Wk 34: GUM Flashcards
What are the long term complications of STIs?
- Ectopic pregnancy
- Infertility
- Cervical + rectal cancer
- Arthritis
- Pregnancy: abortion, intrauterine death
Which STI has the highest risk of antimicrobial resistance?
Gonorrhoea
Where would you refer the different levels of STIs to?
- 1 + 2: GP, pharmacy
- 3: GUM
What are the main pathogens causing STIs?
- Neisseria gonorrhoea: gonorrhoea
- Chlamydia trachomatis: chlamydia
- Treponema pallidum: syphilis
What are the complications of chlamydia?
- Pelvic inflammatory disease
- Epididymo-orchitis
- Conjunctivitis
- LGV men
- Sexually acquired reactive arthritis
What are the risk factors of chlamydia?
- Under 25
- New sexual partner
- More than 1 in last year
- Lack consistent condom use
What are the symptoms of chlamydia in females?
- Vag discharge
- Dysuria
- Pelvic pain
- Intermenstrual/postcoital bleed
What are the symptoms of chlamydia in males?
- Fever
- Classical urethritis with dysuria and urethral discharge
- Unilateral testicular pain
What is used to screen chlamydia?
Nucleic acid amplification tests (NAATs):
- Women: vag swab or first void urine sample
- Men: first void urine sample
What is first line treatment for chlamydia?
Doxycycline 100mg BD 7 days
- CI pregnant + BF
- GI effects + photosensitivity
What are alt for the treatment of chlamydia?
- Azith 1g stat, 500mg OD for 2 days
- Eryth
- Ofloxacin
What is the treatment for pregnant ppts w/ chlamydia?
- Azith 1g stat, 500mg OD for 2 days
- Eryth
- Amox
What is the follow up for chlamydia?
- Avoid intercourse til treatment complete
- Screen other STI
- Refer GUM for partner notif: symptomatic male (2 wks), asymptomatic (3 months)
What are complications of gonorrhoea?
- Men: Epididymitis, prostatitis, infertility
- Women: PID, pregnancy dangers
- Babies: blindness
What are symptoms of disseminated gonorrhoea?
- Skin lesion
- Arthralgia
- Tenosynovitis
- Arthritis
What are the symptoms of gonorrhoea for females?
- Inc discharge
- Low ab pain
- Dysuria
- Intermenstrual bleed
What are the symptoms of gonorrhoea for males?
- Urethral discharge
- Dysuria
What is the screening for gonorrhoea?
- Women: vuvlovaginal swab
- Men: first pass urine
Culture required if +ve NAAT
What is the treatment for gonorrhoea if antimicrobial susceptibility is not known?
Ceftriaxone 1 g intramuscular (IM) injection
What is the treatment for gonorrhoea if antimicrobial susceptibility is known?
- Ciprofloxacin 500mg orally single dose
- BF/pregnant: Azithromycin 2g orally single dose
What is the treatment for disseminated gonorrhoea?
- Ceftriaxone 1g IM/IV every 24 hrs
- Cefotaxime 1g IV every 8 hrs
24-48hrs after symptoms improve switch:
- Cefixime 400 mg BD OR
- Ciprofloxacin 500 mg BD
What is the follow up for gonorrhoea?
- 1 wk after treatment: confirm adherence, s/e + partner notif
- Asymptomatic: NAAT 2 wks after treatment
- Signs persist: culture 3 days after treatment
What is HPV?
- Double stranded DNA virus
- Infects squamous epithelia: skin + mucosa of upper respiratory + anogenital tracts
What is the immunisation schedule for HPV?
- Under 15: 0.5ml 6 months apart
- > 15: 0, 1 + 4-6 months
What are the treatment options for genital warts?
- Self applied: podophyllotoxin 0.5% solution
- Abrasive: cryotherapy, excision + electrocautery
- Specialist: TCA 80-90% solution
What is the follow up for genital warts?
Change treatment if intolerant or less than 50% response by 4-5 wks
What causes herpes reactivation?
- Local trauma
- UV light
- Smoking + drinking
- Tight clothes
- Stress
What is the treatment for 1st episode herpes?
- Aciclovir 400 mg TDS OR
- Valaciclovir 500 mg BD
What is the treatment for episodic herpes?
- Aciclovir 800mg TDS 2 days
- Famciclovir 1g BD 1 day
- Valaciclovir 500mg BD 3 days
What is the suppressive treatment for herpes?
> 6 attacks per year:
- Aciclovir 400mg BD
- Famciclovir 250 mg BD
- Valaciclovir 500 mg OD
Takes 5 days therapy, discontinue after 12 months
What are the supportive management options for herpes?
- Saline bathing
- Oral painkillers
- Topical anaesthetic
- Inc fluid intake
