Emma, 22, presents with PV discharge for the last 2 weeks and discomfort with sexual intercourse. She reports lower abdominal pain and intermittent fevers. She reports a sexual history with at least 2-3 male partners over the preceding 4-5 months. She has no past medical history, allergies and is on the COCP. She is compliant with it.
What are the likely causative organisms? List 3
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Trichomonas vaginalis – less likely
What are the diagnostic methods? List 3
- Endocervical swab Nucleic Acid Amplification Test (NAAT) (+/- culture for gonorrhoea)
- Self collected vaginal swab NAAT (+/- culture for gonorrhoea)
- First pass urine – NAAT – Not as sensitive as self-collected vaginal swab.
- If anorectal sex – anorectal swab NAAT (+/- culture for gonorrhoea)
- Gonorrhoea only – pharyngeal swab NAAT +/- culture
If possible, culture samples should be obtained from genital and non-genital sites to determine antibiotic susceptibility
What medication do you want to prescribe for treatment? List 2
- Chlamydia and gonorrhoea are frequently asymptomatic and both should be treated immediately if high index of suspicion before results are obtained with:
- Chlamydia – azithromycin PO 1g stat OR Doxycycline 100mg po BD for 7 days
Gonorrhoea – Ceftriaxone 500mg IMI, stat in 2mL 1% lignocaine
Some additional oral regimes on eTG as well
What advice is important when prescribing the treatment in the previous answers? List 1
- Advise no sexual contact for 7 days after treatment is administered.
What other management considerations are there? List 5
- Notification to State/Territory public health
- Contact tracing – Male and female partners should be traced back for 6 months
- Start treatment for patient and sexual partner(s) without waiting for lab results.
- No sex with previous partners until they have been tested/treated
- Screen for other STIs – Hep B/C/HIV/Syphillis etc
Is test of cure required?
No. Not routinely recommended, unless in the following groups 4 weeks after treatment:
- Pregnant women
- Rectal chlamydia
Should the patient be retested later?
- Yes. Re-infection is common. Re-testing at 3 months is recommended, to detect re-infection.
What are the potential complications chlamydia and gonorrhoea infections? List 6
- Short/medium term
- Pelvic inflammatory disease
- Conjuncvitits (gonorrhoea)
- Reactive arthritis (chlamydia)
- Anorectal symptoms
- Septic arthritis (gonorrhoea)
- Meningitis (rare) (gonorrhoea)
- Long term (chlamydia)
- Chronic pevlic pain
- Ectopic pregnancy
http://www.sti.guidelines.org.au/ – really good