Sexually Transmitted Infections
Human Papilloma Viruses
- Serotypes: 6 and 11 (commonest cause of genital warts), 16 and 18 (commonest cause of cervical cancer)
- Spread: Sexual, perinatal, digital (i.e. by fingers)
- Pathology: Multiply in nuclei of epithelial cells, leading to acanthosis and hyperkeratosis- shedding. Can lead to malignancy long term.
- Symptoms: The vast majority are subclinical. Warts in the anogenital region, related to sites of sexual intercourse (microtrauma), or mouth. These can cause irritation and itching, rarely affecting flow of urine, or causing bleeding.
There is currently a vaccination programme for adolescent girls against HPV due to the risk of cervical cancer.
- Serotypes: HSV1 usually affects mouth and HSV2 affects genital region
- Spread: Direct contact (not just sexual). 2/3 female; often asymptomatic in men
- Pathology: Affects many sites on the body. Many lead to viral meningitis
- Symptoms: 4-5 day incubation period, then mild, flu-like symptoms. Tense superficial vesicles leading to painful ulcers.
- Management: Aciclovir oral/IV
- Spread: Intimate physical contact
- Pathology: Neiseria gonorrhoeae is gram negative. Targets epithelium of urogenital tract, rectum, pharynx, conjunctivae
- Male- Dysuria, Urethral discharge. Rectal itch, pain, discharge.
- Female- Vaginal discharge (can be yellow/green), pelvic pain, dysuria, bleeding, dyspareunia.
- Investigation: Endocervical swab
- Management: Ceftriaxone
- Spread: Intimate sexual contact. 1 in 7 <25 year olds infected. Vertical transmission also present.
- Pathology: Chlamydia trachomatis
- Symptoms: Females- often asymptomatic but can present with abdominal pain, abnormal discharge, bleeding and dyspareunia. Males- dysuria, white discharge
- Investigation: Endocervical swab/Self collected swab/Urine
- Management: Azithromycin/Doxycycline
- Complications: conjunctivitis, arthritis, urethritis, pneumonia
- Spread: Sexual, vertical
- Pathology: Troponema pallidum Spirochae affects local sites, leading to systemic illness
- Primary- Papule at site of inoculation, leading to an ulcer that self heals
- Secondary- Fever, sore throat, malaise, arthralgia, organ-itis. Lymphadenopathy, skin rashes everywhere including hands & soles. Warts, ulcers, neuropathy.
- Latent- The above stop after 3-12 weeks, and may recur in the future.
- Tertiary- Gumma form in skin, bones years after infection
- Management: Treat early- procaine benzylpenicillin IM
- Spread: Sexual, perinatal
- Pathology: Trichomonas vaginalis is a protozoon that attaches to squamous epithelium.
- Symptoms: Asymptomatic, or frothy yellow offensive smelling discharge, irritation, and "strawberry cervix" pattern of inflammation.
- Investigation: High vaginal swab
- Management: Metranidazole
- Also known as thrush/yeast infection.
- Spread: Very common, sexual. Pregnancy, immunocompromised individuals and taking the COCP puts you at increased risk of infection.
- Pathology: Fungal infection. Candida albicans is often commensal, and pathology is unclear.
- Symptoms: White "cottage cheese" discharge, pruritis, penile pain post intercourse
- Management: Clotrimazole topical