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SEXUAL HEALTH AND HIV > SEXUALLY TRANSMITTED INFECTIONS IN MALES > Flashcards

SEXUALLY TRANSMITTED INFECTIONS IN MALES Flashcards

1
Q

What is dysuria?

A

Burning pain sensation during urination

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2
Q

What are the two most common causes of urethritis in men?

A

Gonorrhoea infection

Chlamydia infection

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3
Q

What are the less common causes of urethritis in men?

A

Mycoplasma genitalium infection

Trichomoniasis

Herpes simplex virus infection

Adenovirus infection

E. coli infection

Urinary tract infection

Trauma

Foreign body

Autoimmune - associated with reactive arthritis and allied conditions

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4
Q

How long does symptomatic gonorrhoea take to develop after exposure (incubation period)

A

2-5 days

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5
Q

How long do symptoms of chlamydia take to develop after exposure (incubation period)?

A

Normally 1-2 weeks, but pretty much always less than 4 weeks

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6
Q

What is the bacteria that causes gonorrhoea and what class of bacteria is it?

A

Neisseria gonorrhoea

Gram negative intracellular diplococci

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7
Q

What is the bacteria that causes chlamydia and what class of bacteria is it?

A

Chlamydia trachomatis

Gram negative obligate intracellular bacterium

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8
Q

What are the type of chlamydia that cause STIs?

A

Types D-K

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9
Q

What are the initial sites of infection of chlamydia?

A

Epithelial cells of urethra, cervix, rectum, pharynx, and conjunctiva.

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10
Q

What are the two main symptoms of chlamydia in males?

A

Urethral discharge

Dysuria

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11
Q

As well as the urethra, what other sites may be symptomatic in a chlamydia infection?

A

Proctitis
Conjunctivitis
Epididymo-orchitis
Reactive arthritis

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12
Q

What are the initial sites of infection of gonorrhoea?

A

Columnar epithelium of urethra, endocervix, rectum, pharynx, or conjunctiva

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13
Q

What are the main symptoms of gonorrhoea in men?

A

Urethral discharge
Dysruria
Tender inguinal lymph nodes

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14
Q

As well as the urethra, what other sites may be symptomatic in a gonorrhoea infection?

A 
Epididymo-orchitis
Abscesses of paraurethral glands
Pharyngitis
Rectum
Conjunctivitis

Disseminated infection involving skin, joints and heart valves

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15
Q

What is the main method of diagnosis of chlamydia?

A

Nucleic Acid Amplification Test (NAAT)

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16
Q

What is the main method of diagnosis of gonorrhoea?

A

Detection of gram negative intracellular diplococci in smears and culture

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17
Q

What is the method used for screening of asymptomatic gonorrhoea?

A

PCR testing of urine sample

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18
Q

When performing a urethral smear for microscopy, what must you advise the patient to do for optimal results?

A

Optimal results for gram stain and culture are obtained from patients who have held their urine for 4 hours or more.

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19
Q

What would confirm urethritis on microscopy of a urethral smear?

A

Five or more polymorphs per high power yield.

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20
Q

If the smear shows gram negative intracellular diploccoci, what infection would you treat the patient for?

A

This is suggestive of gonorrhoea, however, often patients are treated for both gonorrhoea and chlamydia to cover the possibility of mixed infection. Meanwhile confirmatory tests will be carried out to confirm the presence of chlamydia.

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21
Q

Other than urethral smear, what investigations would be carried out on someone who presents with urethral discharge to confirm the aetiology of infection?

A

Nucleic Acid Amplification Test (NAAT) on first pass urine

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22
Q

How do we treat patients with urethritis where there is no evidence of gonorrhoea? Include doses and course duration.

A

Azithromycin - 1 g stat

OR

Doxycycline - 100mg BD for 1 week

OR

Erythromycin - 500mg BD for 2 weeks

These are all active against chlamydia and other pathogens associated with non-gonococcal urethritis.

23
Q

What is the main side effect that patients who are started on doxycycline must be warned about?

A

Photosensitivity

Contraindicated in pregnancy

24
Q

What is the main side effect of erythromycin?

A

GI upset

Also must warn of p450 inhibiting factors

25
Q

What is the main side effect of azithromycin?

A

GI upset

26
Q

A patient with urethritis where there is no evidence of gonorrhoea is given a stat dose of azithromycin. 1 week later he is still experiencing symptoms. What other pathogens might be causing his infection?

A

Gonorrhoea that was not picked up

Trichomonas vaginalis

Mycoplasma genitalium

27
Q

How do we treat patients with urethritis caused by gonorrhoea? Include doses and duration of course

A

Ceftriaxone 500 mg IM stat

OR

Cefixime 400 mg PO stat (if IM is refused)

AND

Azithromycin 1 g PO stat (this is to cover mixed infection)

Traditional use of ciprofloxacin is decreasing as there is evidence of increased resistance.

28
Q

What are the local complications of gonorrhoea?

A

Urethral stricture

Epididymitis

Salpingitis

Infertility (due to salpingitis)

29
Q

What are the disseminated complications of gonorrhoea?

A

Classic triad of disseminated gonorrhoea infection are:

Tenosynovitis

Migratory polyarthritis

Dermatitis - maculopapular or vesicular

Later complications include:
Septic arthritis

Endocarditis

Perihepatitis (Fitz-Hugh-Curtis syndrome)

30
Q

What is epididymo-orchitis?

A

Inflammation of the epididymis and/or testes, most commonly due to infection.

31
Q

What are the main symptoms of epididymo-orchitis?

A

Scrotal pain and swelling

32
Q

What is the differential diagnosis of scrotal pain and swelling?

A

Infection

Torsion of testis

Hydrocoele, spermatocoele, varicocoele

Vasculitis: HSP, Kawasaki’s disease and Buerger’s disease

Amiodarone therapy

Tumour

Hernia

Trauma

33
Q

What are the organisms that commonly cause epididymo-orchitis?

A

Gonorrhoea

Chlamydia

Tuberculosis

Mumps virus

Gram-negative bacteria: E. coli, Klebsiella, Pseudomonas, Proteus

34
Q

What is the first thing to exclude when someone presents with scrotal pain and swelling?

A

Acute torsion

35
Q

Which age group is most affected by torsion?

A

Teenagers

36
Q

What symptoms often accompany scrotal pain in acute torsion?

A

Vomiting

37
Q

What investigations should be done for someone with acute onset scrotal pain to exclude torsion?

A

Doppler scan to demonstrate blood flow

38
Q

What are the distinguishing features of mumps in someone who presents with scrotal pain?

A

Parotid swelling

Severe testicular pain a few days after onset of parotid swelling

Systemic symptoms (fever)

Don’t forget that parotitis may be absent

39
Q

What tests should be done with suspected infective epididymo-orchitis?

A

Urethral smear

MSU

Investigations for gonorrhoea and chlamydia

40
Q

When should you start treatment for gonorrhoea and chlamydia in young male that presents with scrotal pain and swelling?

A

If history and examination indicate that it is likely. Should not wait for results in a young male.

41
Q

What is a varicocoele?

A

An abnormal enlargement of the pampiniform venous plexus in the scrotum.

42
Q

What are the causative organisms for most cases of prostate infection?

A

Gram negative bacteria: E. coli, Klebsiella, Pseudomonas, Proteus

Streptococcus faecalis

43
Q

What is the most common cause of pelvic or prostatic pain in men?

A

Chronic pelvic pain syndrome (also called chronic non-bacterial prostatitis

44
Q

What is the NIH (national institutes of health) classification of prostatitis syndromes?

A

I - Acute bacterial prostatitis

II - Chronic bacterial prostatitis

III - Chronic prostatitis (CPPS)
IIIa - inflammatory (presence of leucocytes)
IIIb - non-inflammatory (absence of leucocytes)

IV - Asymptomatic inflammatory prostatitis

45
Q

What are the causes of pelvic pain or prostatic symptoms in men?

A

Infection

CPPS

Specific or non-specific granulomatous prostatitis

Pudendal neuralgia

Bladder outlet obstruction (BPH)

Bladder tumours

Urinary stone disease

Ejaculatory duct obstruction

Seminal vesicle calculi

Irritable bowel syndrome

46
Q

What are the STIs that can, but don’t commonly, affect the prostate?

A

Gonorrhoea

Chlamydia

Trichomoniasis

47
Q

What investigations may be helpful in a patient with prostatic symptoms?

A

Transrectal USS

Urodynamic studies

Biopsy

48
Q

What is the first choice antibiotic for prostate infection of unknown cause? Include course duration.

A

A quinolone or a tetracycline for 28 days. Good prostate penetrance.

49
Q

What are the common symptoms associated with anorectal STIs?

A

Pain

Tenesmus

Bleeding

Discharge

Diarrhoea (rare)

50
Q

What examination should be done in anyone presenting with signs and symptoms of anorectal infection?

A

PR

Proctoscopy

51
Q

How might you readily diagnose herpes proctitis from examination?

A

Perianal vesicles or erosions

Pain is often too severe to allow proctoscopy or even PR

52
Q

Which drug should be given for rectal chlamydia infections? Include course length

A

Rectal chlamydia infections have been shown to respond better to doxycycline than azithromycin.

Normally given for 3 weeks

53
Q

What are the non-infectious anal conditions that men often present to STI services with?

A

Anal fissures

Haemorrhoids

Perianal haematomas

Pruritus ani

54
Q

What are the orally transmitted infections in sex that cause symptoms?

A

Primary syphilis may present on the tongue or lips

Secondary syphilis can cause oral mucositis

HIV - oral candidiasis, angular cheilitis, gingivitis, oral hairy leucoplakia, Kaposi’s sarcoma

Perioral warts

SEXUAL HEALTH AND HIV (13 decks)

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