STDs, Gonorrhoea, Chlamydia

Question 1

STDs also known as

Answer 1

STIs or venereal diseases (VD)

Question 2

What are the modes of transmission for STI spread?

Answer 2

• sexual contact with an infected person
• direct contact of broken skin with open sores, blood or genital discharge
• receiving contaminated blood
• from infected mother to her child during preg (e.g. syphilis, HIV) or childbirth (e.g. chlamydia, gonorrhoea, HSV), or breastfeeding (HIV) (Mother to child transmission)

Question 3

What are the risk factors of getting STDs?

Answer 3

• unprotected sex
• no. of sexual partner (multiple partners more sexual contact)
• MSM
• Prostitution (CSW)
• Illicit drug use

Question 4

How can someone prevent getting STDs?

Answer 4

• abstinence and reduce no of sexual partners
• barrier contraceptive methods
• avoid drug abuse and sharing needles
• pre-exposure vacc: HPV, Hep B, Hep A
• Pre- and Post-exposure prophylaxis: HIV

A: abstinence
B: be faithful
C- condom use

Question 5

Why is the management and prevention of STDs important?

Answer 5

• reduce related morbidity, progression to complicated disease
• prevent HIV infection: HIV inc risk of transmission causes other infections too –> gential herpes, gonococcal, and syphilis infections might occur
• prevent serious complications in women: STIs –> infertility; HPV prevention reduces number of women with cervical cancer
• protect babies: untreated STIs assoc w congenital and perinatal infections in neonates, premature deliveries and neonatal death or stillbirth

Question 6

Which bacteria causes Gonorrhoea?

Answer 6

Neisseria gonorrhoeae
(intracellular gram -ve)

Question 7

How is Neisseria gonorrhoeae transmitted?

Answer 7

sexual contact, mother-to-child during childbirth

Question 8

How to diagnose Gonorrhoea?

Answer 8

gram-stain of genital discharge, culture, NAAT (Nucleic Acid Amplification Test)

Question 9

Gonorrhoea can infect which various sites?

Answer 9

• urethritis
• cervicitis
• proctitis
• pharyngitis
• conjunctivitis
• disseminated (systemic circulation –> to joints)

Question 10

What are the presentation of gonorrhoea?

Answer 10

• some may be asymptomatic
• smx (uncomplicated urogenital gonorrhoea)
  ~ Males: purulent urethral discharge, dysuria, urinary frequency
  ~ Females: mucopurulent vaginal discharge, dysuria, urinary frequency

Complications if untreated:
~ Males: epididymitis, prostatitis, urethral stricture, disseminated disease
~ Females: pelvic inflammatory disease, ectopic preg, infertility, disseminated disease
Both: disseminated - skin lesions, tenosynovitis, monoarticular arthritis

Question 11

What are the treatment options for uncomplicated urogenital gonococcal infections?

Answer 11

1ST LINE:
Ceftriaxone 500mg IM * single dose for persons <150kg (1g for >= 150kg)

Alternative if ceftriaxone not available:
- Gentamicin 240mg IM single dose + Azithromycin 2g PO single dose

OR

Cefixime 800mg PO single dose*

• If chlamydial infection not been excluded (if included), treat for chlamydia with Doxycycline 100mg orally BD x 7 days
  2nd agent only added if chlamydial infections has not been excluded
  Ceftriaxone + Doxy or
  Cefixime + Doxy

Test of cure not require unless smx persist

Question 12

What is the management of sex partners if someone has gonorrhoea?

Answer 12

• sex partners in last 60 days should be evaluated and treated. If last sexual exposure >60days, the most recent partner to be treated
• to minimise disease transmission, persons treated for gonorrhoea should be instructed to abstain from sexual activity for 7 days after treatment and resolution of smx, if present OR 7 days of treatment if taking doxy
• to minimise reinfection risk, pts should be instructed to abstain from sex until all their sex partners have been treated

Question 13

Which bacteria causes Chlamydial infections?

Answer 13

Chlamydia trachomatis

Question 14

Chlamydia is similar to Gonorrhoea in which terms (presentation and diagnosis, etc.)?

Answer 14

presentation similar to gonorrhoea, perhaps milder

Diagnosis using NAAT or antigen detection

Can infect various sites as per gonorrhoea

Complications as per gonorrhoea

Transmission: sexual contact, mother-to-child during childbirth

Question 15

What are the treatment options for Chlamydia?

Answer 15

1ST LINE:
Doxycycline 100mg PO BD x 7 days

Alternative:
Azithromycin 1g PO single dose
or
Levo 500mg PO OD for 7 days

• Erythromycin not recommended anymore
• Levo effective while other FQs are unreliable
• Azithromycin used as 1st line if adherence is a concern

Treatment highly effective, test-of-cure not required unless specific concerns (e.g. preg, non-adherence) or smx persist

Question 16

What is the management of sex partners if someone has chlamydia?

Answer 16

• sex partners in last 60 days should be evaluated and treated. If last sexual exposure >60days, the most recent partner to be treated
• to minimise disease transmission, persons treated for gonorrhoea should be instructed to abstain from sexual activity for 7 days (after single dose therapy) or until completion of 7-day regimen and resolution of smx if present
• to minimise reinfection risk, pts should be instructed to abstain from sex until all their sex partners have been treated