STIs

Question 1

STIs:

How often and what to test in Aboriginal or Torres Strait Islanders?

Answer 1

-annually or more often depending on risks

Question 2

STIs:

How often and what to test in MSM?

Answer 2

-annually (up to 4 times per year if high risk)

Question 3

STIs:

How often and what to test in female sex workers?

Answer 3

-annually (as often as needed if condom use is not 100%)

Question 4

STIs:

Important history points?

Answer 4

• ideally use open ended questions
• use the term “partner” to avoid assumptions
• clarify BBV risk (IVDU, tattoos, piercings)
• be specific about type os sexual contact that occurs eg. penis in mouth, vagina, bum etc

Question 5

STIs:

Contact tracing?

Answer 5

STI: Time (months)
Gonorrhoea 2
Primary Syphilis 3 AND since symptoms
Chlamydia 6
hepatitis B or C 6
Secondary Syphilis 6 AND since symptoms
Tertiary Syphilis 12 AND since symptoms

HIV - as far back as there was risky behaviour

Question 6

STIs:

Chlamydia?

Answer 6

• 80% of cases in sexually active people <29yo

- if untreated in women carries a 2 - 8% chance of infertility

Question 7

STIs:

Testing for STI’s?

Answer 7

SCREENING:

Average risk
-urine PCR chlamydia/gonorrhoea (opportunistically - ideally yearly)

ATSI

• Average risk testing AND
• Syphilis, HIV, Hep A, Hep B

High risk (IVDU or sex worker)

• ATSI testing AND
• Hep C

MSM

• Average risk testing AND
• Throat/rectal swab for chlamydia/gonorrhoea PCR
• Hep C IF HIV positive or IVDU

SYMPTOMATIC:

Cervicitis in women, urethral irritation/dysuria/discharge in MSM = mycoplasma genitalium PCR on urine and MCS swab

Proctitis:

• anorectal swab for MCS
• anorectal swabs for HSV, Mycoplasma genitalium, Syphillis, chlamydia, gonorrhoea

Glandular fever/flu like symptoms = HIV Ab, Syphillis serology

Fishy PV discharge:
-high vaginal swab MCS
The following all have to be positive to diagnose Bacterial vaginosis
1) whiff test during examination (Offensive ‘fishy’ odor)
2) thin white homogenous discharge observed
3) pH of discharge <4.5
3) clue cells on MCS

Profuse and frothy PV discharge:
-High vaginal swab NAAT or first pass urine NAAT

Question 8

STIs:

Treatment?

Answer 8

Chlamydia:
1) Doxycycline 100mg BD 7 days 
**If anorectal disease then 21 days
2) Azithromycin 1g stat
**If anorectal disease then repeat dose in 7 days
NO TEST OF CURE

Gonorrhoea:
1) Ceftriaxone 500mg in 2mL Lignocaine 1% AND Azithromycin 1g stat
**if Pharyngeal disease then 2g Azithromycin instead (is poor at penetrating mucous)
TEST OF CURE IN 5 WEEKS

HSV:

Genital

• 1st episode (treat within 72hrs) - Valaciclovir 500mg BD 10 days
• Recurrent episodes - Valaciclovir 500mg BD 3 days
• Prophylaxis - Valaciclovir 500mg daily

Oral HSV

• Valaciclovir 1g BD 7 days
• minor recurrence - Aciclovir 5% cream 5times a day for 5 days
• Severe recurrence - Valaciclovir 2g BD as a once off

Shingles (VZV)
Valaciclovir 1g TDS 10 days

Mycoplasma Genitalium:

• resistance to Azithromycin is common in MSM
• can be fluoroquinolone resistant also

Susceptible
-Doxycycline 100mg BD 7 days AND Azithromycin 1g stat then 500mg daily for 3 days

Resistant
-Doxycycline 100mg BD for 7 days AND Moxifloxacin 400mg daily for 7 days
TEST OF CURE IN 2 WEEKS

Syphilis:
Primary - 1.8g benzathine penicillin IM stat
Secondary - 1.8g benzathine penicillin IM stat
Early latent - 1.8g benzathine penicillin IM stat
Late latent - 1.8g benzathine penicillin IM, weekly for 3 weeks
TEST OF CURE AT 3, 6 AND 12 MONTHS

Bacterial Vaginosis:
1) Metronidazole 400mg BD for 7 days
OR
Metronidazole 0.75 gel PV nocte for 5 days
OR
Tinidazole/Metronidazole 2g stat once off

2) Clindamycin 300mg BD for 7 days
OR
Clindamycin 2% cream PV nocte for 7 days

Trichomoniasis:
-Tinidazole/Metronidazole 2g stat
TEST OF CURE IN 4 WEEKS if still having symptoms