours treat all members of the household, close contact, sexual contacts with topical insecticide
Machine wash at 50degrees
Partner notification within 2months
Topical Permethrin 5% apply twice one week apart
How is thrush treated?
Fluconazole 1tablet STAT
How is epididymitis treated?
GC suspected: Ceftriaxone 500mg IM STAT & Azithromycin & Doxycycline
Epididymitis alone: Doxycycline 100mg oral BD 2weeks
How is NSU treated?
Heterosexual: Azithromycin 1mg oral STAT
MSM: Doxycycline 100mg oral BD 1week
