STIs and Non-STIs Flashcards
What is the most common pathogen to cause candidiasis?
Candida albicans
Give risk factors for candida
Pregnancy Diabetes Broad spec abx Corticosteroids Immunosuppresion
What are the main symptoms of candidiasis?
Itching
White, thick discharge
Dysuria
What signs can be noted on examination of candidiasis?
Erythema
Swelling
Satellite lesions
Thick white discharge
How does bacterial vaginosis tend to present?
Foul smelling white discharge
Which kind of organism is responsible for trichomonas vaginalis?
Flagellated protozoan
Which investigations are used for vulvovaginal candidiasis?
Not routine
When would a vaginal smear be performed in cases of candidiasis?
“Complicated”
Recurrent
Pregnancy say
Immunocompromise
How is uncomplicated candidiasis treated?
Anti-fungal
Intra-vaginal - clotrimazole
Oral - fluconazole
How is candida in pregnancy treated?
Intravaginal antifungal (clotrimazole)
What causes bacterial vaginosis?
Disturbance in vaginal flora
Reduction in lactobacilli numbers causing increase in pH
What should the pH of the vagina be?
<4.5
What are the most common pathogens which cause bacterial vaginosis?
Gardnerella vaginalis
Anaerobes
Mycoplasms
What are the main risk factors for bacterial vaginosis?
Sexually active IUD STI Vaginal douching Abx use Smoking
What is seen on examination of bacterial vaginosis?
Thin, white/grey discharge
How is bacterial vaginosis investigated?
high vaginal smear
Which cells are seen on microscopy of bacterial vaginosis?
Clue cells
How is symptomatic bacterial vaginosis treated?
Metronidazole
or clindamycin or tinidazole
Which bacterium causes chlamydia?
Chlamydia trachomatis
Which serotypes of chlamydia cause ocular infection?
A-C
Which serotypes of chlamydia cause GU infection?
D-K
Which serotypes of chlamydia cause lymphogranuloma venereum?
L1-L3
Which group get LGV with chlamydia?
MSM
What are the risk factors for chlamydia?
Recent change in sexual partner
Another STI
What is the incubation period of chlamydia?
7-21 days
What are the main symptoms of chlamydia in females?
Dysuria Abnormal discharge Intermenstrual/post-coital bleeding Deep Dyspareunia Lower abdo pain
What may be noted in examination of chlamydia in females?
Cervicitis
Mucopurulent discharge
Pelvic tenderness
Cervical excitation
What are the main symptoms of chlamydia in men?
Dysuria
Urethral discharge
Testicular pain
What may be noted on examination of chlamydia in men?
Epididymal tenderness
Mucopurulent discharge
How is chlamydia investigated?
F - VVS
M - first pass urine or urethral swab
Sample sent for NAAT
What investigations are recommended in chlamydia suspicion?
Full STI screen
What causes genital herpes?
HSV
How is genital herpes transmitted?
Skin to skin contact in genitals/oropharynx
What are the main risk factors for herpes?
Multiple sexual partners
Oral sex with a partner suffering from cold sores
How does primary herpes present?
Small red blisters
Discharge
Flu-like symptoms
Itch
How does secondary/recurrent herpes present?
Burning and itching around the genitals
Painful red blisters around genitals
How is herpes investigated?
Swab and open sore
PCR for HSV
How is primary herpes treated?
Aciclovir
How are recurrent outbreaks of genital herpes treated?
Painkillers
Petroleum jelly
Ice packs
if regular - aciclovir daily
What is the main cause of genital warts?
HPV 6 and 11
What are the main risk factors for warts?
Early age at first sexual intercourse Multiple partners Immunosuppression Smoking Diabetes
Describe a genital wart
Painless fleshy growths on the genitals
How are genital warts investigated?
None routine
May biopsy if malignancy suspected
How are warts treated?
Not always req’d
Imiquimod 3 times weekly
Podophyllotoxin 2x day for 3 days and then 3 days rest
How are warts non-medically managed?
Excision
Cryotherapy
Electrosurgery
Laser surgery
What is the causative organism for gonorrhoea?
Neisseria gonorrhoeae
Which groups are most commonly affected by gonorrhoea?
<25
MSM
What are the main risk factors for gonorrhoea?
Multiple partners
Prev infection
How does gonorrhoea present in a female?
Thin, watery yellow discharge
Dysuria
Dyspareunia
Lower abdo pain
How does gonorrhoea present in the male?
Mucopurulent urethral discharge
Dysuria
What is seen on examination of female in gonorrhoea?
Discharge
Easily induced cervical bleeding
Pelvic tenderness
What is noted on infection of the male in gonorrhoea?
Discharge epididymial tenderness
How is gonorrhoea investigated females?
Endocervical/vaginal swab for NAAT
How is gonorrhoea investigated in males?
First pass urine for NAAT
How is gonorrhoea treated?
IM ceftriaxone
When would a gonorrhoea patient be admitted to hospital?
Features of gonococcal meningitis
Signs of severe PID
What is pelvic inflammatory disease?
Infection of upper genital tract in females which affects uterus, fallopian tubes and ovaries
Which STIs most commonly cause PID?
Chlamydia
Gonorrhoea
How does PID present?
Lower abdo pain
Menstrual/bleeding abnormality
Dysuria
Vag discharge
What may be noted on examination of PID?
Tenderness of uterus/adnexae
Cervical excitation
Palpable mass in lower abo
How is PID investigated?
Endocervical swab
HVS
Pregnancy test
How is PID treated?
Broad spec abx
When would a PID patient be admitted to hospital?
Pregnant
Severe symptoms- n&v, fever
Need IV abx
What are the common complications of PID?
Ectopic pregnancy Infertility Tubo-ovarian abscess Chronic pain Fits-Hugh Curtis syndrome
What type of organism causes syphilis?
Spirochete gram neg bacterium
What organism causes syphilis?
Treponema pallidum
What is a chancre?
Painless, hard ulcer formed at the site of entry
In which stage of syphilis would you find a chancre?
Primary
How does secondary syphilis present?
Non-specific (w, f, f)
Skin rash (hands and feet)
Condylomata lata
Silver-grey mucous membrane lesion
What are the three types of tertiary syphilis?
Gummatous
Neurosyphilis
Cardiovascular syphilis
How is syphilis investigated?
PCR of swab from active lesion
Syphilis specific IgG remains positive for life on serology
true/false
True
What is measured to assess response to treatment?
VDRL
When may a false positive result on VDRL occur?
Pregnancy
Inflammatory conditions
What is used to treat syphilis?
Penicillin
What should be given alongside penicillin in neurosyphilis or cardiovascular syphilis?
Steroids
Why are steroids sometimes given with penicillin treatment in syphilis?
Prevent Jarisch Herxheimer reaction - inflammatory response to death of syphilis pathogen
How does trichomonas vaginalis present in females?
Offensive vaginal odour Discharge - thick/thin, frothy, yellow/green Itchy Dyspareunia Dysuria
How does trichomonas present in the male?
Discharge Dysuria Freq Pain Itch
How is trichomonas vaginalis investigated?
HVS
M- first pass urine
What is used to treat trichomonas vaginalis?
Metronidazole
