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amy somerville > INF2 - A. TREATMENT OF STIS-COVERED > Flashcards

INF2 - A. TREATMENT OF STIS-COVERED Flashcards

1
Q

signs and symptoms of chlamydia (gram-ve) in men

A
  • 50% asymptomatic
  • urethritis
  • unilateral pain and swelling of scrutum
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2
Q

signs and symptoms of chlamydia in women

A
  • 70% asymptomatic
  • post-coital or inter menstrual bleeding
  • purulent vaginal discharge
  • dyspaneuria
  • lower abdominal pain
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3
Q

diagnosis of chlamydia in women

A
  • first void urine sample (NAAT test) or vulvo-vaginal/cervical swab
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4
Q

treatment of chlamydia and advice

A

single dose azithromycin (1g) orally followed by 500mg once daily for 2 days (better tolerated and less side effects and interactions)

or

7 days doxycycline (100mg twice daily)

*no test for cure unless pregnant
*partner notification
*avoid sex (oral aswell) until treatment completed or for 7 days if azithromycin treatment

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4
Q

diagnosis of chlamydia in men

A
  • first void urine sample or urethral swab if symptomatic
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5
Q

what to use if pregnant/breastfeeding

A
  • azithromycin, erythromycin, amoxicillin
  • NOT doxycycline or ofloxacin
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6
Q

signs and symptoms of gonorrhoea (gram-ve) in men

A
  • mucupurulent urethral discharge
  • epididymal swelling
  • dysuria 2-5 days after infection
  • rectal infection can cause anal discharge and pain in intercourse
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7
Q

signs and symptoms of gonorrhoea in women

A
  • 50% asymptomatic
  • dysuria
  • vaginal discharge 10 days after infection
  • rectal infection can cause anal discharge and pain in intercourse
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8
Q

diagnosis of gonorrhoea in men

A
  • first pass urine for men
  • ID by microscopy, culture, NAAT
  • NAAT: allows testing for chlamydia at same time
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9
Q

diagnosis of gonorrhoea in women

A
  • vaginal or endocervical swab
  • ID by microscopy, culture, NAAT
  • NAAT: allows testing for chlamydia at same time
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10
Q

treatment for gonorrhoea and advice

A
  • 1st line: IM ceftriaxone (cephalosporin antibiotic), single dose (1g) if susceptibility not known prior
    Ciprofloxacin 500mg orally as single dose if susceptibility known prior or if allergic to penicillin
  • 2nd line: gentamicin, azithromycin etc

*avoid sex (oral aswell) until treatment completed or for 7 days if azithromycin treatment
*follow up after 1 week
*confirm partner notification
*return for TOC

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11
Q

what is PID

A
  • inflam of uterus, ovaries, fallopian tubes
  • abscess, peritonitis?
  • scar formation with adhesions to neighbouring organs
  • 15% risk of infertility after 1 attack, 50-80% after 3 due to adhesions
  • complication of chlamydia or gonorrhoea in women
  • can be caused also by IUD or tampons
  • increased risk of cervical cancer
  • miscarriage in pregnancy and infertility
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12
Q

symptoms of PID

A
  • often asymptomatic
  • lower abdominal pain
  • deep abdominal pain on intercourse
  • intermenstrual bleeding
  • green/yellow vaginal discharge
  • fever or vomiting
  • could be appendicitis or endometriosis etc
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13
Q

diagnosis of PID

A
  • STI screen
  • ultrasound
  • laparoscopy (incision)
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14
Q

treatment of PID

A
  • pain relief: paracetamol, ibuprofen, codeine
  • combined antibiotics for 14 days
  1. IM ceftriaxone (1g single dose) + oral doxycycline (100mg twice daily) + oral metronidazole (400mg twice daily)
  2. oral ofloxacin + oral metronidazole (both 400mg twice daily)

different antibiotics used to cover different microbes (aerobic, anaerobic etc)

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15
Q

symptoms of syphilis (gram-ve)

A
  • small sores around your genitals or bottom
  • rash (usually on your hands or feet)
  • white patches in your mouth
16
Q

diagnosis of syphilis

A
  • routine serology in GUM clinic
  • dark ground microscopy
  • PCR
17
Q

treatment of syphilis

A
  • IM benzylpenicillin single dose
    *effective for primary/secondary
    *safe in pregnancy
    *2 week course for tertiary syphilis (systemic)
  • doxycycline, azithromycin, ceftriaxone, erythromycin, amoxicillin if allergic to penicillin etc
18
Q

what happens if a pregnant women gets secondary syphilis

A
  • infects foetus
  • miscarriage
  • stillbirth
  • congenital syphilis
19
Q

symptoms of trichomoniasis (protozoa parasite) in women

A
  • up to 50% asymptomatic
  • symptoms can be 5-28 days after infection or more
  • itching
  • soreness
  • inflam of vagina
  • dysuria
  • thin smelly vaginal discharge (different to gonorrhoea)
20
Q

symptoms of trichomoniasis in men

A
  • up to 50% asymptomatic
  • symptoms can be 5-28 days after infection or more
  • itching inside penis
  • burning sensation when urinating or ejaculating
  • discharge
21
Q

treatment of trichomoniasis

A
  • oral metronidazole (400mg twice daily for 5-7 days or 2g dose)

*ok in pregnancy but trichomoniasis increases risk of pre-term delivery and LBW baby
*avoid high doses in breastfeeding
*avoid alcohol as disulfiram reaction makes people very sick

22
Q

treatment for public lice (parasitic insect)

A
  • topical insecticide: malathion 0.5% lotion, permethrin 1% cream applied to hair
  • OTC
  • wash clothing and bedding >50 degrees Celsius to kill lice
23
Q

prevention of HPV

A
  • vaccination and screening
  • NHS cervical screening programme as HPV related to cervical cancer
  • liquid-based cytology: smear taken, applied to slide, microscope
  • colposcopy
  • biopsy
  • histology
  • excision or ablation of HPV-infected abnormal cells
  • severe infection: hysterectomy
24
Q

HPV vaccine

A
  • Gardasil vaccine to girls and boys between 12-13 (protective against types 6, 11, 16, 18)
  • Cervarix vaccine (protective against 16 and 18)
  • don’t use in pregnancy
  • effective against HPV types 16 and 18 (high risk cervical cancer) and 6 and 11 (low risk but associated with anogenital warts - most common)
  • 2nd injection 6-12 months after 1st
  • protective for 8 years
25
Q

what usually causes anogenital warts

A
  • HPV types 6 and 11
  • can take up to a year to develop after infection
26
Q

symptoms of anogenital warts

A
  • usually painless
  • itching or bleeding from urethra
  • small, flesh-coloured or grey swellings in genital area
  • warts will clear in 18 months
27
Q

treatment for anogenital warts

A
  • treatment only for visible warts
  • soft non-keratinised warts:
    0.15-0.5% podophyllotoxin cream (not in pregnancy)
    imiquimod 5% cream (POM) for keratinised and non-keratinised warts (not in pregnancy)
  • physically ablative therapies are more effective (cryotherapy, electrocautery, surgery, laser treatment)
  • 40% reoccurrence after successful treatment
28
Q

what causes genital herpes (viral)

A

HSV-2

29
Q

treatment for genital herpes

A

antiviral: Aciclovir 200mg 5x daily for 5 days
not OTC

30
Q

how to treat primary genital herpes in pregnancy so not passed to baby

A
  • oral or IV aciclovir
  • Caesarean section for women with genital lesions within 6 weeks birth
  • antivirals not recommended for recurrent genital herpes during pregnancy
31
Q

who should have a vaccine for hepatitis B (viral)

A

high risk travel
healthcare worker
babies as part of 6-in-1 vaccine at 12 months, need revaccination later in life

32
Q

treatment for hepatitis B

A
  • no treatment as usually short term (few months)
  • can become chronic: leads to liver damage (cirrhosis)
  • antivirals (entecavir or tenofovir)
33
Q

how does a community pharmacy contribute to STI help

A
  • advice
  • PGD or independent prescribing for chlamydia
  • vaccination for HPV and maybe hepB
34
Q

how does a GUM clinic contribute to STI help

A
  • diagnose and treat all STIs
  • advice
  • free condoms, pregnancy testing
  • drop in sessions/appointments
  • walk-in
35
Q

how does infectious disease ward contribute to STI help

A
  • severe/resistant cases (HIV, gonorrhoea, syphilis)

amy somerville (70 decks)

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