STI

Question 1

What are commensal micro-organisms?

Answer 1

A micro-organism that derives food or other benefits from another organism without hurting or helping it

Question 2

What is a sexually transmitted microbe?

Answer 2

• A virus, bacteria or protozoan which can be spread by sexual contact
  
  • Commensal
  • Pathogen

Question 3

What is a sexually transmitted infection?

Answer 3

An infection by a pathogen which is sexually transmissible and which is unlikely to be transmitted by non-sexual means

Question 4

What is sexually transmitted disease?

Answer 4

A disorder of structure or function caused by a sexually transmitted pathogen

Question 5

What is on the current list of sexually transmitted organisms? (bacteria, viruses, parasites)

Answer 5

• Bacteria
  
  • Chlamydia trachomatis
  • Klebsiella granulomatis
  • Mycoplasma genitalium
• Viruses
  
  • HSV
  • HIV
  • HPV
  • Molluscum contagiosum virus
• Parasites
  
  • Pthirus pubis
  • Sarcoptes scabei
  • Trichomonas vaginalis

Question 6

How can STIs impact on home life? Is an STI diagnosis or a being temporarily colonised by a commensal organism worse?

Answer 6

Effect the relationship.

STI diagnosis is worse so reasuring someone that they are just colonised is v important sometimes.

Question 7

What are some sexually transmissible microbial pathogens that are not classified as STIs?

Answer 7

• Ebola
• Zika virus

Question 8

What are characteristics of STIs and the implications that these characteristics carry?

Answer 8

• Transmissable: need to tell partner
• Asymptomatic majority of time: hard to eradicate from population
• All manageable but not always curable: treat and prevent complications
• Avoidable: primary prevention is education

Question 9

List sexual contact from low risk to high risk.

Answer 9

1. mutual masturbation
2. Touching anothers genitals with your own genitals
3. oral sex
4. vaginal sex
5. anal sex
6. group sex

Question 10

What can spread via genital contact only?

What can spread via group sex?

Answer 10

• pubic lice (Pthirus pubis)
• Scabies (Sarcoptes scabeii)
• Warts (human papilloma virus types 6 &11)
• Herpes (Herpes Simplex Virus types 1 & 2)
• Hep C

Question 11

What are some systemic symptoms and adverse outcomes?

Answer 11

• Fever
• Rash
• Lymphadenopathy
• Malaise
• Infertility
• Cancer. 250,000+ deaths globally from cervical cancer.
• 300,000 adverse pregnancy outcomes from syphilis per year (globally)

Question 12

Why have we had a change in number of cases of STIs?

Answer 12

• Increased numbers of partners/person
• Increased concurrent partners
• More people having anal sex
• More men reporting sex with men

Question 13

Has there been a change in the number of diagnoses?

Answer 13

• There has but this does not necessarily mean there has been a rise in incidence.
• Likely rise in diagnoses because there is increased awareness.

Question 14

How can we model the spread of STIs over an area?

Answer 14

Sexual network analysis

Question 15

What does assortive mixing mean?

What are the implications of assortive mixing?

Answer 15

When people within a certain population only have sex with each other.

Leads to high prevalence within a subpopulation (core) but limited spread through the wider community.

Question 16

What are the implications of a small ‘core’ or a large ‘chain’ when discussing assortive mixing?

Answer 16

• Small core: high incidence of infection
• Large chain: infection can spread further

Question 17

What are the 4 key management factors for someone complaining of STI symptoms?

Answer 17

• Good history
• HIV testing
• Partner notification
• Health promotion

Question 18

What is needed along with the basic history for an STI history?

Answer 18

• Gynae history
• Direct questions such as “discharge from the penis/pain in abdomen?”

Question 19

What is the sexual history necessary for?

Answer 19

• determining possible cause of symptoms
• detecting high-risk behaviour and advising re reducing future risk
• tracing contacts

Question 20

What are some of the questions required in a sexual history?

Answer 20

1. When did you last have sexual contact?
2. Casual contact vs ‘regular’ partner?
3. How long were you going out with them for?
4. Were they male or female?
5. Asking about nature of sex act sometimes useful
6. anxiety about a specific incident
7. If it’s going to alter where you swab from eg MSM
8. Did you use condoms?
9. Other contraception used
10. Nationality of contact

Question 21

What need’s to be asked in a risk assessment for a man?

Answer 21

• Have you ever had sex with a man?
• Have you ever injected drugs?
• Sexual contact with
  
  • anyone who’s injected drugs
  • someone from outside UK
• Medical treatment outside the UK? [those fenians got nothin on the NHS]
• Involvement in sex industry

Question 22

How can we notify the partner of an STI?

Answer 22

• Patient tells: ‘client referral’
• NHS tells: ‘provider referral’

Question 23

What do we offer and why during an STI consultation?

Answer 23

• Recommend further testing for things such as HIV.
• Health promotion: Allows the patient to know benefits/risks of condoms, the risk of oral sex and drugs/alcohol