23.3 STIs and the oropharynx

Question 1

Which people are at high risk of STIs?

Answer 1

• People aged under 25
• Recent partner change
• Unprotected sex
• Multiple sexual partners

Question 2

Describe chlamydia.

Answer 2

• Oropharyngeal infection seldom symptomatic
• Common in the UK
• Genital symptoms in men include discharge, pain when weeing and urethral irritation, in women: bleeding between periods and bleeding after sex
• Can lead to serious health complications

Question 3

Describe gonorrhoea.

Answer 3

• Pharyngeal infection is usually asymptomatic
• Can cause pharyngitis with pus-like exudate
• 50% of women are asymptomatic, men are usually symptomatic and will have discharge and pain when urinating
• Can lead to serious health complications

Question 4

If a patient has an ulcer/lesion on the lip, which 2 STIs may have caused it?

Answer 4

• Herpes simplex virus
• Syphilis

Question 5

Describe herepes simplex virus.

Answer 5

• Usually HSV type I orally (but could still be type 2)
• 85% of the UK population have been exposed to HSV
• Symptoms include painful ulceration, tender lymphadenopathy, meningism, urinary retention
• Recurrences are common and unpredictable
• Episodes can be triggered by UV light, stress and being generally run down
• Most people acquire from an asymptomatic partner

Question 6

Describe genital warts.

Answer 6

• Caused by human papilloma virus 6 and 11
• Most common reason for people to attend STI clinics
• Treated with ablative methods (killing cells with cryotherapy and chemicals) or topical creams

Question 7

Which HPV types are linked to oral cancer?

Answer 7

• 16
• 18

These are targeted by the HPV vaccines.

Question 8

What are the 3 types of syphilis?

Answer 8

• Primary syphilis: first set of symptoms presenting 9-90 days after exposure
• Secondary syphilis: syphilis no longer at single point of entry of mucosa, but is in the bloodstream, 6 weeks to 6 months after exposure
• Tertiary syphilis: several years following infection, often latent and asymptomatic for many years, final stage of infection

Question 9

Describe primary syphilis.

Answer 9

• 9-90 days after infection
• Primary syphilis typically causes a single, painless, ulcer at the site of infection
• If spread through oral sex, the individual will have oral symptoms
• Consider syphilis lesion when you suspect a cold sore
• Important differential for oral cancer

Question 10

What are the features of an oral lesion caused by syphilis?

Answer 10

• Indurated (hard)
• Raised, rolled edges
• Sloughy centre

Question 11

How is syphilis diagnosed?

Answer 11

Diagnosed through blood tests (less accurate early on), dark ground microscopy and PCR.

Question 12

Describe secondary syphilis.

Answer 12

• Syphilis no longer at single point of entry of mucosa, but in the bloodstream
• 6 weeks to 6 months after infection
• Flat, blotchy rash (typically presents on palms of hands and soles of feet)
• Snail track ulcers/mucosa pathces
• Genital ulcers
• Lymphadenopathy
• Syphilitic hepatitis
• Pharyngitis

Question 13

What is the treatment for syphilis?

Answer 13

• High dose penicillin
• Serology (blood tests) remains positive for life; does not mean you are currently infected just means you were at some point
• Sexual partners notified
• People with syphilis are at a much higher risk of having HIV, test for this also

Question 14

What is tertiary syphilis?

Answer 14

Several years following infection, often latent and asymptomatic for many years.

Question 15

What are the features of congenital syphilis?

Answer 15

Hutchinson’s triad:
- Interstitial keratitis (eye problems)
- Sensorineural deafness
- Hutchinsons teeth/Mulberry molars

Question 16

What signs of congenital syphillis does this patient possess?

Answer 16

• Saddle nose deformity
• Frontal bossing