Y4 tutorial STI Flashcards
What test is used test for chlamydia and gonorrhoea?
NAAT (nucleic acid amplification test)
How do you get the sample for a NAAT in men and in women?
Men - first void urine
Women - lower vaginal swab (can be self obtained)
What things may you need a high vaginal swab for?
BV
Candida
TV (in Grampian use NAAT as more sensitive)
What is the most common STI in the UK?
Chlamydia
How can chlamydia present?
Asymptomatic in 70% women, 30% men
Men - discharge, dysuria, urethral itch
Women - post-coital bleeding, IMB, dysuria, deep dysparenuia, pelvic pain
What are complications of chlamydia in men?
Epididymo-orchitis
What are complications of chlamydia in women?
PID
Infertility
What causes lymphogranuloma venereum?
Chlamydia trachomatis-3 serovars
Who is LVG mostly seen in?
MSM
How does LVG tend to present?
Rectal pain
Anorectal bleeding
Mucoid and/or haemopurulent rectal discharge
Tenesmus
Constipation or other symptoms of lower GI inflammation
(Mimics IBS)
How is an uncomplicated chlamydia infection treated?
Doxycycline 100mg bd 7d and abstain for duration of course
If CI multidose azithromycin (1g stat, then 500mg daily for 2d)
What is an essential part of treating STIs?
Contact tracing and notification
How is LGV managed?
Doxycycline 100mg twice daily for 3 weeks
What is a gonorrhoea infection a marker of?
High risk sexual behaviour
Why has gonorrhoea infections increased?
Due to PrEP effect (more MSM having unrprotected sex)
What kind of pathogen is gonorrhoea?
Gram negative diplococcus
What kind of tissue does gonorrhoea infect?
Mucous membranes - urethra, endocervix, rectum, pharynx, conjuctiva
What is the incubation period of gonorrhoea?
2-5 days
How does gonorrhoea tend to present in men?
Urethral infection: Urethral discharge, dysuria, can be asymptomatic
Rectal infection: usually asymptomatic, may get anal discharge, perianal pain/discomfort
Pharyngeal infection: usually asymptomatic
How does gonorrhoea tend to present in women?
Similar to chlamydia
What is the first line treatment for uncomplicated gonorrhoea?
1g ceftriaxone
REVIEW after 14d for test of cure
If ceftriaxone refused oral cefixime 400mg single dose + oral azithromycin 2g should be used
What does mycoplasma genitalium cause?
Non-gonococcal urethritis
Who should you test for MG?
Those with recurrent/persistent symptoms
What ist he first line treatment of MG?
Doxycycline
But may req. treatment with moxifloxacin as many are resistant
List causes of ‘lumps’ on the genitalia
Genital warts Molluscum contagiosum Bartholin's abscess Cysts/abscesses Dermatoses Malignancies Normal findings
What strains of HPV cause genital warts?
6 and 11
What strains of HPV cause cervical cancer?
16, 18
What is the name of the quadrivalent vaccine that protects against HPV strains 6, 11, 16, 18?
Gardasil
What is the investigation for HSV?
PCR from ulcers/vesicular fluid
How do you treat HSV infection?
Aciclovir PO
Analgesics
What is the incubation period of syphillis?
10-90 days
How can syphillis be transmitted?
Sexually
Blood borne (rare)
Transplacental after 9 weeks
What are the stages of syphillis?
Primary
Secondary
Latent
Teritary
What happens in primary stage of syphillis?
Painless ulcers + associated lymphadenopathy
What is the commonest mode of transmission of syphillis?
Orogenital contact
What happens in secondary syphillis?
Haematogenous dissemination so systemically unwell (malaise, fever, myalgia, rash, lympadenopathy)
What are features of tertiary syphillis?
Gumma
Cardiovascular issues
Neurosyphillis
What stage of syphillis carries the greater risk in pregnancy?
Early syphillis
What consequences to the foetus can syphillis in pregnancy lead to?
Spontaneous abortion
Preterm labour
Perinatal death
Congenital syphillis infection
Someone presenting to ENT with ______ should be considered to be tested for syphilis.
Sensorineural deafness
Someone presenting to dermatology with ______ should be considered to be tested for syphilis.
Unexplained skin changes
Someone presenting to ophthalmology with ______ should be considered to be tested for syphilis.
Interstitial keratitis
Someone presenting to haematology with ______ should be considered to be tested for syphilis.
Unexplained lympadenopathy
Someone presenting to cardiology with ______ should be considered to be tested for syphilis.
Conduction defects
Aortic regurg
Aortic aneurysm
Someone presenting to neurology with ______ should be considered to be tested for syphilis.
Meningovascular
Argyll Roberston pupils
General paralysis of the insane
Tabes dorsalis
within what time frame should HIV PEPSE be given?
72 hours
Who should be considered for HIV PEPSE?
Anyone who has had a significant exposure to HIV
What does HIV PEPSE involve?
Combination of antiretrovirals (3 drugs - Truvada and Raltegravir) taken for 1 month
What drug is used for HIV PrEP?
Truvada
What is the discharge in gonorrhoea like?
Profuse
Pussy
What is the discharge in chlamydia like?
Milky, less than in gonorrhoea
When should you test for HIV after someone has taken PEPSE?
4 weeks after stopping the antivirals
What are complications of gonorrhoea?
Urethral strictures
Epididymitis
Salpingitis
What are key features of a disseminated gonococcal infection?
Tenosynovitis
Migratory polyarthritis
Dermatitis
Later complications include septic arthritis, endocarditis, perihepatitis (Fitz-Hugh-Curtis syndrome)
