8132MED - STI BBV Dr Bartley 120924.pdf

Sexually Transmitted Infections & Blood-Borne Viruses Paul B Bartley BMedSc, MBBS (Hons1), FRACP, FRCPA, PhD Infectious Diseases Physician – TWH Medical Microbiologist – QML Pathology Assoc. Prof. Internal Medicine – U of Qld. STI & BBV...

Sexually Transmitted Infections & Blood-Borne Viruses Paul B Bartley BMedSc, MBBS (Hons1), FRACP, FRCPA, PhD Infectious Diseases Physician – TWH Medical Microbiologist – QML Pathology Assoc. Prof. Internal Medicine – U of Qld. STI & BBV Introduction & approach STI History-Taking Examination Diagnostic Testing Individual STIs Treatment Notifications Contact Tracing  Introduction & Approach Major pathogens of Global Public Health Significance Many are treatable if found early & early treatment prevents dire outcomes Some are vaccine-preventable All preventable by education and behavioural modification… Complex interplay of clinical and laboratory medicine, Public Health, personal behaviours and health beliefs, and politics……. Diagnosis based on history, physical examination and appropriate pathology/radiology – just like any other medical discipline  History Taking Calm, methodical and mature with careful, respectful language Discretion/confidentiality must be absolute Some scenarios may be confronting/offensive to your POV or maybe illegal….. How your patient identifies eg nonbinary or transgender-man or -woman Why is the patient there? build trust Symptoms vs concerns vs notification by partner with STI What are the patient’s symptoms? E.g. urethral/vaginal discharge or genital ulceration, “lumps and bumps” Use anatomical names for genitalia – vernacular only if necessary Have you had an STI before? repeat presentation Is your current/recent partner a man or woman? avoid colloquialisms Avoid diminutive terms implications e.g. boys girls How long together & any partners outside the current relationship in last year or 5 years Form of intercourse – insertive/receptive, oral/vaginal/anal Condoms & dental dams contraception or STIs  History Taking - 2 Sex when menstruating some choose or not Vaccination History (HBV, HPV) Pap smear or CST results n partners in the last x-months…..or years Commercial Sex Worker (CSW)? required testing quarterly Sexual partners (from) overseas Chem-sex or sex-for-drugs (oral or injectable); needle-sharing Have you ever been sexually assaulted? riskiness Pregnancy history miscarriage, terminations General Medical History etc. including drug allergies Don’t assume only young people are sexually active………. some older  Estimated Risk HIV Table 1:Type Exposure with Known HIV Positive Source Transmission/Exposure a Receptive anal intercourse (RAI) 1/70 higher with ejaculation ejaculation higher risk with ejaculation withdrawal 1/155 risk on sex act Contaminated injecting equipment 1/125 Insertive anal intercourse (IAI) circumcised protective 1/900 Insertive anal intercourse (IAI) uncircumcised 1/160 Receptive vaginal intercourse (RVI) 1/1250* Insertive vaginal intercourse (IVI) 1/2500* Receptive or insertive oral intercourse Unable to estimate risk extremely low Needle-stick injury (NSI) or other sharps exposure 1/440 Mucous membrane and non-intact skin exposure