STIs & chlamydia Flashcards
What is the most common causative organism of STIs in the UK?
Chlamydia
What age are STIs most prevalent in?
<25yrs
What symptoms might you expect from a male with an STI?
Symptoms men
- Urethral discharge
- Dysuria
- Genital skin problems
- Testicular pain or swelling
- Perianal or anal symptoms in MSM
What symptoms might you expect from a female with an STI?
Symptoms women
- Unusual vaginal discharge
- Vulval skin problems
- Abdominal pain
- Dyspareunia
- Unusual vaginal bleeding (post-coital bleeding or inter-menstrual)
Taking a sexual history in someone with suspected STI to determine exposure to STIs?
Exposure to STIs
- Sexual contacts within last 3m including sex of partners and type of contact (oral, anal, vaginal)
- Contraceptive method and if properly used
- Type and duration of relationship
- Any symptoms in partners
- Risk factors for HIV or hepatitis in partners
- Whether partners can be contacted
- Ask men if ever MSM
Other
- Last menstrual period
- Menstrual pattern, date of last cervical cytology smear
- Current contraceptive
- Current or recent antimicrobial therapy
- HPV vaccine history
- Disclosure of non-consensual or intimate partner violence may occur
Examination of a patient presenting with an STI?
Use chaperone and document name.
Male
- Retract foreskin and inspect urethral meatus for discharge
- Scrotal contents or tenderness or swelling (standing up)
Women
- Vulval examination
- Speculum of vaginal or cervix
- Bimanual examination for adnexal tenderness
- Look for any masses in abdomen or pelvis
What type of bacteria is Chlamydia?
What percentage of men and women are asymptomatically infected with chlamydia?
What is a serious complication of chlamydia infection?
Chlamydia trachomatis is a gram negative bacteria
- It is an intracellular organism meaning it enters and replicates within cells before rupturing the cell and spreading to others.
- Chlamydia is the most commonly sexually transmitted infection in the UK and a significant cause of infertility
- Many affected individuals are asymptomatic (85% women and 50% men) but can still pass on the infection
Risk factors for chlamydia infection?
- Young (<25)
- Sexually active
- Multiple partners
- Prior history of STI
- Not using condoms
Signs and symptoms of chlamydial infection in women
Sexually active &…
- Abnormal vaginal discharge
- Pelvic pain
- Abnormal vaginal bleeding (intermenstrual or post-coital)
- Painful sex
- Painful urination
Signs and symptoms of chlamydial infection in men
Sexually active &…
- Urethral discharge or discomfort
- Painful urination
- Epididymo-orchitis
- Reactive arthritis
How is chlamydia diagnosed?
Nucleic acid amplification test (NAAT) are used to diagnose chlamydia
- Vulvovaginal swab
- Endocervical swab
- First catch urine sample (in men or women)
- Urethral swab in men
- Rectal swab (after anal sex)
- Pharyngeal swab (after oral sex)
Complications of chlamydial infection?
- Pelvic inflammatory disease
- Chronic pelvic pain
- Infertility
- Ectopic pregnancy
- Epididymo-orchitis
- Conjunctivitis
- Lymphogranuloma venereum
- Reactive arthritis
- pre-term delivery or premature rupture of membranes, low birth weight, postpartum endometriosis, neonatal infection.
First line management of chlamydial infection? Alternatives?
Other management?
Doxycycline 100mg BD 1 week
Doxycycline CI in pregnancy and breast feeding = azithromycin, erythromycin, amoxicillin
Other management
- Abstain from sex for 7 days
- Refer patients to GUM for contact tracing
- Test for and treat other STIs
- Provide advice about ways to prevent future infection
- Consider safeguarding issues and sexual abuse in children and young people.
What is the National Chlamydia Screening Programme?
Public Health Englandhas set out aNational Chlamydia Screening Programme(NCSP). This program aims to screen every sexually active person under 25 years of age for chlamydiaannuallyor when they change their sexual partner. Everyone that tests positive should have a re-test three months after treatment. This re-testing is to ensure they have not contracted chlamydia again, rather than to check the treatment has worked.
When a patient attends a GUM clinic for screening, as a minimum what infections are they tested for?
- Chlamydia
- Gonorrhoea
- Syphilis (blood test)
- HIV (blood test)
