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TM: Syndromic Approach to STIs (ii) (Chlamydia (tx: antibiotics with good…
TM: Syndromic Approach to STIs (ii)
gonorrhoea
gram -ve intracellular diplococcus
350000 cases reported annually, >50% asymptomatic
local infection: urethritis, cervicitis
extra-genital infection: pharyngitis, proctitis, conjunctivitis
higher risk in females
esp menstruation, IUCD, adolescence
15% get ascending infection -> PID
premature delivery (PROM), neonatal infected as it passes through birth canal (conjunctivitis)
haematogenous dissemination
reactive monoarthritis (do joint aspirate)
tenosynovitis (inflamm of synovium)
skin lesions
meningitis
infective endocarditis
investigations
culture of any secretions which may contain N gonorrhoeae, incl synovial fluid
NAAT on urine
cervix speculum exam: will be inflamed
Tx
ceftriaxone 250mg IM stat (3GC, single DOT)
if penicillin allergic: spectinomycin 2G IM stat
Chlamydia
gram -ve obligate intracellular organism
certain serovars cause different diseases
trachoma
urethritis/cervicitis
LGV
most common STI in Ire: 5-10% of sexually active adults in early 20s get it
75% asymptomatic
cervicitis
irregular vaginal bleeding
purulent endocervical discharge
epididymitis (common in men < 35)
urethritis (watery discharge)
PID
proctitis
prostatitis
fertility problems
Reiter's syndrome = triad of
aseptic arthritis
conjunctivitis
mucocut lesions
tx: antibiotics with good ic concs
azithromycin 1g po stat
doxycycline 100mg bd for 1 wk
erythromycin
ofloxacin
Bacterial vaginosis
diversification of vaginal flora (facultative anaerobes)
increased in pH (>4.5)
50-75% asymptomatic
common in childbearing age
a/w sexual activity but not a true STI - may increase risk of getting STI
watery/white discharge with fishy odour
coats epithelial cells - Clue Cells
Gardnerella vaginalis
Tx: metronidazole 500mg BD for 7 d
trichomonas vaginalis
most common non-viral STI worldwide
flagellated protozoan
urethritis in males
strawberry cervix
co-infection common
may resolve spontaneously (20-25%)
Tx: metronidazole 2G PO stat
Candida albicans
not an STI
overgrowth of normal vaginal flora
risk factors
antibiotics
pregnancy
OCP
DM (hyperglycaemia)
IUCD
diaphragm
HIV (v common)
curdy white discharge, pruritis
Tx: fluconazole 150 mg stat + topical azoles
relieve symptoms + tx as early as possible
recurrence common: test blood/urine glucose, esp in oder overweight women
PID
Chlamydia
gonorrhoea
anaerobes
mycoplasma
acute + subclinical infection of upper genital tract
chronic pelvic pain
deep dyspareunia
abnormal bleeding/discahrge
adnexal (joins cervix + uterus) + cervical motion tenderness on bimanual exam (1 hand on abdo, 1 inside pushing ovaries, pain = +ve)
fever
long-term problems
infertility
x7-10 increased risk of ectopic pregnancy (as cilia on fallopian tube become inflamed + can't do their job)
tx: empiric antimicrobials x2 wks, possible admit, remove IUD
HSV
primary infection often asymptomatic, likewise contact
multiple vesicular lesions + mild systemic symptoms
HSV1 or 2
90% of recurrent genital herpes is HSV2
viral shedding occurs 5-20% of days in absences of lesions
Dx
PCR
viral culture of ulcer
Tx
symptomatic
topical anaesthetic
saline baths
analgesia
antivirals
e.g. acyclovir
take episodically @ beginning/just before flare-up: reduces severity + duration
effective @ suppression (decreases transmission)
expensive
Medical strategies for STI control
primary care accessibility
well-defined appropriate correctly implemented protocols, incl partners even if asymptomatic
low cost, ideally free
single visit, attendance compliance, early tx (reduces transmission)
prevent asymptomatic infection left untxed