Sexually transmitted infections: diagnosis, partner notification and treatment
RezzySTIs are a massive topic for the AKT, and getting the management right is crucial because the guidelines (BASHH) are very specific. Let's break down the "big hitters" you'll likely see in your exam.
I'll start by finding some high-yield lessons that cover the core diagnostic and treatment pathways for you.
đź“š STI Management Lessons
It's really important to remember that for most STIs, Nucleic Acid Amplification Tests (NAATs) are the gold standard for diagnosis. For men, this is usually a first-catch urine sample; for women, a self-taken vulvovaginal swab is often preferred.
Here is a quick-reference table for the most common STIs you'll encounter in the AKT:
| Infection | Typical Presentation | First-line Treatment (UK) | Partner Notification (PN) Look-back |
|---|---|---|---|
| Chlamydia | Often asymptomatic; dysuria, discharge, PCB/IMB | Doxycycline 100mg BD for 7 days | 6 months |
| Gonorrhoea | Purulent discharge, dysuria | Ceftriaxone 1g IM (single dose) | 4 weeks |
| Trichomoniasis | Frothy yellow-green discharge, 'strawberry cervix' | Metronidazole 400mg BD for 5-7 days (or 2g stat) | 4 weeks |
| Syphilis | Primary: Painless chancre; Secondary: Rash (palms/soles) | Benzathine Penicillin G IM | Variable (3-12 months depending on stage) |
| Mycoplasma genitalium | Similar to Chlamydia; often persistent urethritis | Doxycycline (7 days) followed by Azithromycin | Contact tracing for symptomatic partners |
Partner Notification (PN) in the UK
Partner notification is a cornerstone of STI management. It’s not just about treating the patient in front of you, but also breaking the chain of transmission. There are two main ways this happens:
- Patient-led notification: The patient informs their partners themselves. We often provide "contact slips" to help them do this anonymously or more easily.
- Provider-led notification (Contract Referral): With the patient's consent, a health professional (often a health advisor) contacts the partners directly. The patient's identity is never revealed to the partner.
Key AKT Point: Always advise patients to avoid any sexual contact (even with a condom) until they and their current partners have completed treatment. For Chlamydia (Doxycycline), this means waiting until the full 7-day course is finished.
Let's get some flashcards going to help you lock in these treatment regimens and look-back periods!
🗂️ STI Management Flashcards
Tap to study 16 flashcards in the Oncourse app
When you're managing a patient with a suspected STI, it's standard practice to offer a full STI screen. This includes testing for HIV, Syphilis, and Hepatitis B/C, even if they only have symptoms of one specific infection.
One final thing to keep in mind for your exams is the window period:
- Chlamydia/Gonorrhoea: Usually 2 weeks (though NAATs can pick it up earlier).
- HIV: 4 weeks (for the 4th generation p24 antigen/antibody test).
- Syphilis: Up to 12 weeks.
If a patient tests negative but had a very recent exposure, you'll need to advise them to re-test once the window period has passed.
Would you like to try a quick word-grouping game to see if you can match the treatments to the right STIs? It's a great way to make sure you don't mix them up!
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