STIs Flashcards
most common STI in the UK?
chlamydia
describe chlamydia bacteria
gram -ve obligate intracellular bacterium
vaginal, oral or anal transmission
chlamydia pathogenesis?
unclear
mucosal epithelial cells are primary target, bacteria replicates within vacuole in cytoplasm of host cell
risk of pelvic inflammatory disease in chlamydia?
9%
- risk of ectopic pregnancy
how does chlamydia present in females?
often asymptomatic post coital or intermenstrual bleeding lower abdominal pain dyspareunia mucopurulent cervicitis
how does chlamydia present in males?
urethral discharge dysuria urethritis epididymo-orchitis proctitis (LGV)
potential complications of chlamydia?
PID reactive arthritis (urethritis, uveitis, arthritis) conjuntivitis (more in babies) Fitz-hugh curtis syndrome (perihepatitis) transmission to neonate tubal damage ectopic pregnancy chronic pelvic pain
advice in chlamydia testing?
stop testing for chlamydia in women >25 with discharge (more likely to be candida)
do test women who have had chlamydia in the past year
- 1 in 5 become reinfected within 10 months
serovars L1-L3 of chlamydia?
lymphogranuloma verenum (LGV) type of chlamydia more common in MSM and tropical regions
features of serovars L1-L3?
rectal pain
discharge
bleeding
high risk of concurrent STIs
how is chlamydia diagnosed?
test 14 days after exposure
do NAAT
- vulvovaginal swab in females (self taken)
- first pass urine in males (self taken)
- ass rectal swab if receptive anal intercourse
how is chalmydia treated?
most commonly used doxycyline 100mg BD for 7 days
can still use single 1g dose of azithromycin followed by 500mg daily for next 2 days but not used as much (resistance)
what is mycoplasma genitalium?
emerging STI
associated with non-gonococcal urethritis and PID
- if treatment fails for either of these then test for mycoplasma genitalium
how is mycoplasma genitalium tested?
NAAT (same sites as chlamydia)
ghonoorhoea bacteria?
gram -ve intracellular diplococcus
primary sites of infection in gonorrhoea?
mucous membranes of urethra, endocervix, rectum and pharynx
incubation of gonorrhoea?
urehtral infection in men = 2-5 days
in which direction is gonorrhoea most likely to be transmitted?
more likely in male to female
how does gonorrhoea present in males?
only <10% are asymptomatic green/yellow purulent urethral discharge dysuria pharyngeal/rectal infections - mostly asymptomatic
how does gonorrhoea present in females?
up to 50% are asymptomatic
increased/altered vaginal discharge (in 40%)
dysuria
pelvic pain (<5%)
pharyngeal and rectal infection are usually asymptomatic
potential complications in gonorrhoea?
barthonlinitis tysonitis periurethral abscess rectal abscess epididymitis urethral stricture endometritis PID hydrosalpinx infertility ectopic pregnancy prostatitis
how is gonorrhoea diagnosed?
NAAT screening test microscopy (if symptomatic) - more sensitive in urethral vs endocervical culture (if micro +ve or contact of GC) - gives antibiotic sensitivity
how is gonorrhoea treated?
1st line = ceftriaxone 1g IM
2nd line = cefixime 400mg and azithromycin 2g oral (only if IM injection is contraindicated or refused by patient)
always test for cure after 2 weeks in patient
- check all sites where they had a positive swab
3 classifications of genital herpes presentations?
primary infection
non-primary first episode (have already been exposed but first symptomatic presentation)
recurrent infection
