STI's

Question 1

when should screening for bacterial STI’s be done?

Answer 1

all patients who are already known to have a sexually
transmitted/transmissible infection (including blood-borne infections)

all patients who request testing

any patient identified to be at high risk of STI from their history.

Question 2

what NAATS (nucleic acid amplification tests) can be taken from sites identified from the history in an asymptomatic patient?

NB: gc = gonorrhoea
ct = chlamydia

Answer 2

first pass urine (men only) – urethral GC/CT (can be sent in white universal
pot)

vulvo-vaginal swab – vaginal/cervical GC/CT (use chlamydia swab pack and
break pink swab tip into NAAT medium)

pharyngeal swab – GC/CT of the throat (use plain purple swab and break tip
into NAAT medium)

rectal swab – GC/CT of the rectum (send as for pharyngeal swab)

Question 3

what additional tests can be done in the symptomatic patient?

Answer 3

urethral discharge – charcoal swab to microbiology requesting Gonococcal culture

vaginal discharge – charcoal swab from cervical os for Gonococcal culture;
additional charcoal swab from posterior fornix for
Trichomonas vaginalis and
Candida culture

oral/genital ulceration –
green viral swab for herpes simplex virus (HSV) 1
and 2 PCR

anal discharge – charcoal swab for Gonococcal culture, HSV swab if significant anorectal discomfort

conjunctivitis – GC/CT NAAT from conjunctiva; charcoal swab for Gonococcal culture if significant purulent discharge.

Question 4

what baseline investigations should be done with al patients newly diagnosed with HIV?

Answer 4

Confirmatory HIV test

CD4 count

HIV viral load

HIV resistance profile

HLA B*5701 status

Serology for syphilis, hepatitis B (sAg, cAb, sAb), hepatitis C, hepatitis A

Toxoplasma IgG, measles IgG, varicella IgG, rubella IgG

FBC, U&Es, LFTs, bone profile, lipid profile

Schistosoma serology (if has spent >1 month in sub-Saharan Africa)

Women should have annual cervical cytology.

refer to HIV clinical nurse specialist team for contact tracing

Question 5

what support is available for patients with HIV?

Answer 5

The HIV clinical nurse specialist team offers advice, education, and medical and social support to patients living with HIV, their families, carers and partners.

The CNS team also has links to community support groups if these are required.

Patients with psychological difficulties related to their HIV diagnosis can be referred to the Clinical Psychology Department for assessment

Question 6

how are patients with low CD4 counts vulnerable?

Answer 6

These patients are particularly susceptible to opportunistic infections.

Patients with a CD4 <200 should be prescribed Co-trimoxazole 480mg PO OD as primary prophylaxis against PCP.

If the CD4 is <50 Azithromycin 1250mg PO once weekly should also be given to protect against MAI.

Patients with a CD4 count of <50 should also be assessed by Ophthalmology with dilated fundoscopy to look for evidence of intra-ocular infections such as CMV retinitis.

Question 7

what vaccinations should be offered to HIV positive patients?

Answer 7

All patients with HIV should be vaccinated against hepatitis B and pneumococcus, and should receive annual injectable influenza vaccination.

These vaccinations can be given while the patient is admitted on the ward if appropriate.

Question 8

what should be done in the case of needle stick injury or exposure to HIV from a patient on IDU?

Answer 8

IDU consultant on call can be contacted for advice about the need for Post exposure prophylaxis (PEP).

Queries about PEP from other parts of the hospital should be directed to Occupational Health during working hours, or to the on-call Genitourinary Medicine (GUM) doctor out of hours.

The GUM team is also responsible for managing PEP in the community, including cases of potential sexual exposure to HIV.