Bacterial STDs

Question 1

4 features of chlamydia in females

Answer 1

Increased discharge
Post-coital/ intermenstrual bleeding
Dysuria
Dyspareunia

Question 2

4 features of chlamydia in males

Answer 2

Urethral discharge

Dysuria

Question 3

% of patients asymptomatic with chlamydia

Answer 3

85%

Question 4

Ix for chlamydia

Answer 4

Nucleic acid amplification test on:
F: Vulvovaginal swab
M: FPU. Oral/ anal swabs if appropriate.

Question 5

Tx for chlamydia

Answer 5

Doxycycline 100mg BD 7/7
Partner screening
Avoid SI until tx complete

Question 6

3 features of gonorrhoea in females

Answer 6

Asymptomatic in 50%
Viscous + purulent discharge
Dysuria

Question 7

3 features of gonorrhoea in males

Answer 7

Asymptomatic in 10%
Viscous + purulent urethral discharge
Dysuria

Question 8

Ix for gonorrhoea

Answer 8

NAAT on:
F: Vaginal or endocervical swab
M: FPU
+ve chocolate agar culture of swab

Question 9

Tx for gonorrhoea

Answer 9

Ceftriaxone 1g IM STAT
Sensitivities known: Ciprofloxacin 500mg PO STAT
Partner screening
Avoid SI until tx complete

Question 10

Tx for gonorrhoea in penicillin allergy

Answer 10

Azithromycin 2g PO STAT + Gentamicin 240mg IM

Needle phobic: Cefixime 400mg PO + Azithromycin 2g PO

Question 11

Tx for chlamydia in pregnancy

Answer 11

Azithromycin 1g PO STAT

Question 12

Tx for gonorrhoea in pregnancy

Answer 12

Ceftriaxone 1g IM STAT

Question 13

4 features of primary Syphilis

Answer 13

Macule- Papule - Ulcer (Chancre)
Appears 2-3 weeks after exposure
Heals in 2-6 weeks
Local lymphadenopathy

Question 14

Describe 5 features of the chancre seen in primary syphilis

Answer 14

Single
Round/ oval
Painless
Defined rolled edge
Discharging clear serum

Question 15

When and how does secondary Syphilis arise?

Answer 15

~4-10 weeks after chancre appearance.
Within 2 years of infection
Haematogenous dissemination

Question 16

6 features of secondary Syphilis

Answer 16

Diffuse rash 
Fever
Headache
Myalgia
Condyloma lata
Lymphadenopathy

Question 17

4 features of the rash in secondary syphilis

Answer 17

Macular, Papular or Maculopapular
Symmetrical
Often involves mucous membranes
Usually non-itchy

Question 18

What are condyloma lata?

Answer 18

Raised pale plaques
Painless
Wart-like

Question 19

What is early latent syphilis?

Answer 19

Asymptomatic infection diagnosed on +ve serology alone, acquired <2 years previously
Relapse to secondary syphilis may occur

Question 20

What is late latent syphilis?

Answer 20

Asymptomatic infection acquired >2 years previously

Pt is not known to have been seronegative within the past 2 years

Question 21

What are the 3 manifestations of tertiary syphilis?

Answer 21

Neurosyphilis (though not always considered tertiary)
Gummatous syphilis
Cardiovascular syphilis (aortitis)

Question 22

3 signs of neurosyphilis

Answer 22

Tabes dorsalis (dorsal column loss)
Dementia (general paralysis of the insane)
Aseptic meningitis

Question 23

5 characteristics of Tabes dorsalis

Answer 23

Sensory ataxia 
Lightning pains
Areflexia/ Extensor plantar reflex
Charcot joints
Argyll-Robertson pupils

Question 24

2 features of gummatous syphilis

Answer 24

Destructive granulomatous lesions with necrotic centre

Affect skin, mucous membranes, bones, viscera

Question 25

3 manifestations of cardiovascular syphilis

Answer 25

Aortic regurgitation
Aortic aneurysm
Angina.

Question 26

Ix for syphilis

Answer 26

Dark field microscopy of swab

Bloods for serology; EIA, TPPA/ TPHA and RPR/ VDRL

Question 27

What d treponemal enzyme immunoassays or TPPA show?

Answer 27

Positive = exposure (stays +ve for life)
Trepenome specific
IgG/ IgM for Treponema pallidum

Question 28

What does RPR/ VDRL show?

Answer 28

IgG titre to cardiolipin expressed as a ratio
Trepenome non-specific
Quantitative measure of disease activity
Monitor response to tx

Question 29

Tx for syphilis

Answer 29

Benzathine benzylpenicillin 2.4 MU IM
1/2/ EL: STAT
3/LL: weekly for 3/52

Question 30

Tx for syphilis with penicillin allergy

Answer 30

Doxycycline 100mg PO BD 2/52