STIs Flashcards
High risk population for STIs [7]
Young, <20
Frequent partner change- concurrency
Men who have sex with men
Certain ethnicities
Non-barrier contraception
Inner city/ Deprived residents
History of previous STI
Young people and STIs
Earlier coitarche = poor subsequent sexual health status
Display behaviour more vulnerable to STI
For females, physiologically more susceptible
- transforming cervix
Behaviours of young people, making them more vulnerable to STI [5]
High number of sexual partners and concurrency
Yet to develop skills and confidence in using condoms
More risk taking behaviour and experimentation
Poor contraception awareness
Yet to develop skills in negotiating safe sex
Vulnerabilities associated with early intercourse
Leaving home before 16
Leaving school at 16
Disruption in family
Main source of information on sex was not school/ parents
Where do young people get information about sex?
Parents
School
Internet [porn]
- Free, unrestricted and uncensored.
- A lot of it is unintended
Books
Negative aspects of porn
Unrealistic
- Raises unrealistic expectations
Sets performance anxiety
Lack of censorship
- Hardcore can become addictive
Ethical issues
- Exploitation
Consent blurred
Lack of condom use reduces risk perception
Concurrent relationships
Having more than one sexual partner at the same time
- Increase opportunity for transmission
- Higher rates in younger people
MSM
Men who have sex with men
- High incidence of Syphilis and gonorrhea
Ethnic group and STI rates
Chlamydia particuarly higher in Black or Black British
Mixed ethnic groups second to highest.
Lowest
- Asian/ Asian british
Core group
Sub-group of a population that is not static
- High turnover
Highly sexually active with a high prevalence of infection.
Creates reservoirs of infection
Have high frequency of transmission
GMC guidance for genital examination
Offer a chaperone
Explain the examination
Give privacy to undress and dress
Obtain consent, allowing the patent to stop the examination if required
Female genital exam
Inspect pubic area
- Majora
- Minora
- Perianal
Inspect and palpate inguinal region
Speculum
- Water as lubricant
Male genital exam
Inspect pubic area + inguinal region
Inspect scrotum and perianal region
- Palpate scrotum
Inspect penis
- Circumcised?
- Inspect under foreskin if not
Note urethral discharge
Examples of normal appearance in males
Pearly penile papules
Fordyce spots
Genital enlarged sebaceous glands
Examples of normal appearance in females
Vulval papules/ papillomatosis
Tinea cruris
Fungal infection in inguinal region
Bacterial STI presentation
More florid symptoms
Presents earlier
- Rapidly diagnosed
Effective treatment usually available/ Curative
Reservoirs can be controlled
Viral STI presentation
Many unaware on infection
- Delayed presentation
Diagnostic tests may be unreliable
Only treatments for symptoms
- Often life long
Reservoirs expanding
Bacterial STI examples
Chlamydia
Gonorrhoea
Syphilis
Protozoal STI examples
Trichomonas
Viral STI examples
Herpes
HIV
Hepatitis
Warts [HPV]
Common symptoms of gonorrhoea and syphilis
Dysuria
Discharge
Bacterial appearance of gonorrhoea
Intracellular gram negative, diplococci bacteria
Incubation period of gonorrhoea/ chlamydia
2-30
- On average 4-6.
