Systemic presentation of STIs Flashcards
What are the essential investigations required in SARA?
Full screening for STIs, including HIV. ESR/CRP Or Plasma viscosity (PLV). FBC Urinalysis.
What investigations are often useful in SARA?
Liver and kidney function tests.
HLAB27.
Xrays of affected joints and sacroiliac joints. Electrocardiogram.
Echocardiogram.
Ophthalmic evaluation including slit lamp assessment.
What is the aetiology of SARA?
Chlamydia is the commonest identifiable cause of NGU and SARA - 35-69% of cases
Neisseria gonorrhoeae- 16%
Ureaplasma urealyticum- minority
Mechanism of CT causing inflammatory process in joints in SARA?
CT persists in the synovium in an aberrant form with repressed synthesis of the major outer membrane protein (MOMP) and active production of heat shock protein
This contributes to the inflammatory response.
Causes of STI keratitis?
Keraitis is inflammation of cornea
More common in HIV Viral- HSV/VZV are most common Bacterial- rare but severe Fungal- rare in HIV candida albicans/parapsilosis
Symptoms- eye pain, photophobia, discharge, FB sensation
Diagnosis- slit lamp +/- viral PCR
Epidydimo orchitis
1st and 2nd line treatments
If likely STI-
Ceftriaxone 500mg IM single dose
Plus Doxycycline 100mg po BD 10-14 days
If GC unlikely
Doxycycline 100mg po bd 10-14 days
or Ofloxacin 200mg bd 14 days
EO likely non STI (?enteric organisms)
Ofloxacin 200mg po bd 14 days
Or Ciprofloxacin 500mg bd 10 days
List of SH related notifiable diseases/ infections to PHE
Acute encephalitis/meningitis Neisseria meningitidis Infectious bloody diarrhoea Malaria Measles/mums/rubella Tetanus Tuberculosis Typhus Yellow fever Campylobacter spp Giardia lamblia Haemophilus influenzae Hepatitis A, B, C, delta, and E viruses Legionella spp Polio virus Salmonella spp Shigella spp Streptococcus pneumoniae/ pyogenes Varicella zoster virus Vibrio cholerae Yersinia pestis
Is HIV a notifiable disease in the UK?
No
Risk of infertility % with 1st, 2nd and 3rd episodes of PID?
16%- 1st
20% - 2nd
40% 3rd
What are CV complications with SARA?
Usually asymptomatic Tachycardia Left ventricular dilatation Rarely pericarditis Aortic valve disease may occur.
Electrocardiographic abnormalities, including conduction delay, are recorded in 5-14% of patients
Example of some features in SARA?
Urethritis/proctitis/cervicitis Endocarditis Conjunctivitis Keratoderma blenorrhagica Arthritis Tenosynovitis Sacroilitis Entesopathy Psoriaform rasm Renal disease- GN/IGA nephropathy Thrombophlebitis Fever/weight loss
What is the 1st line outpatient treatment for PID?
Intramuscular ceftriaxone 1g single dose plus Oral doxycycline 100mg BD for 14 days plus Oral metronidazole 400mg BD for 14 days
OR
Oral ofloxacin 400mg BD for 14 days
plus
Oral metronidazole 400mg BD for 14 days
OR
Oral moxifloxacin 400mg OD for 14 days
What is the 2nd line outpatient treatment for PID?
IM ceftriaxone 1 g immediately
PLUS
Oral azithromycin 1 g/week for 2 weeks
1st line inpatient treatment for PID?
IV until 24 hours after clinical improvement -then switched to oral.
Intravenous ceftriaxone 2g daily
PLUS Intravenous doxycycline 100mg BD (oral if tolerated)
Followed by:
Oral doxycycline 100mg BD for 14 days
PLUS Oral metronidazole 400mg BD for 14 days
OR
Intravenous clindamycin 900mg TID
PLUS Intravenous gentamicin 2mg/kg loading dose followed by 1.5mg/kg TID
Followed by:
Oral clindamycin 450mg QID to complete 14 days OR oral doxycycline 100mg BD to complete 14 days
PLUS
Oral metronidazole 400mg BD to complete 14 days
Treatment of SARA?
Treating underlying infection does not affect course of complications but rely treatment may decrease risk of relapsing arthritis in those with previous hx of reactive arthritis
