STI/ sexual health Flashcards
(32 cards)
Features of Chlamydia in women vs men?
Features:
asymptomatic in around 70% of women and 50% of men
women: cervicitis (discharge, bleeding), dysuria
men: urethral discharge, dysuria
Complications of Chlamydia?
epididymitis
pelvic inflammatory disease
endometritis
increased incidence of ectopic pregnancies
infertility
reactive arthritis
perihepatitis (Fitz-Hugh-Curtis syndrome)- complication of PID causing liver inflammation/ adhesions
Investigation for Chlamydia?
Women
Men
Swabs for NAAT
Women: vulvovaginal and urine sample
Men: urine sample (first-line) and urethral swab
First-void sample
Testing should be done 2-weeks after possible exposure
Management for Chlamydia?
First line: Oral doxycycline- 7 days
-Azithromycin if doxy contraindicated (pregnancy)- azithromycin, erythromycin or amoxicillin
-Patients should be offered GUM service/ RN for initial partner notification
-Contact tracing- treat then test
-Abstinence until treatment complete
Syphilis causative organism?
Stages disease + symptoms
Incubation period?
Spirochaete Treponema pallidum
Primary features:
chancre - painless ulcer at the site of sexual contact
local non-tender lymphadenopathy
Secondary features: occurs 6-10 weeks after primary infection
systemic symptoms: fevers, lymphadenopathy
rash on trunk, palms and soles
buccal ‘snail track’ ulcers (30%)
condylomata lata (painless, warty lesions on the genitalia)
Tertiary features:
gummas (granulomatous lesions of the skin and bones)
ascending aortic aneurysms
general paralysis of the insane
Argyll- Robertson pupil
Investigations for Syphilis?
Non-treponemal tests:
non-specific for syphilis and can result in false positives and assesses quantity of Abs produced
-rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL)
treponemal-specific tests:
generally more complex and expensive but specific for syphilis
TP-EIA (T. pallidum enzyme immunoassay), TPHA (T. pallidum HaemAgglutination test)
Management for Syphilis?
Primary, secondary, and early latent syphilis: A single dose of IM penicillin G (benzathine benzylpenicillin) is the first-line therapy.
Tertiary and late latent syphilis or syphilis of unknown duration: Requires a longer course of IM penicillin G for 2-3 weeks.
Neurosyphilis: Treated with IV penicillin G for 10-14 days.
Patients allergic to penicillin may be given doxycycline or tetracycline.
Jarisch-Herxheimer reaction may occur on treatment initiation- acute febrile illness resolving within 24-hours, give antipyretics + reassurance
What cells are seen on microscopy in BV?
Amsel’s diagnostic criteria?- 4 points
Clue cells
Amsel’s criteria 3/4 should be present:
-thin, white homogenous discharge
-clue cells on microscopy
-vaginal pH > 4.5
-positive whiff test (addition of potassium hydroxide results in fishy odour)
Management for BV?
Asymptomatic- no treatment required
Symptomatic- oral metronidazole for 5-7 days (can be used in pregnancy)
Gonorrhoea causiatve organism?
Features in men vs women?
Gram-negative diplococcus Neisseria gonorrhoeae
-males: urethral discharge, dysuria
-females: cervicitis leading to vaginal discharge, bleeding
Investigations for Gonorrhoea?
Self-taken vulvovaginal swab- women
Self-obtained first pass urine- men
Self-obtained rectal swab
Clinician-obtained endocervical or penile swab
Microscopy
NAAT
Culture
Management for Gonorrhoea?
Ceftriaxone IM- first-line
Alternative: IM gentamicin or oral cefixime, both with azithromycin orally.
Ciprofloxacin should only be considered when sensitivities are known and there are no suitable alternative antibiotics.
Causative organisms in PID?
Chlamydia trachomatis: the most common cause
Neisseria gonorrhoeae
Mycoplasma genitalium
Mycoplasma hominis
Investigations for PID?
pregnancy test- exclude ectopic
high-vaginal swab
Chlamydia/ Gonorrhoea screen
Management for PID?
First-line:
stat IM ceftriaxone + followed by 14 days of oral doxycycline + oral metronidazole
Second-line:
oral ofloxacin + oral metronidazole
Complications of PID?
Perihepatitis (Fitz-Hugh Curtis Syndrome)
Infertility
Chronic pelvic pain
Ectopic pregnancy
Features of of Trichomonas vaginalis?
Investigation and what it shows?
offensive, yellow/green, frothy discharge
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis
Investigation:
-microscopy of a wet mount shows motile trophozoites
NAAT
High-vaginal swab
Management for Trichamonas vaginalis?
Oral metronidazole 400-500mg TDS for 5-7 days
OR single dose of 2g orally
Abstinence until treatment done and both partners treated at the same time
Predisposing factors for vaginal candidiasis?
DM
HIV
Pregnancy
Drugs- steroids, Abx
Management for thrush?
-Oral fluconazole 150mg as a single dose first-line
-Clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated
-If there are vulval symptoms- topical imidazole in addition to an oral or intravaginal antifungal
-If pregnant, then only local treatments (cream or pessaries) may be used - oral treatments are contraindicated
Investigations for genital herpes?
Hx
Exam
Swabs of ulcer for NAAT- most effective
HSV serology- only if recurrent
Management for genital herpes?
Conservative:
-saline bathing
-analgesia
-topical anaesthetic agents- lidocaine
Medical:
-oral aciclovir started within 5 days of sx onset
Pregnancy:
-elective c-section if attack occurs >28 weeks
-should be treated with suppressive therapy
What is Lichen sclerosus?
Features/ Sx?
Investigations?
Management?
Complications?
Inflammatory condition affecting the genitalia, more common in elderly females.
Leads to atrophy and white plaques
Sx:
-white plaques that may scar
-itching
-pain on urination/ intercourse
Investigations:
-clinical diagnosis but can take biopsy if atypical features
Management:
-topical steroids/emollients
Complications:
-risk of vulval cancer
Causes of genital warts?
HPV 6 and 11
