Flashcards in Session 6 - Group Work Deck (20)
What are the main public health messages required to limit sexually transmitted infections?
- Practice safer sexual behaviour
o Age at first intercourse
o Total number of partners
o Number of concurrent partners
o Frequency of partner switching
o Sexual orientation
o Specific at-risk sexual practices
- Use correct barrier contraception techniques consistently
- Seek better sexual health education
- Seek early treatment for suspected STI
- Attend for regular screening if at risk
- Avoid teenage pregnancy
- Avoid alcohol abuse and illicit drug use
What factors influence the effectiveness of public health campaigns concerning STI's
Changing societal norms
Targeted advertising and education
Peer group pressure and social activities
o Educational and social disadvantage
o Teenage conception and pregnancy
Ready and confidential access to GUM clinics and other health practitioners
Awareness of serious risks associated with some STIs
What antibiotics are considered for a gonnorohoea infection?
Ciprofloxacin (single large oral dose) because of frequent penicillin resistant Neisseria gonorrhoeae
Ceftriaxone 250 mg IM single dose in regions where ciprofloxacin resistance is prevalent (>5%) or
with likely exposure to CipR N. gonorrhoeae (overseas travel, partner’s diagnosis)
Doxycycline for 7 day for possible Chlamydia trachomatis co-infection
Azithromycin (single large oral dose) if pregnant or unlikely to be compliant
Why are cocomitant STIs common?
Common at risk behaviours and associated factors
Long-term asymptomatic infection
High prevalence rates of Chlamydia trachomatis infection
Identical mode of transmission
Where do you take swabs in a pelvic exam?
Endocervical smear and swab for microscopy and culture of N. gonorrhoeae
Endocervical swab for detection of C. trachomatis by EIA, IF or NAA
Urethral swab for culture of N. gonorrhoeae
Urethral swab for detection of C. trachomatis by EIA, IF or NAA
Throat and/or rectal swabs for culture of N. gonorrhoeae
First-void urine for detection of C. trachomatis by NAA
Mid stream urine (MSU) for microscopy and culture of UTI pathogens
Cervical smear for cytology
Cervical swab for HPV detection
High vaginal smear and swab – Candida, Trichomonas, bacterial vaginosis (BV)
Why can liver pain be a symptom of STI?
Fitz-Hugh Curtis syndrome due to perihepatitis – C. trachomatis or less commonly N. gonorrhoeae
. What is the ‘illness iceberg’? How does this concept apply in the case of sexually transmitted
Only a small percentage of those infected with a pathogen may manifest symptoms and/or signs of
Many STIs exhibit this phenomenon – Chlamydia, HPV, HSV, even syphilis may only manifest
with transient and minor evidence of primary disease
Potential large infectious reservoir – needs to be identified and treated promptly – CONTACT
Why is the pill associated with thrush?
Oral contraceptive use is associated with increased incidence of vulvo-vaginal thrush
Overgrowth of the yeasts is favoured by high oestrogen levels
What conditions in vagina prevent thrush?
Perturbed normal flora – broad spectrum antibiotic use
Warmth and humidity – climate, clothing, obesity
Oral contraceptives and pregnancy – oestrogen levels
Glucose levels – diabete mellitus
Menstrual cycle-associated changes – pre-period symptoms
Colonisation with a recalcitrant Candida species or strain
What is inflammation of fallopian tubes called?
If surrounding structures are involved in PID, what is it called?
PID- if abscess develops may be called tubo-ovarian abscess
List the symptoms of PID?
Lower abdominal pain, dyspareunia (+/- vaginal discharge) fever,(+/- menstrual
What is the differential diagnosis (listed by anatomical structures affected)?
cystitis, bladder stones
irritable bowel syndrome, inflammatory bowel disease, appendicitis
ovarian cysts, endometriosis, ectopic pregnancy, torsion
What investigations would you perform to establish the diagnosis if PID?
ultrasound, laparoscopy, swabs from endocervix, swabs from peritoneum if laparoscopy is
What organisms are involved in PID?
Most episodes of PID will be polymicrobial, including organisms such as chlamydia
trachomatis, neisseria gonorrhoea, mycoplasmas, bacteriodes + other anaerobes.
How would you manage a patient with PID?
analgesia, antibiotic / antimicrobial against specific organism, and broad spectrum
antibiotics with good anaerobic coverage.
bed rest, if hospitalised, Semi-Fowler position to drain pus into pelvis
Aggressive antibiotic Treatment, particularly in young nulliparous patients.
What are the potential sequelae of PID?
chronic recurring infection, increased risk of ectopic pregnancy, impaired fertility, chronic