STI Flashcards
(27 cards)
State 5 risk factors for STI contraction
- young age (<20 years) - low age at 1st intercourse - coitarche
- frequent partner change, high no. lifetime partners, concurrency (simultaneous partners)
- sexual orientation
- ethnicity for some STIs
- use of non barrier contraception
- residence in inner city/ deprivation
- history of previous STI
What are the effects of having sex at an early age?
- Poor subsequent sexual health status
- higher numbers of sexual partners / partners change
- greater numbers of concurrent partners
- yet to develop skills and confidence to use condoms, negotiate safe sex,
- more risk-taking behaviour/ experimentation
- poor contraception awareness
- Physiological changes increase susceptibility to pathology
What is tthe correlation between consent and age?
The earlier intercourse occurs, the more people express regret and rport being more/less willing than their partner
20% men
42% women wish they waited
Rx factors for young people having poor sexual health/ early coitarche
- leaving home / not living with parents before 16 years
- leaving school early
- family disruption & disadvantage
- lack of nurturing relationships
- those whose main source of information on sex was not school / parents
Where do young people get sexual information from?
- Parents
- School
- Books
- Internet (porn)
Internet is free, unrestricted and UNCENSORED. Its unrealistic and raises expectations
State 5 negative aspects of porn
- Unrealistic nature & expectations
- Self-image / performance anxiety
- Lack of censorship / boundaries – hardcore material becomes addictive / normalised
- Ethical issues e.g. exploitation of women
- Sexual consent blurred
- Lack of condom use = reduced risk perception / perceived need to practice safe sex
What should we be telling young people about sex?
- Don’t rush, avoid peer pressure
- Use a condom with all new partners, continue until both screened
- Sort out contraception
- Avoid overlapping sexual relationships
- Get screened for chlamydia/gonorrhoea when you have a new partner
- MSM should have regular sexual health screens, including HIV, get vaccinated for hepatitis A/B and HPV & consider PrEP for HIV prevention
What is the definition of a “core group”
Why are these relevant?
- sub-group of the population, high turnover
- not a static entity
- highly sexually active individuals
- high prevalence of infection
- reservoirs of infection
- high frequency of transmission
Effective control at the population level based on targeting core groups
What is GMC guidelines regarding a genital examination?
- OFFER a chaperone
- Explain to patient why examination is necessary & what it will involve
- Give patient privacy to undress & dress
- Obtain patient’s permission before the examination - discontinue if patient asks you to
- Keep discussion relevant - avoid unnecessary comments
How would you conduct a female genital examination?
- Inspect pubic area, labia majora & minora & perianal area
- Inspect & palpate inguinal region
- Use leg rests - allow better visualisation
- Speculum examination (use water as lubricant - gels can interfere with tests)
- Bimanual examination (if indicated)
How would you conduct a male genital examination?
- Inspect pubic area, inguinal region
- Inspect scrotum & perianal area
- Palpate scrotal contents – note presence of testes, any lumps/ tenderness
- Inspect penis - record whether circumcised - if not inspect under foreskin
- Particular attention to coronal sulcus, frenulum & meatus
- Note presence of urethral discharge
What are pearly penile papules?
What is the female equivalent?
- Normal variation in penis
- Vulval papules / papillomatosis
How can normal subaceous glands become pathological
- Subaceuous glands can turn into subaceous cysts (these are not always pathological
How does psoriasis appear in the moist genital areas?
If you suspect psoriasis what else would you ask/check
Red
- FHx,
- Asthma
- Check elbows
How does scabbies present?
Is scabbies exclusively a STI?
Pruritic papules (red spots on penis)
- Lesions and burrows in finger webs and wrist
No
Consider the bacterial and protozoal category of STIs.
- Give examples
- How do they present?
- Treatment?
Chlamydia, gonorrhoea, syphilis, trichomonas
- more often florid symptoms
- early presentation
- rapid diagnosis
- effective treatment available
- curative
- reservoirs can be controlled
Consider the viral category of STIs.
- Give examples
- How do they present?
- Treatment?
Herpes, warts, HIV, hepatitis
- many unaware of infection –> delayed presentation
- diagnostic tests may be unreliable
- symptomatic treatment only
often life-long - expanding reservoirs
Presentation of gonorrhoea and chlamydia
- Dysuria
- Discharge
What does gonorrhoea discharge look like microscopically?
- Gram negative intracelllular diplococci
How fast will primary syphilis appear?
Presentation?
1-3 weeks after contact (9-90 days), red mark raised spot ulcer at the site of contact
Enlarged lymph nodes in the groin/neck, heals within 1-3 weeks (with or without treatment)
Not painful
How fast will secondary syphilis appear?
Presentation?
- 2-6 weeks after stage 1 (lasts 2-4 weeks)
Systemic dissemination - millions spirochaetes spread through-out the body
Flu-like illness, headache, lymphadenopathy
Mouth ulcers - “snail track” painless
Condylomata lata - white/grey lumps in moist areas
Arthritis
Rapid resolution with effective treatment
Particularly suspect if rash involves palms & soles
Describe trichomonas vaginalis , its symptoms and causes
- Diagnosis?
- Treatment?
Single cell protozoan parasite
Infects vagina & urethra
Dysuria, discharge
Causes frothy discharge, “strawberry cervix”
Diagnosed by seeing motile organisms on microscopy
Responds well to metronidazole
Genital warts causes?
Are increased cervical smears recommended in patients with genital warts?
HPV 6 and 11
No.
State 2 symptoms of Herpes simplex
State 2 signs of Herpes simplex
What proportion of people are aware they have genital herpes?
Type 1 and type 2 herpes simplex cause…
Symptoms
- painful ulceration, dysuria, vaginal discharge
- systemic symptoms e.g. fever and myalgia (more common in 10)
Signs
- blistering & ulceration (+/- cervix/rectum)
- inguinal lymphadenopathy
20%
Genital herpes and cold sores. Not mutually exclusive
