STIs In Practice Flashcards
What is a sexually transmitted infection?
This refers to a pathogen that causes an infection through sexual contact.
What is a sexually transmitted disease?
This refers to a recognisable disease state that has developed from an infection.
How can the pathogens pass from person to person?
They pass through blood, semen, vaginal fluids and other bodily fluids.
How else can these pathogens be passed without sexual contact?
This can be from the mother to the infant during pregnancy or childbirth.
Or
From people sharing the same needles or blood transfusions.
What long term complications can be linked with STIs?
Most STIs are treated with antibiotics however the following can arise:
-pelvic inflammatory disease
-ectopic pregnancy
-infertility
-Chronic abdominal pain in women
-premature delivery of a baby
-infant blindness
-cardiovascular damage
-cancers
-arthritis
-urethral structures in men
What is the most common STI in the uk ?
The most common is CHLAMYDIA.
What is antibiotic resistance and which STI is more susceptible to it?
Increased antibiotic resistance refers to antibiotics becoming ineffective, thus leaving us with reduced treatment options.
GONORRHOEA IS THE HIGHEST RISK OF RESISTANCE.
Who offers sexual health services?
There are three levels of sexual health services:
-LEVEL 1 (asymptomatic)
-LEVEL 2 (symptomatic)
This includes GPs, pharmacies, young people services, online sexual health services etc.
-LEVEL 3 (complex and requires medical attention)
This includes genitourinary medicine (GUM services) and sexual reproductive health services.
What can general services offer ?
-sexual history taking and risk, assessments
-STI screening and treatment
-advice and supply of regular and emergency contraception
-condom distribution
-signposting to appropriate sexual health services
-HIV screening
-cervical screening
How do community pharmacies play a role in sexual health services?
They are level 1 sexual health services, thus meaning that the patient is asymptomatic and they can visit the pharmacy.
They can offer:
-sexual health advice
-emergency hormonal contraception
-ongoing contraception
- chlamydia screening and treatment from age 15-24
-pregnancy testing
-supply of erectile dysfunction treatment
-HPV vaccinations
What is the benefit of Sexual health services in the community pharmacies?
They are confident locations for many patients and they obtain flexible hours.
Which groups are at higher risk?
-adolescents -15-24
-people who have recently visited countries with high rates of HIV or other STIs
-men who have SI with men
-people with multiple partners
-alcohol or substance abuse
-IV drug use
-early onset sexual activities previous bacterial STI
What is some safe sex advice that a community pharmacist should give?
Education:
Transmission of STIs
Partner education:
-the spread of an STI depends on the rate of the change in sexual partners
Condom use
Repeat testing:
-screening for asymptomatic STIs should be recommend at least annually and 3 monthly if high risk
Vaccinations:
HPV and hepatitis
HIV pre exposure prophylaxis
What advice should be given on condom use?
-it should not be promoted as a sole means of reducing risk
-consistent and correct use of condom is the most efficient means of protecting against HIV and other STIs (98%)
What is the CDS?
CONDOM DISTRIBUTION SERVICES
They can be disturbed through a C card.
When should Fraser guidance be considered in regards to STIs?
Under 16 years of age
Under 13s:
-not legally able to consent to sexual activity
-discuss with child protection lead and record the conversation
13-16 years old:
-consider potential harm to the child
-consider informing child protection lead
16-17 years old:
-they have the right to independance
-the law however still defines them as children
-even though they are over the age of consent legally they are still treated as a child thus offer child safeguarding support if needed
How are STIs managed?
-sexual history taking
-screening
-testing
-treatment
-contact tracing
-lifestyle advice in how to prevent STIs in the future
What history is needed to be taken when preforming an STI assessment?
-reason for attendance ( is the patient symptomatic or non symptomatic)
-history of presenting complaint
-full sexual history
-revelevant past medical history
-vaccination history -Hep B ?
-drug history including illicit
-allergies
-females -menstrual, contraceptive
What does the sexual history of an asymptomatic patient consist of?
-confirm lack of symptoms
-establish competency, safeguarding children and vulnerable adults
-date of last sexual contact and number of partners found in the last three months
-gender of partners
-condom use
Any suspected infections
-infection risk
-symptoms in partner of a previous STI
-women :last menstrual period, contraceptive ands cervical cytology
-blood borne virus risk assessment
-Alcohol/illicit drugs
What does the sexual history of an ymptomatic patient consist of?
Ask additional questions in addition to the asymptotic questions:
-symptoms and reason for attendance
-pregnancy and gynaecological history
-past medical history
-medication history and history of drug allergies
-agree the methods of giving results
TEST FOR MULTIPLE STIs BECAUSE PEOPLE CAN PRESENT WITH MORE THAN 1.
What is chlamydia and how is it transmitted?
Bacteria that causes this is :CHLAMYDIA TRACHOMATIS
Transmitted through:
-through penetrative sex
-contact with infected genital secretions
-splash from genetically fluids
From mother to baby at delivery (results in conjunctivitis)
How does chlamydia infect the body?
It infects the endodermis,urethra, rectum and the conjunctiva
Infection of the urogeneital tract usually causes inflammation of the :
-urethra in males
-the cervix and or the urethra in females
Can chlamydia be left untreated?
It can be left untreated and can resolves spontaneously, but will take 12 months to do so, but if left untreated can also cause serious complications.
_________ are more at risk of chlamydia.
Females
If chlamydia is left untreated what could it lead to?
-pelvic inflammatory disease
-swelling of the testicles
-conjunctivitis
-welling and pain in the lymph nodes
-sexually acquired reactive arthritis
-infertility
-adverse outcomes in pregnancy e.g. premature births, infection, low birth weight
-anxiety
What are the risk factors for developing chlamydia?
-aged under 25 years of age
-a new sexual partner
-more than one sexual partner in the last year
-lack of consistent condom use
What are the chlamydia symptoms in females?
-Vaginal discharge
-painful urination which can be mistaken for a UTI
-lower abdominal pain
-fever
-intermenstrual bleeding
-pelvic pain
-cervical motion tenderness
What signs and symptoms are present in a male suffering with chlamydia?
-males tend to have either classical urethritis with painful urination or urethral discharge
-inflammation of the urethra
-unilateral testicular pain and swelling
-fever
-reactive arthritis
Who is screened for chlamydia?
Asymptomatic patients who are at high risk
Symptomatic patients
what equipment is used in a chlamydia screening ?
Nuclei acid amplification tests (NAATS)
These are used as they are highly sensitive and specific
They identify DNA and RNA to observe bacteria
What is first line in testing for chlamydia in females and what are the alternatives?
Vulvovaginal swab
Alternatives : first catch urine sample or endocervival swab
What is first line in testing for chlamydia in males and what are the alternatives?
First catch urine sample this is FIRST LINE, this is also used first line in patients who are transgender.
Repeat at 14 days, this is because it can take up to 14 days for the infection to be present in patients
What is first line treatment with dosing regimes for treatment of chlamydia?
DOXYCYCLINE 100mg twice a day for 7 days
What are the common side effects of doxycycline?
GI side effects
When can doxycycline not be used?
Cannot be used in women who are pregnant or breast feeding.
What would we suggest instead of first line doxycycline if a patient is pregnant or breastfeeding to treat chlamydia( second line treatments) ?
Azithromycin 1g orally as a single dose for 1 day and followed by 500mg orally once daily for 2 days
Erythromycin 500mg twice daily for 10-14 days
Ofloxacin in 200mg twice daily for 7 days (this is second line treatment only if a patient is not breast feeding or pregnant, CANNOT BE USED IN THESE)
What advice would you provide a patient after treatment for chlamydia?
Avoid sexual intercourse including oral sex until the person or their partner has completed the treatment or wait 7 days after treatment of azithromycin
Failure of treatment can be due to re infection
What follow up is recommended for recovering chlamydia patients?
-screen for other STIs
-refer to GUM clinic for partner notification
Symptomatic males all partners within 2 weeks
Asymptomatic preceding 3 months should be notified
-an additional to observe if treatment has been effective
-under 25 years old if diagnosed with chlamydia 3-6 months after completion of treatment check for re infection
-over 25 years old if a high risk only, to check for re infection
What is gonorrhoea?
This is neisseria gonorrhoea and it is a gram negative bacteria
How is gonorrhoea transmitted?
-sexual contact where infected secretions are passed from one mucous membrane to another.
-during childbirth
Where can gonorrhoea spread?
-the mucous membrane of the urethra
-endocervix
-rectum
-pharynx
-conjunctiva
-blood stream so more systemic symptoms e.,g. Fever and rash
What complications can gonorrhoea cause?
Males: infertility
Females : pelvic inflammatory disease and dangers in pregnancy
Babies: blindness and conjunctivitis
What are the signs and symptoms of gonorrhoea in females?
It is asymptomatic in 50% of females
-increased /altered vaginal discharge
-lower abdominal pain
-painful urination
-intermenstrual bleeding
-rectal and pharyngeal
What are the signs of symptoms of gonorrhoea in males?
-this is usually symptomatic in men
-urethral discharge
-painful urination
Where is gonorrhoea screened?
All patients with gonorrhoea should be managed by a level 2 sexual health clinic.
How is a gonorrhoea screening carried out?
A NAAT test looking for the presence of N.gonorrhoea
What is first line in screening females for gonorrhoea?
Vulvovaginal swab
What is the first line in screening males for gonorrhoea?
First pass urine sample
When is a culture test required?
If the NAAT is positive for gonorrhoea, to test for susceptibility and identify resistant strains
Gonorrhoea is _________ to ____________-
Resistance TO antibiotics
How do we treat gonorrhoea if antimicrobial resistance is not known prior to treatment?
Ceftricaxone 1g intramuscular injection one single dose
This is safe in pregnancy and breast feeding
What treatment is given if antimicrobial resistance is known before treatment of gonorrhoea?
Ciprofloxacin 500mg orally as a a single dose
When can you not use ciprofloxacin and what is given instead to treat gonorrhoea where antimicrobial suspecitibilty is already established?
This cannot be used in pregnant or breastfeeding women, this we would use ceftriaxone 1g intramuslcar
or azithromycin 2g orally as a single dose
How to treat disseminated gonorrhoea?
-ceftraixone 1g IM or IV every 24 hours
-cefotaxime 1g intravenous every 8 hours
If improvement on these IV and IM methods change to oral methods after 24-48 hours
-cefixime 400mg twice daily
Or
-ciprofloxacin 500mg twice daily
What advice should be given to patients recovering from gonorrhoea?
Abode sexual intercourse including oral sex until the person and their partner have completed treatment or wait 7 days after treatment of azithromycin.
What follow up is routine with gonorrhoea patients?
-confirm adherence to treatment and symptom resolution
-ask about adverse reactions
-confirm that partner notification has been carried out, can take 14 days for test to be positive
-ask about recent sexual history and the possibility of re infection
-reinforce advice about safe sexual practice
A test to observe if the treatment was effective
Asymptomatic patients should be tests with NAAT at least 2 weeks after completion of treatment
If signs or symptoms persist test with curl;true at least 3 days after completion of treatment, consider additional testing with NAAT after one week if culture is negative
-notify patients it is safer to use condoms
