Sexually Transmitted

Infections

Liyasha Goonetilleke
Definition

Sexually transmitted infection (STI)includes a range of clinical

syndromes that can be acquired and transmitted through sexual
activity and may be caused by various types of pathogen, including
bacteria, fungi, viruses, and parasites.
Types of STIs

● bacterial vaginosis ● Hepatitis B

● balanitis ● HIV
● Chlamydia (genital) ● Lymphogranuloma venereum
● Donavanosis ● Molluscum contagiosum
● Epididymo-orchitis ● Mycoplasma genitalium
● Genital Herpes Simplex ● Pediculosis pubis
Virus (Crabs)
● Genital Warts ● Scabies
● Gonorrhoea ● Syphilis
● Trichomonas vaginalis
History

● Syphilis thought to have been brought to Europe from the

“New World” by Christopher Columbus
● Genital herpes has reportedly been around since Ancient
Greek times. Herpes is a Greek word meaning to creep or
crawl
● Gonorrhoea history not known, the term “the clap” has two
stories behind its origin
General Risk Factors

● unprotected sex
● new or multiple sexual partners
● under 25s
● history of previous STIs
● ethnicity
● low socio-economic background
● IVDU/illicit drug use
Epidemiology
Important Features of a Sexual History

General history

● Contact of an STI
● past medical and STI history
● medications, allergies (emphasise antibiotics) and
contraception
● last menstrual period
● vaccination history
● recreational drug use.
Important Features of a Sexual History

Symptoms and signs

● Onset, character, periodicity, duration and relation

to sexual intercourse and urination
● similarity to previous problems
● any STI in sexual partner(s)
● anogenital discharge and/or dysuria
● dyspareunia and/or pelvic pain
● ulcers, lumps, rashes or itching.
Important Features of a Sexual History

Sexual behaviours/Risk markers

● Any sexual partner(s) and date of last sexual exposure and

others in the last three months
● sex of partner(s) including and history of male to male
contact
● type of intercourse – oral, vaginal, anal
● sex overseas or in high risk areas like beats and saunas
● any history of injecting drug use, what drug, how often
● any tattoo history or blood product exposure.
Physical Exam

● exposure of abdomen, genitals and thighs needed

Inspect

● for rashes, ulcers, discharge, smell, parasites as well

as skin + oral mucosa

Men - penis, retract foreskin, perianal area +/- proctoscopy

Women - Inspection of external genitalia, perineum and

speculum examination of vagina and cervix.
Physical Exam

Palpate

● palpate abdomen + inguinal nodes

Men - Palpation of scrotum and expression of any discharge

from the urethra.

Women - Bimanual pelvic examination.

Investigations

Men Women

● distal and proximal ● PAP Smear

urethral swab ● Endocervical specimens
● pharyngeal swab ● Vaginal swab from lateral
● rectal swab wall and posterior fornix
● first catch urine ● rectal
● ulcer swab ● pharyngeal swabs
● ulcer swab
● first catch urine
+pregnancy test
 Chlamydia
Australia’s most common
notifiable STI
Chlamydia

● caused by gram negative bacteria Chlamydia trachomatis

● can infect the prostate, urethra and testes in men and
the cervix, uterus and pelvis in women
● largely asymptomatic in women
● symptoms can include discharge,abnormal vaginal bleeding,
dysuria in men, pelvic/abdominal/scrotal pain (uncommon),
fevers (uncommon)
● can lead to multitude of complications if untreated
Diagnosis

Diagnosis is made on a positive sample from an infected site

such as:

● first catch urine or urethral swab in males

● physician collected or self-collected vaginal swab
● endocervical swab
● physician collected or self collected rectal swab in
males and females
● in females without a cervix/whom swabs cannot be
taken, a first catch urine is tested
Treatment - Chlamydia

● Azithromycin 1g orally STAT dose

or

● Doxycycline 100mg Oral BD for 10 days or if pregnant,

Amoxycillin 500mg Oral TDS for 7 days
 Gonorrhoea
“the disease of soldiers
and sailors”
Gonorrhoea

● Neisseria gonorrhoeae is a gram-negative bacteria

● pathogen is almost exclusively sexually transmitted
● can be found in the genital tract, pharynx, and rectum
● can also be asymptomatic
● symptoms similar to chlamydia
● Risk factors also similar, but also MSM have higher
incidences of gonorrhoea
● Gonococci have developed resistance to multiple classes
of antibiotics
Diagnosis - Gonorrhoea

Presumptive

Gram stain smear – presence of typical intracellular Gram

negative diplococci (GNID)

Confirmed

Culture of urethral, rectal or pharyngeal swab

Positive NAAT on first catch urine sample or other specimen

Treatment - Gonorrhoea

● Ceftriaxone 500 mg in 2mL 1% lignocaine IM as a single

dose with Azithromycin 1gm orally
Genital Herpes
Genital Herpes

● Genital herpes is caused by infection with either HSV-1 or HSV-

2.
● Women may have genital pain, vesicular rash, discharge, dysuria,
ulcerations on perineum, buttocks, cervix, and vagina
● Men may have vesicles on the penis shaft or glans with
urethritis.
● About 70% have recurrent episodes within the first year, with
attacks decreasing over time.
● For both HSV-1 and HSV-2, asymptomatic shedding may occur in the
absence of lesions; transmission of the virus may occur during
asymptomatic shedding.
Diagnosis - Herpes

● clinical

● NAAT from swab from infected site

● HSV serology
Treatment - Herpes

● Famciclovir 250 mg orally 8 hourly for 7 to 14 days

OR

● Valaciclovir 500 or 1000 mg orally 12 hourly for 7 to 14

days
Genital Warts
(human papillomavirus)
Genital Warts (Human Papilloma Virus)

● Genital warts are most commonly caused by HPV types 6 and

11, which have low potential for oncogenesis
● affects Anal or genital region
● Symptoms apart from warts include itch, bleeding. issues
with hygiene
● can resolve spontaneously, treatment not always needed.
● No evidence exists to indicate that treatment of genital
warts decreases the rate of transmission
Diagnosis
Syphilis
Syphilis

● Caused by the bacteria Treponema pallidum

● Classifications: Congenital, Acquired - primary,
secondary early latent, late latent, tertiary
● if left untreated, can cause serious, irreversible damage
● Symptoms: chancre, lymphadenopathy, rash, fatigue,
constitutional symptoms
Treatment - Syphilis

Parenteral penicillin G is the preferred drug for treating

all stages of syphilis

● Benzathine Penicillin G 1.8g IM single dose

OR for a penicillin allergy (anaphylaxis)

● Doxycycline 100 mg orally twice a day for 14 days OR

Tetracycline HCl 500 mg orally four times a day for 14
days.

An RPR should be done to test for cure.

Disease Notification

● Gonorrhoea
● Donovanosis
● Genital Chlamydia
● Syphilis
Acknowledgements

● SA Health Sexually Transmitted Infection Guidelines

● Surveillance of sexually transmitted infections and
blood-borne viruses in South Australia 2013
● http://www.sahealth.sa.gov.au/NotifiableDiseaseReporting
● Australian Bureau of Statistics 4102.0 - Australian
Social Trends, Jun 2012
● SA health Clinical history, examination, specimen
collection and tests guidelines for sexually transmitted
infections