Pharmaceutical Care and Public Health: Sexually Transmitted Infections (STIs)

Flashcards covering key terms and definitions related to sexually transmitted infections (STIs) and their impact on public health.

Sexual Health

A state of physical, emotional, mental, and social well-being in relation to sexuality.

Sexually Transmitted Infections (STIs)

Infections commonly transmitted through sexual contact, including diseases like chlamydia, gonorrhoea, and syphilis.

Chlamydia trachomatis

The microorganism responsible for the most common STI, which can cause significant health issues if untreated.

Pelvic Inflammatory Disease (PID)

A complication of STIs that can lead to severe reproductive health issues in females.

Antimicrobial Resistance

The ability of bacteria like Neisseria gonorrhoeae to resist treatment from antibiotics, posing a public health threat.

Community Pharmacy's Role in STIs

Pharmacies can contribute to the prevention, screening, and treatment of sexually transmitted infections.

Primary Syphilis

The initial stage of syphilis characterized by the appearance of a primary chancre (sore).

Human Papillomavirus (HPV)

A virus responsible for genital warts and some types of cervical cancer; vaccination is available.

HIV Transmission

The process by which HIV is passed from one person to another, often exacerbated by the presence of STIs.

National Chlamydia Screening Programme (NCSP)

A UK initiative aimed at the early detection and treatment of chlamydia among young people.

"What is the WHO definition of sexual health?"

"A state of physical; emotional; mental; and social well-being in relation to sexuality; not just absence of disease/STIs."

"Why is sexual health fundamental?"

"It underpins overall health and contributes to social/economic development within countries."

"What approach does sexual health require?"

"A positive; respectful approach to sexuality and sexual relationships."

"What issues does sexual health encompass?"

"Sexual orientation; gender identity; sexual expression; relationships; and sexual pleasure."

"Why is STI transmission a public health concern?"

"High prevalence; often asymptomatic; major complications (pregnancy outcomes; HIV; cancers); and antimicrobial resistance."

"Approx. how many curable STI infections occur daily worldwide (15–49)?"

">1 million per day."

"Key point about many STIs?"

"Many are asymptomatic; so transmission can continue unknowingly."

"Consequences of poor sexual health (examples)?"

"Unplanned pregnancy/abortion; psychological consequences; poor maternity outcomes; neonatal infection; PID; increased HIV risk; cervical cancer (HPV); hepatitis/chronic liver disease."

"Why can untreated STIs be serious beyond the acute infection?"

"Long-term complications (pregnancy issues; infertility; neuro/cardiovascular damage in late syphilis) + antimicrobial resistance."

"High-risk groups for STIs (lecture list)?"

"Ages 15–24; Black/minority ethnic populations; gay/bisexual/MSM; people in most deprived deciles."

"How do STIs increase HIV transmission risk?"

"Lesions/sores break skin barrier + inflammation → easier HIV entry."

"Which STI has strong evidence of association with HIV transmission?"

"HSV (herpes simplex virus)."

"Causative organism for chlamydia?"

"Chlamydia trachomatis."

"Main transmission routes for chlamydia?"

"Oral; vaginal; anal sex."

"How common is asymptomatic chlamydia?"

"~70% women asymptomatic; ~50% men asymptomatic."

"Possible symptoms of chlamydia?"

"Bleeding after sex; intermenstrual bleeding; new/unusual discharge; discharge may be yellow/green and foul; texture/smell changes."

"Key complications of untreated chlamydia?"

"PID; pregnancy/maternity complications; neonatal infection; infertility."

"Chlamydia test method?"

"First-catch urine; urethral swab; vaginal swab."

"First-line chlamydia treatment (non-pregnant)?"

"Doxycycline 100 mg twice daily for 7 days."

"Why avoid doxycycline in pregnancy/children

"Affects bone/teeth development; fetal bone growth inhibition; tooth discoloration in children."

"Alternative for chlamydia in pregnancy (lecture example)?"

"Azithromycin."

"Causative organism for gonorrhoea?"

"Neisseria gonorrhoeae."

"Transmission routes for gonorrhoea?"

"Oral; vaginal; anal sex (bodily fluids)."

"Gonorrhoea symptom pattern vs chlamydia?"

"More symptomatic overall; but can still be asymptomatic."

"Time to gonorrhoea symptoms after exposure?"

"~1–14 days."

"Possible throat symptoms after oral sex (gonorrhoea)?"

"Sore throat; swollen glands (can mimic URTI)."

"Genitourinary symptoms common in STIs?"

"Bleeding after sex; intermenstrual bleeding; discharge change; dysuria."

"Gonorrhoea complications?"

"PID; neonatal transmission during childbirth; infertility."

"Where is gonorrhoea testing/treatment usually done?"

"Sexual health/GUM clinic (GP may refer)."

"Gonorrhoea first-line treatment (lecture)?"

"Ceftriaxone 1 g IM single dose (monotherapy)."

"Why is gonorrhoea important re antimicrobial resistance?"

"High resistance risk globally; management difficult where resistance is high."

"Why is ciprofloxacin use restricted?"

"Resistance + significant side effects; MHRA alerts; use only when necessary/short course."

"Older dual therapy for gonorrhoea included what?"

"Ceftriaxone + azithromycin (now often ceftriaxone alone at higher dose)."

"Causative organism for syphilis?"

"Treponema pallidum (spirochaete)."

"Why is syphilis tricky clinically?"

"Staged disease; symptoms can be mild/resolve; can be latent for years."

"Primary syphilis hallmark lesion name?"

"Chancre."

"Primary syphilis timing to symptoms?"

"~2–10 weeks after infection."

"Secondary syphilis symptoms (examples)?"

"Swollen lymph nodes (neck/groin/axilla); rashes/skin growths; flu-like symptoms; hair loss."

"Latent syphilis key feature?"

"No symptoms but infection persists; can be undetected up to ~30 years."

"Late syphilis complications (examples)?"

"Cardiovascular damage; neurological damage; increased dementia/stroke risk; numbness."

"Syphilis and HIV?"

"Syphilis increases HIV risk."

"Syphilis testing?"

"Blood test often alongside HIV; lesion swab may help distinguish from HSV."

"Syphilis treatment (lecture)?"

"IM penicillin injections (often 1–2 doses spaced ~2 weeks; clinic-delivered)."

"Where is syphilis treated?"

"Sexual health clinic/GUM clinic."

"Cause of genital warts?"

"HPV types 6 and 11."

"HPV and cervical cancer link?"

"Other HPV strains (not 6/11) increase cervical cancer risk."

"HPV vaccine programme key points (UK)?"

"Given at ~12–13 in school; now includes boys and girls; ideally before sexual activity."

"Genital wart symptom onset timing?"

"May appear up to ~1 year after infection."

"Diagnosis of genital warts?"

"Visual diagnosis + sexual history."

"Is there a cure for HPV?"

"No; warts may resolve spontaneously and may recur."

"Key counselling point for genital warts?"

"Stigma common; discuss partner disclosure and transmission risk."

"Cause of genital herpes?"

"Herpes simplex virus (often HSV-2)."

"HSV transmission route?"

"Direct skin-to-skin contact; exposure to infected saliva/semen/vaginal fluid/blister fluid."

"Typical initial herpes symptoms?"

"Flu-like symptoms; headache; fever; malaise; tender lymph nodes."

"Local herpes symptoms?"

"Painful genital ulcers; dysuria; possible discharge."

"Herpes diagnosis?"

"Visual + swab of lesion; PCR may be used."

"Herpes treatment (lecture)?"

"Aciclovir 400 mg TDS for 5–10 days OR 200 mg five times daily for 5–10 days; alternatives: valaciclovir/famciclovir depending on factors."

"Herpes self-care advice?"

"Avoid tight clothing; analgesia; avoid sharing towels; reduce irritation."

"Why ask about discharge colour/texture/smell?"

"To differentiate STIs from thrush; B; UTI/cystitis; vaginal atrophy, BV, etc."

"Typical STI discharge description?"

"Yellow/green; foul-smelling; consistency change."

"BV discharge description?"

"Watery/greyish-white; thin/stringy; fishy odour."

"Thrush discharge description?"

"Thick white 'cottage cheese'; itching/soreness; sometimes bready smell."

"Dysuria differential besides STI?"

"Cystitis/UTI."

"Postmenopausal symptoms mimicking thrush?"

"Vaginal atrophy due to low oestrogen → dryness, irritation, discomfort, discharge change."

"Is thrush an STI?"

"No (imbalance/overgrowth; can be transferred but not classified as an STI)."

"Female thrush name?"

"Vulvovaginal candidiasis."

"Male thrush symptoms?"

"Redness/irritation/burning around glans/under foreskin; possible white discharge."

"Thrush risk factors (examples)?"

"Recent antibiotics; diabetes/poor control; immunocompromise; pregnancy (high oestrogen); new contraception early months; HRT; steroid inhalers (oral thrush if poor technique)."

"Why do antibiotics predispose to thrush?"

"Reduce normal flora → Candida overgrowth."

"Oral thrush pharmacy tip?"

"Check inhaler type/technique; especially steroid inhalers."

"OTC management of female vaginal thrush?"

"Clotrimazole cream/pessary OR oral fluconazole 150 mg stat; external cream can be added."

"What should not be used together for thrush?"

"Oral capsule and vaginal pessary together (use one of those; external cream can be added)."

"How long can fluconazole take to work?"

"Up to ~72 hours for noticeable effect; full resolution may take 7–14 days."

"Pregnancy + suspected thrush: pharmacy action?"

"Refer to GP (OTC restrictions + safety/licensing)."

"Male thrush: pharmacy action?"

"Refer to GP (OTC licensing limits)."

"Non-pharm advice for thrush?"

"Keep area clean/dry; cotton underwear; avoid perfumed soaps/sprays; avoid sex until resolved."

"When to refer recurrent thrush?"

">2 episodes in 6 months."

"Why refer age ≥60 with thrush symptoms (lecture)?"

"Menopause/low oestrogen and other causes need investigation."

"Pharmacist role in STIs (lecture)?"

"Prevention; health promotion; signposting/screening support; possible future expanded management roles."

"Core sexual health needs common to everyone?"

"High-quality information/education + access to high-quality services/treatment."

"Key advice after STI diagnosis?"

"No sex until treatment completed; written + verbal info; safer sex (condoms); encourage screening."

"Partner notification: pharmacist role?"

"Support patients with how to inform partners; acknowledge stigma; signpost services."

"Public health strategies mentioned (UK)?"

"Open access sexual health services (in-person/online); relationships/sex education; screening programmes (e.g.; chlamydia; antenatal testing); HPV immunisation; syphilis action plan."

"Why is sexual health considered part of safeguarding practice for pharmacists?"

"It involves respecting sexual rights; supporting non-coercive relationships; and signposting to appropriate services when harm or vulnerability is identified."

"Why do sexual health needs vary between individuals?"

"They vary by age; gender; sexual orientation; ethnicity; and deprivation; while core needs like education and access remain shared."

"What does positive sexual health promotion mean in pharmacy practice?"

"Using consultations proactively to discuss prevention; screening; and safer sex in a non-judgemental way."

"How does Chlamydia trachomatis cause tissue damage?"

"It attaches to mucosal surfaces and induces a strong inflammatory response."

"Why is gonorrhoea harder for the immune system to clear than chlamydia?"

"Neisseria gonorrhoeae can resist phagocytosis and provoke intense inflammation."

"How does HPV evade the immune system?"

"It delays activation of adaptive immunity; allowing persistent infection."

"Why can syphilis remain undetected for years?"

"It causes an ineffective cell-mediated immune response and can enter a latent stage."