STI
Most common infection = Chlamydia
Most common colonisation = HSV
Sexual History
P ractices
P rotection
P artners
P revious STI
P regnancy
Clinical Features
Chlamydia
Gonorrhoea
Trichomonas
HSV1/2
HPV
Syphillis
HIV
Investigations
NOTE: Test for other STIs if 1 is found
Chlamydia
Gonorrhoea
Trichomonas
HSV1/2
Syphilis
HIV
Management
Education: Condom is best prevention
Chlamydia
Gonorrhoea
Trichomonas
NOTE: Alcohol makes pt very ill
HSV1/2
HPV
Syphilis
HIV
Complications
Chlamydia/ Gonorrhoea
Source
Dr Felicity Dukes 2014
Most common colonisation = HSV
Sexual History
P ractices
P rotection
P artners
P revious STI
P regnancy
Clinical Features
Chlamydia
- Can be asymptomatic
- Women: vaginal discharge, irregular PV bleed (esp post coital), pelvic pain, dyspareunia, dysuria
- Men: penile discharge, urethra erythema, dysuria
- Neonates: anus, mouth, eyes, lung
Gonorrhoea
- same as chlamydia
- More commonly progresses to generalised sx (sepsis, arthritis)
Trichomonas
- Malodourous green vaginal discharge
- Strawberry cervix
HSV1/2
- Can be asymptomatic
- Painful genital ulcers, dysuria, lymphadenopathy
HPV
- 6/11 = genital warts; 16/18 = cervical ca
- Genital warts (can take months to develop)
- Cervical changes in pap smear
Syphillis
- Primary: painless genital sore
- Secondary (disseminated stage): generalised sx (fever, malaise, painless lymphadenopathy), condylomata lata (large painless papula plaque joining together)
HIV
- Initially asymptomatic (3mo incubation)
- Generalised sx
- Oral thrush, Karposi Sarcoma, pneumositis,
Investigations
NOTE: Test for other STIs if 1 is found
Chlamydia
- 1st void urine PCR
- Endocervical swab - PCR
Gonorrhoea
- Same as Chlamydia
Trichomonas
- Vaginal swab MCS x 4
- PCR swab
HSV1/2
- PCR from base of ulcer
- Serology
Syphilis
- Dark field microscopy
- Serology
HIV
- ELIZA,, if +ve, then Western Blot or IF
Management
Education: Condom is best prevention
Chlamydia
- Azithromycin 1g stat
- or Doxycycline 100mg BD 7/7
- No unprotected intercourse 1/52 after rx
- Test of cure: repeat test 3/52 post rx
Gonorrhoea
- Ceftriaxone 500mg IM
- Then same as Chlamydia if PID and + metronidazole 400mg
Trichomonas
- Metronidazole 2g stat with food
- Tinidazole 2g stat with food
- Metronidazole 400mg BD 7/7
NOTE: Alcohol makes pt very ill
HSV1/2
- Valcyclovir (Episodic/ suppressive therapy)
HPV
- No cure. Immune sys will clear
- Antiprolific solutions, cryotherapy, diathermy, laser, excision
- Vaccination - Gardasil (6,11,16,18), Cervarix (16,18)
Syphilis
- Penicillin IM
HIV
- HAART
Complications
Chlamydia/ Gonorrhoea
- Women: Infertility, PID
- Men: Epididymitis, orchitis, arthritis
Source
Dr Felicity Dukes 2014