STI Flashcards
What is pelvic inflammatory disease?
caused by an STI - (Chlamydia trachomatis or Neisseria gonorrhoeae) in the upper genital tract
• Most common in younger women, <25
• Symptoms include: Pelvic or lower abdominal pain
o Deep dyspareunia, Dysmenorrhoea
o Abnormal vaginal bleeding, Fever
If acute PID isn’t managed, then it can present as subfertility many years later
What is given for pelvic inflammatory disease
• Paracetamol or ibuprofen, or both, should be used to manage the pain Mild symptoms - An STI screen Severe symptoms: Antibiotic therapy should be started straight away without screening first • First line regimen for PID: o Ceftriaxone 1000mg IM stat o Metronidazole 400mg BD for 14 days o Doxycycline 100mg BD for 14 days • Second line regimen for PID: o Metronidazole 400mg BD for 14 days o Ofloxacin 400mg BD for 14 days
What is bacterial vaginosis?
overgrowth of anaerobic bacteria in the vagina e.g. Gardnerella vaginalis
• fishy-smelling vaginal discharge - Not normally itchy or sore
• Gardnerella can cause balanitis in men, along with a fishy odour
What treatment is given for bacterial vaginosis?
First line treatment is metronidazole
• Metronidazole works on anaerobic bacteria
!!! Very important to avoid alcohol – this still applies with the vaginal dosage form because of systemic absorption!!!
• The tablets should be taken after food, and swallowed whole with a full glass of water
CLOTRIMAZOLE
FLUCONAZOLE:
DOXYCYCLINE:
OFLOXACIN:
What is chlamydia?
Chlamydia infection is caused by Chlamydia trachomatis, which is a Gram-negative bacterium. symptoms (can be asymptomatic) In women: • Increased vaginal or cervical discharge –can be purulent (containing pus) • Deep pain during sex • Bleeding after sex • Intermenstrual bleeding • Dysuria In men: • Dysuria • Urethral discharge • Pain in the testicles
What treatment is given for chlamydia?
First Line - Doxycycline - A tetracycline antibiotic
• 100mg BD for seven days
• No sexual activity while taking the treatment
• Second Line
Azithromycin - A macrolide antibiotic
• 1g single dose, then 500mg daily for two more days
• No sexual activity for seven days after treatment
• Counselling
• Treatment for STIs is free through GUM clinics, so we don’t generally see many scripts - You need to be aware of it though
• If chlamydia, test for reinfection at 3 to 6 months following treatment if under 25 years; or consider if over 25 years and high risk of re-infection.
What are genital warts?
- Genital warts are caused by the Human Papillomavirus (HPV)
- The warts tend to be small and soft, but can link to look like cauliflower-like lumps
- in women can lead to cervical cancer; it can also cause changes to the penis, mouth and throat, and anus, causing cancers there.
What is the treatment for genital warts (HPV)?
Treatment is not always needed - In 30% of people, the warts spontaneously resolve within six months
Imiquimod cream (Aldara®) - three times a week for up to 16 weeks
Podophyllotoxin cream (Warticon®) - twice daily for three days, then nothing for four days, repeat this cycle up to four times
The patient would be shown by the prescriber where all the warts are, so they can be sure they are treating all of them
HPV vaccination programme
• Girls and boys under 15 are given two doses of Gardasil® at least six months apart
• Older people can access the vaccination privately
• Cervical cancer screening
• Testing for the presence of HPV
• Testing for cellular changes
What is gonorrhoea?
Gonorrhoea
• Gonorrhoea infection is caused by Neisseria gonorrhoeae, which is a Gram-negative bacterium.
• N. gonorrhoeae has developed resistance to most antibiotics used for treatment, and so antibiotics are now used in combination.
Symptoms: In women: • Increased vaginal discharge – thick green/yellow • Lower abdominal pain • Dysuria – with no change in frequency • Pain during sex • Intermenstrual bleeding In men: • Purulent urethral discharge • Dysuria – with no change in frequency
What is the treatment for gonorrhoea?
Dependent on local resistance patterns
Usually: Ceftriaxone 500mg IM injection – single dose
• Generally managed in secondary care
• Important that a test of cure is carried out
• Contact tracing is important
What is syphillis?
infection is caused by Treponema pallidum, which is a spirochaete bacterium. It is Gram-negative but is considered too thin to be Gram stained.
Stages: Primary:
• Presents as a single ulcer (chancre) in the anogenital region
• Usually develops 14-21 days after infection
• Can be 0.3-3cm in size
Secondary:
• Presents as a non-itchy rash – often involving the palms of the hands and the soles of the feet
• Wart-like lesions
• Fever, headache, and malaise
Tertiary:
• Rarely seen – due to effective antibiotics
What is treatment for syphillis?
Treatment:
• Benzathine benzylpenicillin - unlicensed
• 2.4 Mega Unit IM injection – single dose
• The benzathine component makes it a long-acting treatment
What is Trichomonas vaginalis (TV)
infection caused by Trichomonas vaginalis, which is a protozoa. Symptoms: In women: • Changes to vaginal discharge o Classically frothy and yellow-green o Can be thinner or thicker than usual o Can be more or less than usual • Vulvovaginal itching or soreness • Vaginal odour • Dysuria In men: • Urethral discharge • Dysuria • Balanitis • Urethritis
What is the treatment for Trichomonas vaginalis (TV)?
• Metronidazole
o 400mg BD for 5-7 days
o 2g single dose
o The single dose may cause more side effects
• Better adherence to the single dose
• The longer course is possibly more effective
• Contact tracing and follow up is important
• No sexual activity for a week
