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Medicine Unit 8 > Pathogens: Sexually-transmitted infection > Flashcards

Pathogens: Sexually-transmitted infection Flashcards

1
Q

sexual health clinic

A

commissioned buy local authority
some provided by NHS
free confidential service
no postcode restriction
STI free treatment

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2
Q

STI contacts

A

when someone is diagnosed with STI contact sexual partners at risk
with patients consent
options include patient themself contacting
or provider referral

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3
Q

provider referral

A

name of index patient isn’t given
need consent from index to name the STI
national network
maintains confidentiality
recommend treatment, don’t have to tell them what for

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4
Q

how do patients access sexual health clinics

A

self referral
recommendations
hand held letter/ “my GP told me to come”
formal referral form GP/ other doctors

with extremely complex problems needing a senior member a formal referral is beneficial but not essential

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5
Q

who do sexual health generally see

A

13+
screening, treatment and prevention of all STI’s
recurrent vaginal discharge
recurrent genital itching
genital lumps, bumps, rashes
emergency and on going contraception
pelvis testicular or genital pain
sexual dysfunction, some services
chronic HIV care, some services

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6
Q

sunderland sexual health

A

manage people living with HIV
chronic pelvic and genital pain, sex related pain
genital problems in transgender people including after gender reassignment
medical psychosexual cre

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7
Q

sexual health stats

A

1 in 2 attend sexual health with identified mental health problems
1 in 3 partners unfaithful in long term relationships
1 in 5 partners in unfaithful marriage
1 in 6 difficulty in sex
1 in 10 genital herpes, men having sex with men
1 in 1000 living with HIV in north east

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8
Q

risk of STI’s

A

everyone
higher prevalence in under 25s and men who have sex with men
important to have regular testing if not in long term relationship, suggest every 3 months
all STI’s can be asymptomatic

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9
Q

what should you never assume

A

someone isn’t at risk of STI’s

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10
Q

sexual behaviour

A

people having sex at younger age

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11
Q

sexual history taking

A

reason for attendance: symptoms and duration
casual and regular sexual contacts, gender
past 3 months or as relevant
sexual practices: oral/anal/vaginal, condom
past history of STI
recent medications and allergies
medical/gynaecolgocial history

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12
Q

major presenting complaints

A

urethral discharge/dysuria (urethritis)
vaginal discharge genital ulcers/sores
lumps and bumps

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13
Q

GMC guidance for intimate examination

A

offer chaperone
obtain consent
keep discussion relevant
explain why examination is necessary and what it involves
give patient privacy to undress and dress

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14
Q

genital examination

A

often only if required
not needed if no symptoms
undress below waist
examine mons pubis to natal cleft including inguinal region, palpate for lymphadenopathy
remember extra genital signs of STI’s, other conditions may present with genital signs

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15
Q

females genital exam

A

lithotomy position allowing good visualisation
speculum exam
bimanual exam only if clinically indicated

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16
Q

how to screen

A

explain what it is!!!!

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17
Q

typical check ups

A

first pass urine if not born with vagina
vaginal swab if born with one
rectal/ throat swabs for MSM
heterosexual men and women don’t routinely have throat or rectal swabs
check up with no concerns or symptoms, no need to examine
self taken swabs better than healthcare taken
blood test for HIV and syphilis encouraged

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18
Q

main 4 STI’s

A

syphilis, gonorrhoea, chlamydia and trichomoniasis

19
Q

declining STI’s

A

genital warts
pubic lice
new HIV diagnoses

20
Q

decline in pubic lice

A

shaved pubic hair
now rare to see pubic lice in sexual health clinics

21
Q

genital warts decline

A

150 types of HPV
6 and 11 cause warts
Gardasil vaccine protects 6,11,16,18
16 and 18 are associated with cancers in cervix, oral cavity, rectum,penis, vulva,vagina
rates of genital warts declined

22
Q

Gardasil vaccine

A

girls and now boys vaccinated age 12
MSM can be vaccinated for free at sexual health clinics if under 45

23
Q

why have HIV rates declined

A

use of pre-exposure prophylaxis PrEP, daily tablet stopping you catching HIV
change in guideline and funding so all patients with HIV can now have treatment regardless of their immune function (CD4 count), people taking effective treatment aren’t infectious

24
Q

which STI’s are going up

A

Gonorrhoea, Syphilis, Herpes, Trichomonas, Chlamydia

25
Q

gonorrhoea

A

bacterial infection
super bug and global threat
increasing resistance
treatment only in sexual health
partner notification is essential
test of cure is essential
can get everywhere
causes: discharge, pain urinating, pelvic and testiculat infection, conjunctivitis
rarely: sepsis and arthritis

26
Q

gonorrhoea gram stain

A

gram negative intracellular diplococci

27
Q

what is the most common bacterial STI in the uk

A

chlamydia trachomatis

28
Q

chlamydia trachomatis

A

very transmissible
symptoms: discharge, pain urinating, irregular bleeding, pain with sex, testicular swelling, conjunctivitis
many asymptomatic
NAAT test to diagnose

29
Q

chlamydia treatment

A

single dose antibiotic
doesn’t treat rectal infection
caused resistance in another STI, no longer recommended

30
Q

syphilis

A

bacterial infection caused by spirochete called treponema pallidum
highest incidence now since WW2
congenital syphilis is back in UK
mainly blood tests to diagnose
curable with high dose penicillin
untreated can cause serious health problems

31
Q

stages of syphillis

A

early, caught under 2 years ago
late, caught more than 2 years ago

32
Q

early syphillis

A

latent, no symptoms or signs but positive test
primary: ulcer “chancre”
secondary: whole body infection, multiple organs can be affected

33
Q

late syphillis

A

latent: no symptoms or sings but positive test
cardiovascular
neurological
gummatous

34
Q

images primary syphilis

A
35
Q

images secondary syphilis

A
36
Q

untreated syphilis in pregnancy

A
37
Q

congenital syphilis early

A
38
Q

congenital syphilis late

A
39
Q

mycoplasma genitalium

A

new STI
smallest bacteria ever found
NAAT tests available to look for DNA
unsure on numbers
diagnosis is still not in all clinics

40
Q

when would you test for mycoplasma genitalium

A

suspected pelvic infection in women
male urethritis
contacts of mycoplasma
already resistant worldwide

41
Q

trichomoniasis

A

protozoa
many people in uk haven’t heard of it
causes discharge and urethral/vaginal soreness
associated with miscarriages

42
Q

most common worldwide STI

A

trichomoniasis

43
Q

genital herpes

A

1 in 10
herpes simplex virus
primary infection= flu like and lasts 5-7 days
painful lymph nodes
tingling pain in genital area, bum or legs
genital blisters or ulcers
can get recurrent sores
can’t cure but treatment to prevent it coming back
life long infection

44
Q

complications of STI’s

A

Medicine Unit 8 (24 decks)

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