STIs self learning package Flashcards
Gonorrhoea is caused by?
Neisseria gonorrhoea
Symptoms of gonorrhoea in men
10% assymptomatic
thick profuse, yellow discharge, dysuria. rectal & pharyngeal infection, often assymptomatic
Symptoms of gonorrhoea in women
>50% assymptomatic
vaginal discharge, dysuria or intermenstrual/post-coital bleeding
Complications of gonorrhoea
Male- epidyymitis
female- PID, bartholin’s abcess
Both- acute monoarthritis (elbow/shoulder)
disseminated gonococcal infection: skin lesions, pustular with halo
incubation period of gonorrhoea
Average 5 to 6 days. Range 2 days to 2 weeks (if get symptoms at all).
Who are most cases of Ghonorrhoea found in?
MSM
much less common than chlamydia
How is gonorrhoea diagnosed
Nucleic Acid Amplification Test (NAAT) on urine or swab from an exposed site – vagina, rectum, throat. Could be self-obtained or clinician-obtained.
Gram stained smear from urethra/cervix/rectum in symptomatic people.
Culture of swab-obtained specimen from an exposed site using highly selective lysed blood agar in a 5% CO2 environment. Should be done for all confirmed cases to assess antibiotic sensitivity.
Treatment of gonorrhoea
Blind treatment with ceftriaxone 1g im. Can also treat according to antibiotic sensitivities.
Follow up for cases of gonorrhoea
Test of cure at 2 weeks and test for reinfection at 3 months
Chlamydia- caused by?
Chlamydia trachomatis serovars D to K
Symptoms of chlamydia in men, women and both
men: >70% asymptomatic
Slight watery discharge, dysuria
women: >80% asymptomatic. Vaginal discharge, dysuria, intermenstrual/post-coital bleeding
Both: conjuctivitis
Complications of chlamydia in men, women and both
Men: epidydmitis
Women: PID, ectopic pregnancy, pelvic pain & infertility (only in 1%)
Both: reactive arthritis/reiter’s syndrome- urethritis/cervicitis + conjuctivitis + arthritis
Who is chlamydia most often found in
Common
most cases in people under 25, especially sexually active teenage women
Diagnosis of chlamydia
First void urine in men
Swab from cervix, urethra, rectum
All specimens tested using NAAT
Treatment of chlamydia
Doxycycline 100mg bd 1 week
Azithromycin 1g po once pregnant
Flollow up for chlamydia treatment
Test for re-infection at 3-12 months. earlier test of cure not needed unless symptoms persist
Cause of herpes
Herpes simplex virus types 1 and 2
Symptoms of herpes
80% have no symptoms. The rest have recurring symptoms – monthly, annually. Burning/itching then blistering then tender ulceration.
Tender inguinal lymphadenopathy. Flu-like symptoms.
Dysuria, Neuralgic pain in back, pelvis and legs,
Complications of herpes
Autonomic neuropathy (urinary retention), neonatal infection, secondary infection
Incubation period of herpes
About 5 days to months
some people never report symptoms
How common is HIV?
Very common ~ 15-20% of UK population has it. Both strains equally common in genital infection. Roughly equal between sexes. HSV2 is important co-factor for HIV transmission.
Diagnosis of HIV
Clinical impression.
Swab from lesion tested using PCR.
Describe the treatment of HIV, in the case of a Primary outbreak
Aciclovir: various regimens – eg 400mg tds for 5 days Lidocaine ointment
Describe the treatment of HIV, in the case of infrequent recurrences:
Lidocain ointment
aciclovir 1.2g once daily until symptoms are gone (1-3 days)
Describe the treatment of HIV, in the case of frequent recurrences:
Aciclovir 400bd long term- as supression
Cause of trichomoniasis
Trichomonas vaginalis
Symptoms of trichomoniasis
Men: Usually asymptomatic
Women: 10-30% asymptomatic
Profuse thin vaginal discharge - greenish, frothy and foul smelling. Vulvitis.
Is trichomoniasis common & who is it most common in
Uncommon, approx 100/yr in Grampian. More common in middle aged women than some other STIs are.
Complications of trichomoniasis
Miscarriage & preterm labour
Diagnosis of trichomoniasis
PCR on vaginal swab
Point of care: microscopy of wet preparation of vaginal discharge
Treatment of trichomoniasis
Metrondiazole 400mg po bd for 5 days
or 2g single dose
Anogenital warts; caused by
Human Papilloma Virus types 6 and 11 (and occasionally type 1). (NB different strains from those that cause cervical cancer.
Symptoms of anogenital warts
Lumps with a surface texture of a small cauliflower. Occasionally itching or bleeding especially if perianal or intraurethral.
how much of the population gets genital HPV during their life
90% of UK population have a genital HPV infection at some point in their life. Only about 20% of those infected with a wart-causing strain of human papilloma virus get warts. A drop in cases is anticipated in response to quadrivalent HPV
Any common complications of anogenital warts?
None common. Neonatal laryngeal papillomatosis.
Diagnosis of anogenital warts
Appearance. Biopsy if unusual – to exclude intraepithelial neoplasia, but this is rarely needed
Treatment of anogenital warts
Podophyllotoxin (brands warticon and condyline), imiquimod (brand Aldara). Both home treatments. Others – cryotherapy
Causes of syphillis
Treponema pallidum subspecies pallidum
Symptoms/stages of syphillis
Diverse. Often entirely asymptomatic or mild symptoms
Primary- local ulcer (chancre)
Secondary- rash, mucosal ulceration, neuro symptoms, patchy alopecia, others
Early latent- no symptoms but <2 years since caught
Late latent- no symptoms but >2 years since caught
Tertiary- neurological, cardiovacular or gummatous (skin lesion)- all very rare
Who is most commonly affected by syphillis
MSM
Complications of syphillis?
neurosyphilis – cranial nerve palsies are commonest, cardiac or aortal involvement. Congenital syphilis (extremely rare in Scotland).
Incubation period of syphillis
9 to 90 days until appearance of chancre. But can be asymptomatic.
Diagnosis of syphillis
Clinical signs
Serology for TP IgGEIA, TPPA and RPR PCR on sample from an ulcer
Treatment of syphillis
Early (<2 yrs and no neurological involvement): Benzathine penicillin 2.4 MU im once Or Doxycycline 100mg bd po 2 weeks
Late (>2 years) and no neurological involvement Benzathine penicillin 2.4MU im weekly for 3 doses Doxycycline 100mg bd po 28 days
