STIs

Dornubari Lebari SpR GUM

Overview

Sexual history taking Most common GU infections

Sexual history

Embarassing! Matter of fact Alone/with someone else Posture Language Silence The history!

Sexual history

Set the scene!

Sexual history

Warning

I need to ask some intimate questions about your sex life which may be helpful.

Reassure confidentiality

Id like to remind you that just with other things you have told me, this is also kept confidential and only the team here involved in your care will have access to the information on a need to know basis

Sexual history

Embarassing! Matter of fact Alone/with someone else Posture Language Silence The history! Summarise

Sexual history

If no symptoms:

Clarify asymptomatic

When? Regular/non-regular partner? If regular, how long for? Gender Origin (place of birth) Type of sex Condom use?

Any symptoms in partner?

Sexual history

If symptomatic:

The problem as the patient sees it How long has the problem been present? Is the problem related to the time, place, or partner? Is there a loss of sex drive or dislike of sexual contact? Are there problems in the relationship? What are the stress factors as seen by the patient and by the partner? Is there other anxiety, guilt, or anger not expressed? Are there physical problems such as pain felt by either partner?

Sexual history

Obs & gynae

LMP Cycle Contraception Cervical smear (if >25yrs) Pregnancy? TOP/miscarriage/birth? Dates!

Social aspects

The patients marital state How many previous sexual partners have there been Who the current partner is and for how long How many children the patient has Which of them lives with the patient Whether there is obvious stress in the family Whether there are financial worries

Medical aspects

Full medical history Medication history

Allergies

INFECTIONS

Bread and butter Chlamydia (the drip)

Most common STI Intracellular, ATP dependent, tiny! (0.5 1.0m) Squamocolumnar cells (D-K serovars) LGV

Transmissibility ~ 10%.
Condoms 6% Incubation 7 21 days

Chlamydia (the drip)

Asymptomatic ~ 50% (m), 80% (f) Dysuria, abnormal discharge, testicular swelling, sore throat, red eye NAAT test PID, epididymitis, prostatitis, chronic pelvic pain, ectopic pregnancy, urethral stricture Fitz-Hugh-Curtis syndrome, SARA, Azithromycin 1g stat Doxy 100mg bd 7 days No SI for 1/52 PN + Rx

Bread and butter Gonorrhoea (the clap)

Neisseria gonorrhoeae

Bread and butter Gonorrhoea (the clap)

Neisseria gonorrhoeae Transmissibility 60%-80%(mf), 20%(fm) Incubation 5-8 days (1 14 days) Asymptomatic, abnormal discharge, dysuria, abdominal pain, IMB, sore throat, red eye Microscopy Culture + Sensitivity NAAT

Gonorrhoea (the clap)

Ceftriaxone 500mg IM (with lidocaine) + Azithromycin 1g PO stat Abscesses, Urethral strictures, Cowperitis, Prostatitis, PID Fitz-Hugh-Curtis syndrome, DGI, Endocarditis, Hepatitis, Meningitis (very very rare). PN + treated

Bacterial vaginosis

NOT an STI Blacks, IUCD, smokers, sexually active Imbalance in vaginal flora Thin, white (malodorous) discharge, pH Microscopy lack of lactobacilli of varying degrees, anaerobes predominate Amsel criteria/Hay-Ison criteria Metronidazole 400mg bd for 5 7 days Avoid douching, tight clothing, using perfumed products

Trichomoniasis

Trichomonas vaginalis Flagellated protozoan Associated with other STIs Incubation 4 28 days

Asymptomatic, abnormal discharge, dysuria, abdo pain, vulval discomfort, malodorous discharge Direct microscopy

Trichomoniasis

Culture Pap smears PCR Metronidazole 400mg bd 5 7 days/2g stat

Candidiasis (thrush)

Candida species, usually albicans Itching/irritation White discharge Superficial dyspareunia External dysuria Erythema, fissuring, discharge (curdy but may be thin), oedema Clotrimazole 1% cream and/or Clotrimazole pessary

Candidiasis (thrush)

Advice:

Avoid using soaps or washing internally Avoid tight clothing Avoid local irritants

Genital warts

HPV (>100 types) Growths/bumps Itching, painless Clinical examination

Warticon/Aldara or cryotherapy Prevention: quadrivalent/bivalent vaccine

Will I get cancer doc?

Genital warts

QUESTIONS?