T3 L8 Sexually transmitted infections Flashcards
Who gets STIs?
Young age Frequent partner change, high number, concurrency (simultaneous partners) Sexual orientation Ethnicity for some STIs Use of non-barrier contraception Residence in inner city / deprivation History of previous STI
What factors are associated with early intercourse?
Leaving home / not living with parents before 16 years
Leaving school early
Family disruption & disadvantages
Lack of nurturing relationships
Those whose main source of information on sex wasn’t school / parents
What are the negative aspects of porn?
Unrealistic nature & expectations Self-image / performance anxiety Lack of censorship / boundaries Hardcore material becomes addictive / normalised Ethical issues eg exploitation of women Sexual consent becomes blurred Lack of condom use Reduced risk perception or perceived need to practice safe sex
What are the main messages to get across to young people?
Don't rush into it - avoid peer pressure Use condoms with all new partners Sort out contraception Avoid overlapping sexual relationships Get screened for chlamydia / gonorrhoea with new partner
What is the GMC guidance for genital examinations?
Offer chaperone
Explain why examination is necessary and what it involves
Give patient privacy to undress and dress
Obtain permission before examination and discontinue if patient asks you to
Keep discussion relevant
Describe the female genital examination
Inspect pubic area, labia major, minor and perianal area Inspect and palpate inguinal ring Leg rests for better visualisation Speculum examination Bimanual examination if indicated
Describe the male genital examination
Inspect pubic area, inguinal region Inspect scrotum and perianal area Palpate scrotal contents Inspect penis Particular attention to coronal sulcus, frenulum and meatus Note presence of urethral discharge
What are pearly penile papule?
Coronal papillae
Secrete oil that moistens glans of penis
What are fordyce spots?
Visible sebaceous glands present in most individuals
What other conditions can present with genital signs?
Malignant melanoma
Psoriasis
Tinea cruris
Scabies
Describe the appearance of scabies
Pruritic papules on genitals
Lesions and burrows in finger webs and wrists
Often find a rash down side of body
Give examples of bacterial STIs
Chlamydia
Gonorrhoea
Syphilis
Give example of protozoal STI
Trichomonas
Describe bacterial STIs
More often florid symptoms Rapid diagnosis Effective treatment available Curative Reservoirs can be controlled
Give examples of viral STIs
Herpes, warts, HIV, hepatitis, molluscum contagiosum
Describe viral STIs
Many are unaware of infection Delayed presentation Diagnostic tests may be unreliable Symptomatic treatment only Often life-long Expanding reservoirs
What are the common symptoms of gonorrhoea and chlamydia?
Dysuria
Discharge
What is the incubation period of gonorrhoea and chlamydia?
2 to 30 days
Most symptoms occur 4-6 days after being infected
Describe primary syphilis
1-3 weeks after contact
Red mark leading to raised spot leading to ulcer at site of contact
Enlarged lymph nodes in groin / neck which heal within 1-3 weeks
Lesions don’t tend to be painful
Describe secondary syphilis
2-6 weeks after primary stage
Lasts for 2-4 weeks
Systemic dissemination - millions of spirochetes spread throughout body
Flu-like illness (headache, lymphadenopathy)
Mouth ulcers
Condylomata lata
Arthritis
Rapid resolution with effective treatment (penicillin)
Particularly suspect if rash involves palms & soles
Describe trichomonas vaginalis
Single cell protozoan parasite Infects vagina and urethra Dysuria, discharge Strawberry cervix Diagnosed by seeing motile organisms on microscopy
What is used to treat trichomonas vaginalis?
Metronidazole
What are the most common types of genital warts?
6 and 11
What types of HPV cause cervical cancer?
16
18
31
33
What are the signs and symptoms of herpes simplex?
Painful ulceration, dysuria, vaginal discharge
Systemic symptoms - fever, myalgia
Signs - blistering, ulceration, inguinal lymphadenopathy
Describe candida / thrush
Fungal
Itching, discharge, swelling
Popular rush in males
Topical antifungals
Describe bacterial vaginosis
Discharge, fishy odour Imbalance of vaginal flora Overgrowth of anaerobes Often due to over-washing Responds to metronidazole
What are the complications of chlamydia / gonorrhoea?
PID Epididymitis Infertility Chronic pain Reiter's syndrome (urethritis, arthritis, conjunctivitis)
What are the complications of HPV / warts?
Cervical cancer
AIN
VIN
PIN
What are the complications of bacterial vaginosis?
Miscarriage
Early labour
Low birth weight
What are the complications of trichomonas vaginalis?
Miscarriage
Early labour
Low birth weight
What are the complications of syphilis?
Dementia
Cardiac abnormalities
what are the complications of hep B/C?
Cirrhosis
Liver cancer
What are the complications of HIV?
Long-term morbidity and mortality
Opportunistic infections
Tumours
Non-AIDs malignancies
