STIs

Question 1

Sexual History components:

Answer 1

‘5 P’s’

Partners: number, risk groups, location
Practices: IVDU
Protection: condoms, PEP
Pregnancy: contraception
Past STIs: ?treated

Sexual abuse screen

Question 2

STI DDx vaginal/ urethral discharge:

Answer 2

Chlamydia
Gonorrhoea
Candidiasis
BV
Trichomonas
Mycoplasma/ Ureaplasma

Question 3

STI DDx genital ulceration:

Answer 3

Herpes simplex (2)
Chancre (syphilis)
Lymphogranuloma venereum (chlamydia)
Donovanosis

Question 4

STI screening:

Answer 4

Smears:
- F: Vaginal, Cervical PAP
- M: Urethral
–> For gram stain

Swabs:
- F: Vaginal, endocervical, urethral, rectal, throat
- M: Urethral, rectal, throat
–> For culture

Urine:
- BHCG:
- Chlamydia/gono PCR (First Pass)
- MCS (Mid Stream)

Serology
- HIV
- Hep B, (Hep C)
- Syphilis

…. consider sexual abuse, pregnancy, opportunistic screening

Question 5

Chlamydia

Answer 5

Chlamydia Trachomatis

Often asymptomatic, especially women

Screening recommended for 18-24 + sexually active, or older with new partner/s.

Discharge, dyspareunia, intermenstrual bleeding, proctitis, epididymorchitis, sterile pyuria, PID, Reactive Arthritis.
Lymphogranuloma venereum

TEST
- Swab for gram stain, or FPU for PCR.

TREAT
- AZITHROMYCIN 1g PO x1
(uncomplicated)
- Add Ceftriaxone + Metro if PID

Notifiable

Question 6

Gonorrhoea

Answer 6

Neisseria Gonorrhoeae

Discharge, dysparunia
‘Ascending’: PID, ectopic pregnancy, prostatitis
‘Disseminated”: polyarthritis, pustular rash and tenosynovitis

Rectal or pharyngeal infection not uncommon

Disseminated rash: pustule on red base.

TEST
Swab for gram stain, or FPU for PCR.

TREAT
CEFTRIAXONE 500mg IM x1 (with 2ml lignocaine)

Question 7

Anogenital Herpes

Answer 7

Herpes Simplex (2)

Primary episode is worst. Constitutional flu-like Sx.

Lesions are infectious for 2 weeks after onset/ cleared. BUT, can transmit HSV whilst subclinical–> ALWAYS use barrier.

TEST
Swab fluid for PCR
+- HSV 2 serology

TREAT
eg.
ACICLOVIR 200mg x5 per day
–> 10 days for primary episode
–> 5 days for recurrences

Question 8

Genital warts (HPV)

Answer 8

Majority of HPV is asymptomatic.

Usually cleared by the body spontaneously, within 2 years. No treatment for virus itself.

In that time: Cervical Ca, Genital warts (internal + external)

TEST
Clinical. +- biopsy.

TREAT (warts)
Expectant is okay, partic pregnancy.
Mucosal: Imiquimod topical
Hardened: Cryotherapy or surgical
….and do a pap smear!

No contact tracing

Question 9

Syphilis

Answer 9

Treponema Pallidum

Mainly MSM and ATSI
50% asymptomatic

___________
Primary Syphilis
- Painless anogenital chancre

Secondary Syphilis (6 weeks)
- Constitutional
- 90% have rash which can be palms/soles
- Neurosyphilis: visual, hearing, vertigo, cranial nerve palsy, meningoencephalitis.

Latent
- Subclinical

Tertiary Syphilis (10+ years)
- Gummatous
- Cardiovascular
- Neuro
___________
All stages, and latencies, highly infectious.

TEST
- Serology
- Swab for PCR

TREAT
- PENICILLIN G IM

Question 10

STI management in pregnancy

Answer 10

All therapies are safe (incl. aciclovir- Cat B)

Consider:
- Congenital
- Vertical transmission