STIs Flashcards
(51 cards)
1
Q
Examples of infections which can be transmitted sexually but aren’t STIs
A
- Hep A
- Hep C
- Zika
- Giardiasis
2
Q
Difference between STI and STD
A
- STI - infection which is predominantly sexually transmitted
- Chlamydia trachomatis
- HIV
- STD - disease caused by infection
- HPV is STI and warts is the STD
3
Q
General principles of STI
A
- If have one, risk of having others
- Most symptomatic - detection difficult
- Delay in diagnosis can lead to increased transmission and complications
- Can be traumatising
- Partner contact essential
- MD approach
4
Q
Cause of gonorrhoea
A
- Neisseria gonorrhoea
5
Q
Male symptoms of gonorrhoea
A
- 10% no symptoms (might have clinical signs)
- Thick profuse yellow discharge
- Dysuria
- Rectal and pharyngeal infections often asymptomatic
6
Q
Female symptoms of gonorrhoea
A
- >50% have no symptoms
- Vaginal discharge
- dysuria
- Intermenstural/post-coital bleeding
7
Q
Male complications of gonorrhoea
A
- Epididymitis
8
Q
female complications of gonorrhoea
A
- Pelvic inflammatory disease
- Bartholin’s abscess [Gonococcal ophthalmia neonatrium]
9
Q
Both complications of gonorrhoea
A
- Rare
- Acute monoarthritis - usually elbow or shoulder
- Disseminated gonococcal infection - skin lesions (pustular with halo)
10
Q
Incubation period of gonorrhoea
A
- Average 5-6 days
- Range from 2 days - 2 weeks
11
Q
Epidemiology of gonorrhoea
A
- Approx. 150 cases/year in Grampian
- Much less common than chlamydia
- Most cases men, often MSM
12
Q
Diagnosis of gonorrhoea
A
- Nucleic acid amplification test (NAAT) on urine or swab from site
- vagina, rectum, throat - clinician or self obtained
- Gram-stained smear from urethra/cervix/rectum in symptomatic people
- Culture of swab-obtained specimen from an exposed site using highly selective lysed blood agar in a 5% CO2 environment
- Should be done for all confirmed cases to assess antibiotic sensitivity
13
Q
Treatment of gonorrhoea
A
- Blind treatment with ceftriaxone 1g im
- Can also be treated according to sensitivities
14
Q
Follow up of gonorrhoea
A
- Test of cure at 2 weeks
- Test of reinfection at 3 months
15
Q
Cause of chlamydia
A
- Chlamydia trachomatis serovars D to K
- The rare Serovar L2b, which causes Lymphogranuloma venereum, usually gives symptoms of severe proctitis
16
Q
Male symptoms of chlamydia
A
- >70% asymptomatic
- Slightly watery discharge
17
Q
Female symptoms of chlamydia
A
- >80% asymptomatic
- Vaginal discharge
- Dysuria
- Intermenstrual/post-coital bleeding
18
Q
Both symptoms of chlamydia
A
- conjuctivitis
19
Q
Male complications of chlamydia
A
- Epididymitis
20
Q
Female complications of chlamydia
A
- PID - hence ectopic pregnancy, pelvic pain and infertility
- Only 1% infertility problems
21
Q
Both complications of chlamydia
A
- Reactive arthritis/Reiter’s syndrome
- Urethritis/cervicitis + conjuctivitis+ arthritis
22
Q
Epidemiology of chlamydia
A
- Common - approx 2000 cases/year in Grampian
- Most cases people <25, especially sexually active teenage women
23
Q
Diagnosis of chlamydia
A
- First void urine in men
- Self-taken or clinician-taken swab from cervix, urethra, rectum
- All specimens testing using NAAT
24
Q
Treatment of chlamydia
A
- Doxycycline 100mg bd 1 week
- Azithromycin 1g po once if pregnant
25
Follow up of chlamydia
* test for reinfection at 3-12 months
* test of cure not needed unless symptoms persist
26
What causes herpes
* HSV 1 & 2
27
Symptoms of herpes
* 80% have no symptoms - the rest recurring
* Burning/itching then blistering then tender ulceration
* Tender inguinal lymphadenopathy, flu-like symptoms
* Dysuria, neuralgic pain in back, pelvis, legs
28
Complications of herpes
* Autonomic neuropathy (urinary retention)
* Neonatal infection
* Secondary infection
29
Incubation period of herpes
* About 5 days to months
* Some never report symptoms
30
Epidemiology of herpes
* Very common - 15-20%
* Both strains equally as common in genital infection
* Roughly equal between sexes
* HSV2 is important co-factor for HIV transmission
31
Diagnosis of herpes
* clinical impression Swab from lesion tested using PCR
32
Treatment of herpes
* Primary outbreak
* Aciclovir: various regimes e.g. 400mg tds for 5 days
* Lidocaine ointment
* Infrequent recurrence
* Lidocaine ointment
* Aciclovir 1.2g once daily until symptoms gone (1-3 days)
* Frequent recurrence
* Aciclovir 400bd long-term suppression
33
Cause of trichomoniasis
* *Trichomonas vaginalis*
34
Male symptoms of trichomoniasis
* Usually asymptomatic
35
Female symptoms of trichomoniasis
* 10-30% asymptomatic
* Profuse thin vaginal discharge - greenish, frothy and foul-smelling
* Vulvitis
36
Epidemiology of trichomoniasis
* Uncommon approx 100/year in Grampian
* More common in middle age women than some other STIs
37
Complications of trichomoniasis
* Miscarriage and pre-term labour
38
Diagnosis of trichomoniasis
* Metronidazole
39
Cause of anogenital warts
* HPV type 6&11 (occasionally 1)
* Different to strains that cause cervical cancer
40
Symptoms of anogenital warts
* Lumps with a surface texture of a small cauliflower
* Occasionally itching or bleeding especially perianal or intraurethral
41
Epidemiology of anogenital warts
* \>90% have HPV infection at some point
* only 20% of those with wart causing strain get warts
* Drop in cases anticipated due to vaccine
42
Complications of anogenital warts
* None common
* Neonatal laryngeal papillomatosis
43
Diagnosis of anogenital warts
* Appearance
* Biopsy if unusual - to exclude intraepithelial neoplasia
44
Treatment of anogenital warts
* Popophyllotoxin (brans warticon and condyline), imiquimod (bran Aldara)
* Both home treatments
* Others - cryotherapy
* Bulkywarts - diathermy, scissor removal
45
Cause of syphilis
* *treponema pallidum* subspecies *pallidum*
46
Symptoms of syphilis
* Diverse
* Often entirely asymptomatic or mild symptoms which go unreported
* Primary - often ulcer
* Secondary - rash, mucosal ulceration, neuro symptoms, patchy alopecia
* Early latent - no symptoms but \<2 years since caught
* Late latent - no symptoms but \>2 years since caught
* Tertiary - neurological, cardiovascular or gummatous - skin lesions
47
Epidemiology of syphilis
* Approx. 20 cases/year in Grampian
* \>90% cases MSM
48
Complications of syphilis
* Neurosyphilis - cranial nerve palsies are commonest, cardiac or aortal involvement
* Congenital syphilis (rare)
49
Incubation of syphilis
* 9-90 days until appearance of chancre but can be asymptomatic
50
Diagnosis of syphilis
* Clinical signs
* Serology for TP IgEIA, TPPA and RPR
* PCR on samples from an ulcer
51
Treatment of syphilis
* Early (\<2 years and no neurological involvement)
* Benzathine penicillin 2.4 MU im once
* Or doxycycline 100mg bd po 2 weeks
* Late (\>2 years) an no neurological involvement
* Benzathine penicillin 2.4 MU im weekly for 3 doses
* Doxycycline 100mg bd po 28 days
