STIs Flashcards
Which is the most commonly reported bacterial infection in STI clinic?
chlamydia
What % of people are asymptomatic in chlamydia?
WOMEN: 70-80% MEN: 50%
Which STI stains as a gram negative intracellular diplococcus?
gonorrhoea
Give some complications of chlamydia
-PID (affects 9% of women) - tubal disease - chronic pelvic pain - transmission to neonates - Reiter’s: conjunctivitis, reactive arthritis and urethritis
How does chlamydia present in females?
- abnormal bleeding eg PCB and IMB - lower abdominal pain - dyspareunia - mucopurulent cervicitis
How do men present with chlamydia?
- milky discharge - urethritis
What are the complications of PID?
It increases the risk of ectopic pregnancy by 10x and carries a 15-20% risk of tubal factor infertility
When can you test chlamydia?
14 days post sexual
How do you test chlamydia and gonorrhoea?
female- HVS or vulvovaginal swab
male - first void urine also: rectal, throat, and eye swabs
Can you culture chlamydia?
no
By which method are chlamydia and gonorrhoea test samples tested?
NAAT - nucleic acid amplification testing
How to treat chlamydia?
1st line = doxycycline 100mg BD for 7 days
azithromycin 1g
When is test for cure done in chlamydia?
pregnancy
How long should patients abstain from sex after completing their treatment for chlamydia?
1 week (once course has finished)
Which serotypes of chlamydia are associated with lymphogranuloma venereum infection in MSM?
Serotypes L1,L2 &L3
What % of people with gonorrhoea are asymptomatic?
men - 10% women - 50%
How does gonorrhoea present in men?
mucopurulent urethral discharge, dysuria
How does gonorrhoea present in women?
inc/altered vaginal discharge, dysuria, pelvic pain
How do you treat gonorrhoea?
ceftriaxone 500mg IM and test for cure at 2 weeks
Which sub-species of herpes simplex is more likely to cause genital herpes?
HSV-2 - also has higher viral shedding so more likely to be transmitted
Describe symptoms of primary genital herpes
up to 3 weeks of blistering and ulceration of external genitalia + pain + external dysuria + discharge + local tender lymph nodes + fever + myalgia
How long does a secondary genital herpes attack tend to last?
5-7 days
How do we treat genital herpes?
Antiviral PO eg aciciclovir 400mg 3x/day for 5 days
What is the most common viral STI?
HPV
Name some clinical presentations of HPV
anogenital warts, palmar and plantar warts, cellular dysplasia/ intraepithelial neoplasia
Give 2 treatments for HPV warts
podophyllotoxin imiquimod
What is the infective organism in syphilis?
treponema pallidum
In which type of syphilis is a chancre seen?
primary
Describe some symptoms of secondary syphilis
- Maculopapular rash on palms and soles
- snail track mouth ulcers
- generalised lymphadenopathy
- alopecia
- condylomata lata (ulcer)
How do you diagnose syphilis?
viral swab for PCR
How do you treat syphilis?
long-acting IM penicillin once if early, 3x if late
Which STIs do we follow-up?
syphilis at 3, 6 and 12 months, all in pregnant women, gonorrhoea 2 weeks after treatment
Where can chlamydia infect?
urethra, rectum, endocervix, eyes and throat
How does trichomonas vaginalis present?
- yellow/green vaginal discharge
- offensive smell
- irritation
- strawberry cervix
how do you treat trichomonas vaginalis?
oral metronidazole
How does bacterial vaginosis present?
- grey fishy vaginal discharge
- pH >4.5
What risks are associated with bacterial vaginosis?
pre-term labour, intra-amniotic infection in pregnancy, susceptibility to HIV and post-termination sepsis
Which organism causes bacterial vaginosis?
gardnerella vaginalis
Which genital infections is indicated by the presence of “Clue cells” on microscopy?
bacterial vaginosis
How do you treat pubic lice?
malathion lotion
In which condition, are genital lesions described as looking like cauliflower seen?
genital warts caused by HPV
Which condition is this, how would you test it and treat it? “ A 28 yr-old woman presents with several attacks of painful small blisters that turn into pustules. She also describes difficulty passing urine”
- genital herpes ( most likely caused by HSV-2) - swab deroofed lesions for viral PCR - antiviral eg aciclovir
Which condition is this, how would you test it and treat it? “ A 30-year-old male with ulcerated penis and enlarged lymph nodes following unprotected sex in Thailand” ?
Syphilis (treponema pallidum) Swab lesion for PCR Penicillin IM long-acting
Which condition is this, how would you test it and treat it? “ A 28-yr-old male with pain when passing urine and a yellowy urethral discharge after having sex with a prostitute. “
Gonorrhoea PCR IM ceftriaxone
Which condition is this, how would you test it and treat it? “ A 19-yr-old female with thick white vaginal discharge and intense vulval itch”.
candida albicans infection (NOT AN STI) no test topical clotrimazole
Which condition is this, how would you test it and treat it? “ A 28 year old woman with yellow vaginal discharge and vulval irritation. Slide looks like strawberry vagina.”
trichomonas vaginalis no test treat: metronidazole and also treat partner
Which infections are treated with metronidazole?
Bacterial vaginosis Trichomonas vaginalis
When can you test for a) chlamydia b) gonorrhoea c) HIV d) syphilis post-exposure?
a) 14 days b) 14 days c) 3 months d) 3 months
Which STIs are viral?
HPV
HSV
Which STIs are bacterial?
- chlamydia
- gonorrhoea
- syphilis
- bacterial vaginosis
What is trichomonas vaginalis?
a parasite
Select the organism that causes a sexually transmitted infection. It does not stain with Gram stain. It is an intracellular organism that produces both elementary bodies and reticulate bodies during its reproductive cycle. It is diagnosed by PCR.
chlamydia
Which organism is an STI that does not stain with gram-stain and is a spirochete?
treponema pallidum
How does late stage syphilis present?
cardio or neuro complications
what is HAART?
A combination of 3 drugs from at least 2 different drug classes to which the virus is susceptible
