Testing, Treating and Managing STIs Dr Jean Irvine

Transcription

1 Testing, Treating and Managing STIs Dr Jean Irvine 1

2 Chlamydia 2

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4 Chlamydia: key facts Intracellular bacterial infection Sexually transmitted: Vaginal sex Anal sex?oral sex Most common bacterial STI in UK Condoms reduce risk but do not eliminate risk Mostly asymptomatic 80% women 50% men Possible health implications if untreated (esp. multiple infections) 4

5 Complications of Chlamydia Pelvic Inflammatory Disease (PID) Ectopic Pregnancy Tubal Factor Infertility Urethritis and Epididymitis in men Reiter s Syndrome 5

6 Who To Test for Chlamydia. SIGN PUBLICATION No

7 Testing for Chlamydia and Gonorrhoea Women Endocervical swab or Vulvo-vaginal swab (urine if V-V swab not acceptable) Men First void urine If symptoms suggest referral to Sandyford Service 7

8 Management of Chlamydia Infection Azithromycin 1g stat If pregnant needs TOC 6 weeks after end of treatment Advise no sexual intercourse until patient and current partner(s) fully treated Partner Notification should be discussed (choice between patient or provider) Written info for partners provided Consider Sexual Health Adviser Input Epidemiological treatment for partners (irrespective of findings) Verbal Follow-up (telephone?) in 2-4 weeks Recommend test for re-infection 3-12 months (or sooner if change of partner) SIGN PUBLICATION No

9 Gonorrhoea 9

10 Gonorrhoea Facts Bacterial infection Sexually transmitted: oral, vaginal, rectal, on hands, sharing sex toys Condoms reduce risk but do not eliminate risk Symptoms: Oral/anal - generally no symptoms. Penile - generally heavy green discharge and dysuria Vaginal - generally no signs (? Discharge or dysuria) 10

11 Who to test: Routine sexual health screen Anyone with symptoms Vaginal Urethral Anal Pharyngeal Contacts of Gonorrhoea Under 25s / MSM 11

12 Testing for Chlamydia and Gonorrhoea Women Endocervical swab or Vulvo-vaginal swab (urine if V-V swab not acceptable) Men First void urine If symptoms suggest referral to Sandyford Service 12

13 Swabs vs urine N gonorrhoeae detection Urine Vag swab Cx swab Knox 2002 Schachter

14 Management of Gonorrhoea Infection Encourage to attend Sandyford service for culture Blind therapy: Cefixime 400 mg stat But maybe not if overseas travel If acquired in Far East and Hawaii Ceftriaxone 250 mg im injection If sensitivities known from a culture test: Usually Ciprofloxacin 500 mg stat Treatment for chlamydia if result not known Epidemiological treatment for partners Partner Notification Verbal Follow-up in 2 weeks 14

15 Trichomonas Vaginalis (T.V.) 15

16 T. V. Protozoan infection Sexually transmitted Visible under microscope on wet preparation slide Rising incidence in Glasgow 16

17 Symptoms Women commonly will have symptoms Most men asymptomatic Symptoms include: Vaginal discharge Vulval itching Dysuria Offensive odour discomfort 17

18 Testing for T. V. Test women with symptoms Microscopy - wet mount preparation from posterior vaginal fornix (sensitivity 40 80%) Charcoal HVS Screening not done if asymptomatic Diagnosis on cervical smears unreliable (30% false positive rate) confirm with culture Difficult to isolate in men usually treated epidemiologically without positive result 18

19 T. V. Management Metronidazole 400mg BD for 5 days Partner notification 19

20 Asymptomatic Sexual Health Screen... Women EndoCx or Vulvo-vaginal swab for Chlamydia/Gonorrhoea NAATs Bloods for Syphilis and HIV Men First void urine for Chlamydia/Gonorrhoea NAATs Bloods for Syphilis and HIV 20

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22 Sexual and Reproductive HealthServices in Glasgow and Clyde... Sandyford Central (Sauchiehall Street): Walk-in Mon, Weds, Thurs, Fri: 8:30am 2 pm Tues 8:30am 10:30am Appointments:

23 Sandyford Hubs Sandyford South East (Govanhill) Sandyford East (Parkhead) Sandyford North (Springburn) Sandyford South West (Pollok) Sandyford Renfrewshire (Russell Institute, Paisley) Sandyford East Renfrewshire (Barrhead) Sandyford Inverclyde (Greenock) Sandyford West Dunbartonshire (Vale of Leven) Sandyford East Dunbartonshire (Kirkintilloch) 23

24 Referrals... Self Referral (+/- letter) Walk-in Appointment By Letter to send appointment STI Shared Care Helpline (staff only)

25 References Chlamydia SIGN guideline BASHH guidelines National Stats and reports Patient information and resources