STIs Flashcards
What is the definition of sexually transmitted infection?
The main mode of transmission of the organism is through sexual contact
What is the definition of sexually transmitted disease?
A disease caused by a sexually transmitted infection e.g. pelvic inflammatory disease
What is a sexually transmissible infection?
Disease can be transmitted by sexual contact, but it is not its main mode of transmission
What are different forms of sexual contact?
What are infective causes of vaginal discharge?
- Candida albicans
- Trichomonas vaginalis
- BActerial vaginosis
- Neisseria gonorrhoae
- Chlamydia trachomatis
- HSV
What are non-infective causes of vaginal discharge?
- Cervical polyps
- Neoplasms
- Retained products - tampons
- Chemical irritation
What are infectious causes of urethral discharge?
- Nesseiria gonorrhoae
- Chlamydia trachomatis
- Mycoplasma genetalium
- Ureaplasma urealyticum
- Trichomonas vaginalis
- HSV
- HPV
- UTI
- Reponema Pallidum - meatal chancre
What are non-infective causes of urethral discharge?
- Physical/chemical trauma
- Urethral stricture
- Nonspecific
What are infective causes of genital ulceration?
- Sypillis - primary chancre, secondary mucous patches, tertiary gumma
- Chanroid
- Lymphogranuloma venereum
- Donovanosis
- HSV - Primary, recurrent
- HZV
What are non-infective causes of genital ulceration?
- Behcet’s syndrome
- Toxic epidermal necrolysis
- SJS
- CArcinoma
- Trauma
What are the main symptoms that can occur in STIs?
- Dyspareunia
- Vaginal/urethral discharge
- Ulceration
- Pain
- Itch
- Malodour
- Genital swelling
- Eye symptoms
- Dysuria
- Haematuria
- Abdominal pain
- Systemic symptoms - Skin rash, joint pain, malaise, lymphadenopathy,fever
What things would you want to ask about in a full sexual history?
- PC/HPC
- Past sexual history
- Menstrual history
- Gynae history
- Obstetric history
- PMH
- Medications + Allergies
- Social history
What would you want to ask about in a menstrual history?
MR FLOPPI DIC
- Menopause
- Regularity
- Flow
- Odd bleeding - Post-coital, Post-menopausal, Intermenstrual
- Dysmenorrhoea
- Initiation - menarche
- Cycle - days on/days off
What would you want to ask about in the gynae history section of a sexual history?
- Previous gynaecological disease +/- treatment
- Last smear - date and result
What would you want to ask about in past sexual history?
- Last sexual contact?
- Casual/regular partner - how long for?
- Consensual?
- Male or female?
- Types of sex involved - anal, vaginal, oral, multiple partners
- Contraception used - condoms and/or other
- Nationality of contact
- Any other partners
What would you want to ask about in the obstetric section of the history when taking a full sexual history?
- Contraception being used?
- Current pregnancy/unsure?
What specific questions could you ask about HIV to identify positive risk factors for infection?
- Have you ever had a partner whom is known to be HIV positive?
- Have you ever had sex with a bisexual man/engaged in male homosexual activity?
- Have you ever had sex with someone abroad, or who was born in a different country?
- Have you ever injected drugs?
- Are you aware of any of your previous partners having ever injected drugs?
- Have you ever paid someone for sex, or been paid for sex?
What is the following?
Balanitis - specifically candida balanitis
What is the following?
Genital ulcer - think of infectinve and non-infective causes
What is the following?
Genital warts - specifically HPV warts
What is the causative organism of gonorrhoea?
Neisseria gonorrhoeae
What is the general incubation period of neisseria gonorrhoea?
Usually 5-6 days - can be 2 days - 2 weeks
What sex does gonorrhoea occur in most commonly?
Men - often in MSM
What are symtpoms of gonorrhoea in men?
10% asymptomatic
- Thick profuse yellow discharge
- Dysuria
- Pharyngeal/rectal infection
What are symptoms of gonorrhoea in women?
>50% asymptomatic:
- Vaginal discharge
- Dysuria
- Intermenstrual/post-coital bleeding
What investigations would you consider doing if you suspected gonorrhoea?
NAAT testing on samples obtained as follows:
- Women - a vulvovaginal swab (which may be self-taken)
- Men - first pass urine
Sites sampled for swabs should be mucosal sites associated with symptoms, and sites related to the type of sexual activity reported.
What is NAAT?
Nucleic acid amplification test
A technique utilized to detect a particular nucleic acid, virus, or bacteria which acts as a pathogen in blood, tissue, urine. Amplification is done using PCR or ligase chain reaction
What might you see on urinalysis in someone with gonorrhoea?
Positive leukocyte esterase
What gram-type is gonorrhoea?
Intracellular gram-negative diplococci
Why might you do imaging in someone with gonorrhoea?
Look for features of PID - inflammatory changes of fallopian tubes and ovaries, abnormal fluid collection
How would you treat confirmed gonorrhoea?
- Ceftriaxone 500mg IM once plus Azithromycin 1g Oral
- Add doxycycline +/- metranidazole if complicated
When is metranidazole added to treatment of gonorrhoea?
If there is a history of sexual assault/abuse
What complications can occur in men with gonorrhoea?
- Epididymitis
- Acute mononeuritis
- Disseminated gonococcal infection
What complications can occur in women with gonorrohoea?
- PID
- Bartholin’s Abscess
- Acute Mononeuritis
- Disseminated gonoccocal disease
What is disseminated gonococcal disease?
Bacteremic spread of the sexually transmitted pathogen, Neisseria gonorrhoeae, which can lead to a variety of clinical symptoms and signs, such as arthritis or arthralgias, tenosynovitis, and multiple skin lesions
How should you follow-up someone with gonococcal infection?
Test of cure at 2 weeks and test of reinfection at 3 months
What organism causes chlamydia infection?
Chlamydia trachomatis serovars D to K
How does chlamydia present in women?
Asymptomatic - 80%
- Vaginal discharge
- Dysuria
- Intermenstrual/post-coital bleeding
- Dyspareunia
What proportion of women are asymptomatic with chlamydia infection?
80%
How can chlamydia present in men?
Asymptomatic > 70%
- Slight watery discharge
- Dysuria
What is the consistency of urethral discharge produced in chlamydial infection?
Watery discharge
What is the consistency of urethral discharge produced in gonococcal infection?
Thick yellow discharge
How would you test for chlamydia infection?
NAAT for diagnosis of smaples collected as follows:
-
Women
- Swabs - urethra, vagina, cervix, rectum
- First void urine
-
Men
- First void urine
- Urethral swab
-
Both
- Rectal swabs if symptomatic
How would you manage someone with chlamydia?
Azithromycin 1g PO
What are complications of chlamydia in women?
- Pelvic inflammatory disease
- Reactive arthritis
- Infertility
- Ectopic pregnancy
- Cervical cancer
- Perihepatitis (Fitz-Hugh-Curtis syndrome)