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Flashcards in STD's Deck (18)

What has MSM caused?

• Associated with rise in other STDs • Syphilis
• Gonorrhoea • Lymphogranuloma venereum (LGV)
• Associated HIV infection


What STI's can oral sex cause?

• Throat
• Chlamydia, gonorrhoea (non specific urethritis NSU)
• Syphilis
• Mouth • Herpes
• HPV • HIV transmission only if “penile” receptive


What's Chlamydia and what are the stats for it?

Symptoms & signs in women:
• Vaginal discharge/ dysuria/ pelvic pain/ PCB/ IMB
• Mucopurulent cervical discharge/ cervicitis
Symptoms and signs in men:
• Urethral discharge/ dysuria/ urethral ‘itch’ or ‘discomfort’/ rectal discharge or bleeding
• Mucoid urethral/ rectal discharge (may be purulent)
• Frequently asymptomatic • 70% women no symptoms • >50 % men in community setting no symptoms
• National Chlamydia Screening Programme: • Rolled out Nationally 2007 • 2011-12: 30 % uptake 15-24 yr olds Bristol

• 3% sexually active population < 25yrs
• 7-9% young people (under 25) requesting a test
• Decreases after age 25 yrs


What are the complications of pelvic inflammatory disease?

• x10 increased risk ectopic pregnancy • recurrent episode • persistent lower abdominal pain 20% • Infertility
•1episode 10-20% • risk doubles with each episode


What's the National Chlamydia Screening Programme (NCSP)?

• A national prevention and control programme for genital chlamydial infection across England...
• All 15-24yr olds should be screened for Chlamydia every year
• opportunisitc


What's Gonorrhoea?

• Less common than Chlamydia
Symptoms and signs same as chlamydia but:
• Discharge often more purulent
• Accompanied by ++inflammation
• High risk populations eg MSM, certain ethnic groups
• Infects urethra, endocervix, rectum,
pharynx and conjunctiva
• May also be asymptomatic • 10% men with urethral infection no symptoms • Up to 93% men rectal infection no symptoms • >90% of pharyngeal infection no symptoms
• 50% women with endocervical infection no symptoms


What are the diagnostics for chlamydia and gonorrhoea?

• NAAT = Nucleic Acid Amplification Test
• Technology similar to PCR
• Men • first voided urine (FVU) specimen
• Women • Vaginal swab or FVU specimen • Endocervical swab


What's the treatment for chlamydia and gonorrhoea?

• General principles:
• No sex for 7 days after stat dose antibiotics
• No sex until partner also treated
• ‘No sex’ also includes no oral sex or sex with condoms
• Contact tracing vital part of treatment (3/12 usually)
• May need to involve health advisors

Uncomplicated infection:
• Chlamydia:
• 1st line: Azithromycin 1g stat po or Doxycycline 100mg bd 7/7 po
• Gonorrhoea:
• 1st line: (Ceftriaxone 500mg im stat)
• 2nd line: (depending on sensitivities) Ciprofloxacin 500mg stat po or Ofloxacin 400mg stat po
• Plus azithromycin 1g (synergistic)
For complicated infections (see later) eg PID/ epididymitis need longer courses antibiotics


What are the causes of genital ulceration?

1) Herpes simplex virus 2) Primary syphilis 3) Non sexually transmitted inf. / condition


What are genital herpes?

Common: 20 – 60% have virus. Prevalence increases with age.
Less than 50% have symptoms. 2 types virus HSV- 1 & HSV- 2 indistinguishable.
Infection in genitals/ eye or oral (coldsores).
Transmission vaginal/ anal/ oral/ sex or toys. Can get from direct contact with coldsores (type 1).
Associated with other STI/ full screen recommended. Incubation period 2 days to several weeks. Prodrome of tingling and ‘flu like symptoms. In both sexes small vesicles burst to form ulcers. Ulcers crust and heal (anywhere in genital area). Often dysuria.
Latent infection in spinal nerve root ganglia.
Diagnosis with swab in viral transport media Treatment with aciclovir for 5- 10 days. Analgesia, salt water bathing, lignocaine gel. Admission if severe systemic upset, urinary retention. May get recurrences, usually mild/ self limiting. Asymptomatic shedding occurs once healed.
High level of psychological distress/ stigma.


What's syphilis?

Spirochaete bacterium called Treponema pallidum. Less common but increasing. Esp men who have sex with men/ sex worker . Very common in Africa/.
Natural history of infection complex. Transmission vaginal/ anal/ oral sex.
Incubation period 9- 90 days (mean 21 days). Primary infection 9-90 days.
Secondary infection 6 weeks – 6 months. Early latent < 2 years.
Late latent > 2 years


What are genital warts?

Common (at least 50% sexually active have virus). Caused by Human Papilloma Virus (>100 types). Site specific types for hands/ feet/ genitals. Transmitted via skin to skin contact.
Incubation period 2 weeks – 8 months. (? Years). Diagnosis by visual recognition (no test for infection).
Associated with other STI/ full screen recommended. Treatment cryotherapy/ topical self applied creams. 20%- Resolve spontaneously if left for long enough. DO NOT become cancer if untreated.
Few types of virus associated with cervical cancer. Women should keep PAP smear up to date.
Recurrences in ~ 25% Virus cleared over time by immune system.


What's the risk of cancer with human papilloma virus (HPV)?

• 1% of those with high risk HPV on cervix develop cervical cancer
• HPV 16 and 18 account for 75% cervical cancers in Europe
• Oncogenic HPV types associated
• Oral cancer • Anal cancer


Is there a HPV vaccine? (cervical cancer vaccine)

• Gardasil licensed UK 2006 (Merck) • Cervarix licensed UK 2008 (GSK) • Replaced by Gardasil 2013
• Injection x 3
• High risk oncogenic strains HPV 16 and 18 (Gardasil combined with 6 and 11 ie. quadrivalent)
• Vaccinate 12 year old girls (year 8) • Catch up programme for age 12-18


What's the UK perspective on HIV?

• Measures of incidence show that HIV transmission among MSM remains high
• > 1⁄2 of heterosexuals are thought to have acquired HIV in the UK compared with 27% in 2002
• HIV prevalence is linked to deprivation especially in London
• Antiretroviral treatment has revolutionised care
• Numbers attending care have risen
• 1.5% mother to child transmission rate with antenatal intervention
Long latent period where virus/ CD4 levels stable. Eventually (usually years), CD4 ↓, viral load↑. Infectious throughout esp seroconversion/ AIDS. AIDS (Acquired Immuno Deficiency Syndrome). Progression to AIDS delayed by medication.


What's an HIV Epidemiology summary?

• HIV prevalence remains highest in sub- Saharan Africa
• In Europe highest rates are seen in Eastern Europe, where the predominant transmission route in this group is intravenous drug use
• In Western Europe and the UK, in contrast, risk groups are MSM and migrant populations.


HIV tests?

• Current HIV tests are 4th generation tests
• Test for antigen and antibody
• Much more sensitive at picking up earlier stage infection (4 weeks after exposure)
• However for definitive result MUST test 3 months after exposure (see BASHH g/l)
Window period 3 months:
• ‘This test will only tell us about any risk you had before 3 months ago, not within the last 3 months’
• Benefits of testing: • ‘Better to know than not to know, treatments
easy to take, life expectancy almost normal’ • Results:
• How to be given, will be back within 3 weeks, no UPSI until results known + window period
• If positive – partner may not be positive


What's Post exposure prophylaxis (PEP)?

1 month HAART if needlestick/
splash injury from high risk patient, same for after sexual exposure.
• If any possible exposure contact needlestick hotline ASAP
• Bear in mind high risk fluids:
• Blood/ CSF/ Peritoneal fluid/ Breast milk/ Amniotic fluid/ Any blood stained body fluid/ Saliva (dentistry only)
• Low risk fluids: • Vomit/ Faeces/ Urine/ Saliva