STIs and other stuff Flashcards
Urethritis clinical features
Discharge
Dysuria
Meatitis
Urethritis causative organisms
Chlamydia trachomatis Neisseria gonorrhoea Mycoplasmum genitalium Ureaplasma urealyticum HSV Trichomonas vaginalis
Urethritis diagnosis
- Gram stain >5pus cells/high powered field = urethritis
- Look for gram -ve intracellular diplococci. None found = non-gonococcal urethritis
- All negative = non specific urethritis
Urethritis treatment
Uncomplicated gonorrhoea: • ceftriaxone 500mg IM PLUS azithromycin 1g single dose • ciprofloxacin orally if sensitive • ofloxacin orally Uncomplicated chlamydia/NSU • azithromycin 1g orally single dose • doxycycline 100mg bd for 1 week Contact tracing
Gonococcal complications
Local abscess formation (eg bartholinitis)
Epididymo-orchitis and prostatitis
PID
Disseminated gonococcal infection
Transmission to neonate - opthalmia neonatorium and mucus membrane infections
Chlamydia complications
PID → tubal damage → chronic pain, ectopic pregnancy, infertility
Perihepatitis (Fitz-Hugh Curtis syndrome)
Transmission to neonate - conjunctivitis, pneumonitis
Bacterial vaginosis
Overgrowth of anaerobic bacteria, esp Gardenerella vaginalis
Not sexually transmitted
Commoner in IUCD users
Diagnosis - 3 of:
• Maloderous, thin, homogenous grey vaginal discharge
• pH>4.5
• +ve amine test (KOH)
• clue cells on vaginal wet screen or gram smear
Treatment - not necessary for asymptomatic. Metronidazole 400mg bd 5-7 days
Candidiasis diagnosis
Clinically - vulvo-vaginitis with fissuring and thick white, non-smelly vaginal discharge
Spores and pseudohyphae on gm stained vaginal smear or wet film
Candidiasis predisposing factors
Pregnancy Diabetes Immunosuppression Irritants Broad spectrum antibiotics Anaemia Endocrine disorders Poor hygiene
Candidiasis treatment
Acute: • clotrimazole vaginal pessary 500mg or fluconazole 150g single dose • clotrimazole 1% cream if vulvitis Recurrent: • Investigate for predisposing factors • Confirm diagnosis and 'tyoe' candida • Initially try course of pessaries: clotrimazole 100mg nocte, 6 nights • Prolonged course systemic antifungals
Trichomonas
Vulvovaginitis - offensive vaginal discharge (green/yellow)
Asymptomatic in men
Usually sexually transmitted
Diagnosis - motile protozoan on wet mount vaginal sample
Treatment:
• Metronidazole 400mg bd 7 days OR
• Metronidazole 2g stat
Genital ulceration
Infections (inc STIs: HSV, syphilis (1+3), tropical STIs, scabies) Trauma Immune mediated Neoplastic Misc
Genital HSV
Types 1 and 2
Transmission: oral, genital, autoinoculation
Asymptomatic carriers: common cause for transmission
First episode - severe symptoms
Recurrence (50-70%) milder
Diagnosis: Hx and Ex, PCR, serology
Treatment:
• Primary - immediate acyclovir, analgesia (topical and oral), advice and counselling
• Recurrence - supportive; episodic short course antivirals; continuous suppressive antivirals
Lumps caused by STIs
Genital warts
Secondary syphilis
Molluscum contagiosum
Scabies
Genital warts causative, clinical features and diagnosis
HPV 6+11 Carriers often subclinical Cervical cancer risk Painless Diagnosis clinical and biopsy if doubt
