STI's Medicine notes

INFECTION

ORGANISM

SYMPTOMS/SIGNS

DIAGNOSIS

TREATMENT

RISKS

THRUSH

Candida Albicans

White ‘cottage cheese/curd’, nonoffnsive discharge. Vulval or vaginal redness, fissured or sore. (Vulvitis)

MICROSCOPY: strings of mycelium or oval spores. & CULTURE

Topical treatment – CLOTRIMAZOLE 500mg pessary + cream for vulva (if pregnant or breastfeeding) FLUCANOZOLE 150mg PO

Pregnancy Contraception Steroids Immunodeficiency Abx Diabetes

HIGH VAGINAL MICROSCOPY: Vaginal epithelial ‘clue cells’. Coccobacilli

METRONIDAZOLE 2g PO once. CLINDAMYCIN 2% vaginal cream pv 7nights.

++ preterm labour

Males – rash, balbingitis

BACTERIAL VAGINOSIS

Gardenella, Mycoplasma hominis Peptostreptococci Mobiluncus Bacteriodes

Thin, off white, fishy smelling discharge. Vaginal infamy or itch uncommon. Vaginal pH > 4.5

intra amniotic infection.

Pregnant = metroinidazole 400mg/12h PO 5d. TRICHOMONAS VAGINALIS

Flagellated protozoa, Anaerobic

Thin, bubbly/frothy, yellow discharge Irritant vulvo-valginits

HIGH VAGINAL MICROSCOPY: Motile flagella CYTOLOGY: ‘strawberry cervix – colpitis.

METRONIDAZOLE 400mg/12h PO 5d OR 2g PO stat. Pregnant (5day routine)

Exclude gonnorhoea (often co-exsists)

CHLAMYDIA

C. Trachomonis – 50%

Asymptomatic nature ~80% Vaginal discharge +/dysuria Postcoital bleeding IMB

ENDOCERVICAL MICROSCOPY: C. Trachomatis (obligate intracellular pathogen) (reticulate bodies)

PID – L abdo pain, dyspareaunia, IMB MEN – acute epidiymoorchitis, urithritis, discharge GONNORHOEA

Niesseria Gonnorrhoea, Gram –ve

Usually asymptomatic ~50% Vaginal dischage – white/green/yellow, distinctive smell Dysuria Dysparaeria MEN- urethral discharge +/- dysuria Proctitis, tenesmus,

ENDOCERVICAL MICROBIOLOGY: Gram –ve intracellular diplococci

DOXYCYCLINE 100mg/12h PO 7days

OFLOXACIN 400mg/d 7d

PID Infertility Ectopic Pragnany – PROM, late miscarriage Neonate – conjunctivits, pneaumonia

Pregnancy – Azithromycin as above Erythromycin 500mg bd 14d

Perihepititis – adhesions btwn liver capsule and ant abdo wall.

CIPROFLOXACIN 500mg PO stat

Acute prostitis Epidiymo-orchitis Bartholn’s gland abscess PID Perihepititis Systemic septicaemia (petechiae, hand/foot pustules, arthritis, fever – reiters) Opthalmia neonatorum Infertility

AZITHROMYCIN 1g po (single dose)

CEFTRIAXONE 250mg IM stat OFLOXACIN 400mg PO stat CEFIXIME 400mg Postat (50% concomitant so trat also)

GENITAL HERPES HSV –1 HSV- 2

Irritable lesions – rupture to form small, tender ulcers on ex.genitalia

PAP SMEAR

ACICLOVIR 200mg OD 5d FAMCICLOVIR 250mg 8hrly

Lesions at urethra, vagina, cervix, perianally, anus with assoc dysuria, vaginal/urethral discharge, pain.

VALACICLOVIR 500mg 12hrly Pregnancy- aciclovir

HSV in neonateseptic, dissemination to lungs, liver & CNS.

Constitutional – fever, headache, malaise Dermatome based ANOGENITAL WARTS

HPV-6 HPV-11

Subclinical infection Warts on penis, vulva, vagina, cervix, perineum or anus. Oral warts

Urinary retention (autonomic neuropathy) aseptic meningitis recurrent episodes – particularly with stress. Prodromal synirritation, burning, neuralgic pains

CYTOLOGY: HPV changes Koilocytotic cells

Use barrier contraception ~3m. 0.5% podophyllotoxin soln 12h/ 3d, 4days rest fro 4 weeks topical 90% trichlloroacetic acid wkly

SYPHILIS

Treponema Pallidum

PRIMARY Incubation 14-28d CHANCRE –painless, ulcerated lesion ENLARGED LYMPH NODESmobile,descrete,rubbery SECONDARY 6-8 wks post chancre due to dissemantion = multisystem disease. RASH – palms and soles feet, (initially macular on trunk and limbs) FEVER< MALAISE CONDYLOMATA LATA – papules coalesque to plaques (warm moist areas ie. vulva, perianal area) MUCOSAL PATCHES – genitalia, mouth, pharynx larynx, eroded papules.

SEROLOGY: Non treponemal test: IgG and IgM levels using cardilolipn antigen Often –ve in pt with just chancres Treponemal test: FTA-ABS test – t.pallidum immobilized Both +ve by 3m

PROCAINEBENZYLPENICCILLIN G, 1.2MU IM 12d BENZATHINE PEN G Or ERYTHROMYCIN (early) DOXYCLYCLATE HYCLATE (late)

Others = meningitis, ureittis, CN palsy, gastritis, hepatitis LATE/TERTIARY 3-10yrs post infection CHRONIC GRANULOMATOUS LESIONS – gumma at skin, muous mem, bone , muscle, vulva involvement tongue may cause leukopenia + rsik malignant change. ARGYLE ROBERTSON PUPIL – small and not constrict to light. DEMUSSET – pigeon head bob NEUROSYPHILLIS – meningovascular syphilis = stroke CARDIOSYPHILLIS – aortic aneurysm, AR.

HX in GUM CLINIC PC –

vaginal discharge - how much - colour - smell Vaginal irritation – itchiness, soreness, redness Dysuria Dyspareunia Post-coital bleeding IMB Pelvic pain

HPC – how long?, how much? Etc….. Sexual Hx –

PMC Drug Hx

no of partners or recent change of partner? Casual vs regular Type of sex ie. oral, active, passive Use barrier contraception? Travel hx Recent or previous STI infection or test (result and treatment)