STIs Flashcards
NORMAL VAGINAL FLORA
What organism predominates in the healthy vagina?
This produces which chemicals to suppress the growth of other organisms?
What are some other organisms which can be found in small quantities?
What is the normal pH of the vagina?
Lactobacillus spp.
Lactic acid +/- hydrogen peroxide
Strep Viridians, Group B strep (beta haemolytic), Candida spp.
4-4.5
CANDIDA INFECTION
30% of vaginas are symptomatically colonised with candida - what is the most common type?
What is significant about candida which is not this type?
Candida albicans
Less responsive to treatment than normal, and more common in the immunosuppressed
CANDIDA INFECTION
What are some factors predisposing to candida infection?
Recent antibiotic therapy
High oestrogen levels
Poorly controlled diabetes
Immunocompromised
CANDIDA INFECTION
What are the main symptoms in females?
How can it present in males?
Is this sexually transmitted?
Itch and white vaginal discharge
Candida balanitis on the penis
No
CANDIDA INFECTION
How is this tested for?
What are the treatment options?
Clinical diagnosis usually, can use high vaginal swab for culture
Topical clotrimazole pessary or cream (available OTC)
Oral fluconazole
BACTERIAL VAGINOSIS
What is the pathology behind this condition?
It is sexually transmitted?
A lack of balance replaces normal vaginal flora with Gardnerella Vaginalis and other species of anaerobic bacteria
No, but it is much more common in people who are sexually active
BACTERIAL VAGINOSIS
How does this present?
Produces a discharge which is white, homogenous and may produce bubbles. It also has a very bad smell.
BACTERIAL VAGINOSIS
Women with this condition are more at risk of what other conditions?
Upper infection e.g. endometritis or salpingitis
PROM and preterm delivery (if pregnant)
HIV
BACTERIAL VAGINOSIS
Describe the ‘whiff test’ for diagnosis?
A wet mount will reveal what?
Large numbers of leukocytes in the wet mount suggests what?
What happens to the vaginal pH?
Adding 10% potassium hydroxide to the discharge elicits a fishy odour
Absence of bacilli and their replacement with clumps of coccobacilli (clue cells)
Coinciding infection
Elevated
BACTERIAL VAGINOSIS
How is this treated?
What is its relapse rate?
Metronidazole for 7 days
30%
CHLAMYDIA
This is more common in which gender?
What is the presentation in 70-80% of women and 50% of men?
What is the highest age of incidence?
What types of sex can cause this?
Females
Asymptomatic
20-24
Vaginal, oral, anal
CHLAMYDIA
This can affect where in the body?
What type of bacteria is it and what does this mean?
What gram stain is it?
Urethra, rectum, endocervix, eyes and throat
Intracellular bacteria - does not replicate outside a host
Does not stain with gram stain
CHLAMYDIA
There are three serological groupings. What does each of the following cause:
Serovars A-C?
Serovars D-K?
Serovars L1-L3?
Eye infection
Genital infection
Lymphogranuloma venereum
LYMPHOGRANULOMA VENEREUM
Who is this more common in?
What can it present with?
There is a high risk of what?
Tropical countries and MSM
Rectal pain, bleeding and discharge
Concurrent STIs
CHLAMYDIA
In females, what are some risks of developing a chlamydia infection?
What is a complication which is more common in males?
PID
Tubal factor infertility
Chronic pelvic pain
Increased risk of ectopic pregnancy
Reactive arthritis (Reiter’s syndrome)
CHLAMYDIA
What are the main symptoms in women?
What are the main symptoms in men?
Abnormal bleeding, lower abdominal pain, dyspareunia, discharge
Discharge, dysuria
CHLAMYDIA
When can testing take place?
What is the screening test used?
What should be used to obtain a sample in females?
What should be used to obtain a sample in males?
What should you add in MSM who have had receptive anal sex?
14 days after exposure
NAATs
Vulvovaginal swab
First pass urine
Rectal swab
CHLAMYDIA
What is the usual treatment?
What is the treatment for lymphogranuloma venereum?
What is the management if people cannot take the first line antibiotic?
Doxycycline 100mg bd for 7 days
Doxycycline 100mg bd for 3 weeks
Azthromycin 1g stat followed by 500mg od for 2 days
GONORRHOEA
What is the incubation period of gonorrhoea in men?
Which sex is it more commonly seen in?
What is the risk of passing on this infection from an infected female to male partner?
What is the risk of passing on this infection from an infected male to female partner?
2-5 days
Males
20%
50-90%
GONORRHOEA
What type of organism is this?
Where does it infect?
This is a fastidious organism - what does this mean?
It produces a tap of what?
Gram - intracellular diplococcus
The mucus membranes of the urethra, endocervix, rectum, throat and eyes
Does not survive in less than ideal growth conditions
Pus
GONORRHOEA
In males, how often is this asymptomatic?
Infections where are more likely to be asymptomatic?
What symptom is seen in > 80% of cases in males?
What is another potential feature in males?
< 10%
Throat and rectum
Purulent urethral discharge
Dysuria
GONORRHOEA
In females, how often is this asymptomatic?
What are some features in females?
Around 50% of cases
Increased/altered vaginal discharge, dysuria, pelvic pain
GONORRHOEA
What is the screening test for this infection?
What investigation is done if the person is symptomatic?
If the above test is positive, what is done next?
NAATs
Endocervical/urethral swabs for microscopy
Culture on selective agar plates
GONORRHOEA
Pharyngeal gonococcal infection results from what?
What type of oral sex more commonly passes this on?
Pharyngeal infection is mostly asymptomatic, but what are some symptoms it could cause?
Isolated pharyngeal infection is common in who?
Orogenital exposure
Oral sex on the penis
Exudative pharyngitis and cervical lymphadenopathy
MSM