Session 6 - Group Work Flashcards Preview

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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
ƒ - Use correct barrier contraception techniques consistently
ƒ - Seek better sexual health education
ƒ - Seek early treatment for suspected STI
ƒ - Attend for regular screening if at risk
ƒ - Avoid teenage pregnancy
ƒ - Avoid alcohol abuse and illicit drug use


What factors influence the effectiveness of public health campaigns concerning STI's

Changing societal norms
ƒ Targeted advertising and education
ƒ Peer group pressure and social activities
ƒ Socio-economic factors
o Poverty
o Educational and social disadvantage
o Unemployment
o Teenage conception and pregnancy
ƒ Ready and confidential access to GUM clinics and other health practitioners
ƒ 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
ƒ Long-term asymptomatic infection
ƒ High prevalence rates of Chlamydia trachomatis infection
ƒ Identical mode of transmission


Where do you take swabs in a pelvic exam?

Endocervical smear and swab for microscopy and culture of N. gonorrhoeae
ƒ Endocervical swab for detection of C. trachomatis by EIA, IF or NAA
ƒ Urethral swab for culture of N. gonorrhoeae
ƒ Urethral swab for detection of C. trachomatis by EIA, IF or NAA
ƒ Throat and/or rectal swabs for culture of N. gonorrhoeae
ƒ First-void urine for detection of C. trachomatis by NAA
ƒ Mid stream urine (MSU) for microscopy and culture of UTI pathogens
ƒ Cervical smear for cytology
ƒ Cervical swab for HPV detection
ƒ 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
ƒ Many STIs exhibit this phenomenon – Chlamydia, HPV, HSV, even syphilis may only manifest
with transient and minor evidence of primary disease
ƒ 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
ƒ Overgrowth of the yeasts is favoured by high oestrogen levels


What conditions in vagina prevent thrush?

Perturbed normal flora – broad spectrum antibiotic use
ƒ Warmth and humidity – climate, clothing, obesity
ƒ Oral contraceptives and pregnancy – oestrogen levels
ƒ Glucose levels – diabete mellitus
ƒ Steroid therapy
ƒ Menstrual cycle-associated changes – pre-period symptoms
ƒ 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)?
bladder conditions

cystitis, bladder stones


bowel conditions

irritable bowel syndrome, inflammatory bowel disease, appendicitis


gynaecological conditions

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
pelvic pain


How can patients prevent PID and these complications?

barrier contraceptives, STD screening, screening of partner, early treatment of STIs,
avoidance of promiscuity