STIs Flashcards
Investigations in asymptomatic heterosexual men:
a) Chlam/Clap
b) HIV/syphilis
a) First void urine for dual chlamydia (CT) and gonorrhoea (GC) nucleic acid amplification test (NAAT)
b) Venous blood sample for serological testing for syphilis (STS) and HIV
Investigating straight men WITH symptoms
a) Chlam/clap (2 extra vs. asymptomatic)
b) HIV/syphilis
a) - First void urine for CT/GC NAAT, and…
- Urethral swab for gram staining with immediate microscopy and for GC culture on selective media
- Dipstick urinalysis
b) As for asymptomatic: venous blood for STS/HIV
Investigations in MSM (whether symptomatic or not):
a) Chlam/clap
b) HIV/syphilis (and what else?)
a) Same as heteroes PLUS…
- pharyngeal and rectal swabs for CT/GC NAAT (may be self-taken)
b) Same as heteroes (STS/HIV), PLUS…
- Hep B serology
Investigations in asymptomatic women
a) Chlam/clap
b) Syphilis/HIV
c) Also consider opportunistic…?
a) Endocervical or self-taken vulvo-vaginal swab for CT/GC NAAT
b) Venous blood for STS/ HIV
c) Cervical smear
Investigations in women WITH symptoms
a) Chlam/clap (and looking for what DDx?)
b) Syphilis/HIV
c) Also consider opportunistic…?
a) - Endocervical swabs for CT/GC NAAT and gram staining and GC culture
- HVS for wet and dry microscopy to look for candida, BV and TV (and possibly for microbial and fungal culture / sensitivity testing)
b) As for asymptomatic: Venous blood for STS/HIV
c) Cervical smear
Risk factors for STIs
a) Chlam/gonorrhoea
b) Bloodborne
a) Young age (< 25), multiple sexual partners, no use of barriers, recent partner change, co-infection with another STI
b) SHARP (Sexual partner with HIV, Homosexual, Abroad sex, Recreational drugs, Paid for sex), coinfection with another STI, immunosuppressed
Opportunistic chlamydia testing
< 25 years
Presenting to GUM clinic/ symptomatic
Prior to coil insertion
Prior to TOP
Management of chlamydia
a) 1st line
b) If contraindicated
c) In pregnancy
d) Other management should involve…?
e) General advice for patient
a) Doxycycline 7 days or single-dose oral azithromycin
b) Erythromycin
c) Azithro or erythro (NOT DOXY!)
d) Screen for other STIs, partner notification, safe sex practices and contraception discussed
e) NO sex till course is complete (even with condom)
Management of gonorrhoea
a) 1st line
b) In pregnancy
a) Stat: azithromycin (oral) + ceftriaxone (IM)
b) Same
Complications of chlam/clap:
a) During pregnancy
b) Other - women
c) Other - men
a) PROM, preterm delivery and LBW, post-partum endometritis, ophthalmia neonatorum
b) PID, infertility, ectopic pregnancy, Fitz-Hugh-Curtis syndrome (peri-hepatitis, RUQ pain), reactive arthritis
c) epididymo-orchitis, reactive arthritis, prostatitis, urethral scarring and strictures
PID: risk factors
- STI (chlam, gonorrhoea) - young age, multiple partners, new partner, no barrier contraception
- TOP
- Recent insertion of IUD
PID: presentation
a) Symptoms
b) Signs
a) Bilateral lower abdominal pain. Deep dyspareunia.
Abnormal vaginal bleeding (postcoital, intermenstrual or menorrhagia). Vaginal discharge that is purulent. Systemic: urinary, nausea and vomiting.
b) Fever (> 38C), vaginal discharge, cervicitis on speculum exam, adnexal tenderness, cervical excitation, abominal tenderness
PID: investigations
a) Bedside tests
b) Bloods
c) Other tests
a) Urine test for beta-hCG, urinalysis for UTI, endocervical swabs for chlamydia/gonorrhoea and send for NAAT and gram staining/culture
b) Serum beta-hCG, FBC and CRP
c) TVUS, diagnostic laparoscopy
PID: management
a) Initial
b) OP management
c) Indications for IP management
d) Further management
a) Analgesia. If severe, inpatient care with IV fluids
b) IM ceftriaxone STAT followed by 2/52 doxycycline and metronidazole
c) Fever > 38C, peritonitis, pregnancy: recommend IV therapy for 24h after clinical improvement before switching to oral as above
d) Partner screening (and empirical treatment for chlamydia and gonorrhoea), contact tracing, advise against unprotected sex until course finished, advise safe sex practices
Bacterial vaginosis:
a) Risk factors - sexual and non-sexual
b) Presentation - many are…? Main symptom?
c) Diagnostic criteria: 3 things to confirm
d) Example organism cause
a) Multiple sexual partners, new sexual partner, other STIs, vaginal douching, smoking, IUD, bubble baths
b) Asymptomatic, fishy-smelling watery discharge
c) Fishy discharge (whiff test), pH > 4.5, clue cells on microscopy
d) Gardenerella vaginalis -grows in depleted lactobacilli (high pH) environment
