stis-penninegptraining.pptVIP

Secondary syphilis 25 % of untreated patients will develop S2 6 - 8 weeks after beginning of S1 sometimes sooner or later S2 can be recurrent over 3 - 9 months up to 2 years All will be antibody +ve Secondary Syphilis S2 “A generalised systemic infection” Fever Malaise Rash + esp “palms and soles++” Lymph nodes + Mucosal ulcers Condylomata lata Alopecia Take home message genital ulcers Think imptcauses ; herpes, syphilis Test for syphilis/HIV Limitations of syphilis blood testing in ulcer stage Dont use Antibiotics on genital ulcers without syphilis testing * * * Last 2-3y 10-15 cases * * Psoraitic arthropathy, RA, adult onset stills, lyme, GC, parvo, gout, rheumatic fever, GARA * * * * * * * * * * * * * * depressed cell-mediated immunity ? * Update for Halifax GPs Dr John Watson Consultant in Sexual health HIV medicine Outline Several cases to cover main syndromes Discharge/testicular pain in men lower abdo pain in women Ulcers Lumps Principles of STI Management Listen to the patient Non-judgemental approach Screen for accompanying STIs blood swab/urine Partner notification Prevention The art of medicine What is the patients agenda? Are their symptoms significant or are they more worried about an exposure Sexual histories : often inaccurate If things dont fit could it be psychosexual Or a mental health issue Case 1 22y man previously well painful left testicle gradual onset over 4 days, no trauma. What history is needed? Dysuria, freq or discharge? History of renal infections or stones Sexual history : symptoms in partner? Angle jaw pain, recent mumps contacts? Case 1 : examination Epididymo-orchitis: differential Non specific pain ; normal exam +/- ultrasound Sexually transmitted : GC and chlamydia Enteric eg E coli : UTIs, stones, congenital renal disease or Anal sex UP Mumps : even if had MMR x2 doses as child If acute 12hr think torsion If chronic TB possible. Differentiating from non specific testicular pain E