Chapter 26: Vaginitis, STIs And PID Flashcards
VAGINITIS, SEXUALLY TRANSMITTED INFECTIONS, AND PELVIC INFLAMMATORY DISEASE Sophie, a 19 year old Pākehā university student attends student health requesting a STI check. She is asymptomatic but has a new male sexual partner who informed her this morning that he was just diagnosed with chlamydia. They have had penile – vaginal sex without condoms several times in the past 2 weeks. Which of the following statements is MOST CORRECT regarding which testing Sophie should have recommended?
Sophie can be reassured that if she has no symptoms she doesn’t need to be tested.
Sophie should have a first catch urine specimen collected to test for Chlamydia
Sophie should have a speculum examination and have ‘triple swabs’ done for Chlamydia (NAAT test) as an endocervical swab and should have endocervical and high vaginal swabs for MC&S.
Sophie should be instructed on how to do self-collected NAAT swab and MC&S swab. She should be offered blood tests for HIV, Hepatitis B and syphilis.
Sophie should have a speculum examination and have ‘triple swabs’ done for Chlamydia (NAAT test) as an endocervical swab and should have endocervical and high vaginal swabs for MC&S. An opportunistic cervical smear should be taken.
Sophie should be instructed on how to do self-collected NAAT swab and MC&S swab. She should be offered blood tests for HIV, Hepatitis B and syphilis.
Complete screen
You are a trainee intern in a general practice seeing Kirsten, a 34 year old para 3 Pākehā woman who presents with a one week history of an itchy white curd-like vaginal discharge. She was seen a week earlier for a chest infection and prescribed Augmentin. She has an IUCD in situ. She is in a stable relationship. Which of the following is the MOST appropriate treatment for her discharge?
Ceftriaxone 1g IM, 2g PO of Metronidazole and 1g of PO Azithromycin
This is normal physiological discharge so no treatment is required.
Metronidazole 400mg bd for one week
Remove her IUCD and treat with Doxycyline 100 mg bd for 14 days
Fluconazole 150mg stat
Remove her IUCD and treat with Azithromycin 1g stat
Fluconazole 150mg stat
You are in antenatal clinic doing a booking visit with Anahera, a 34 year old, G1P0, wahine Māori. You discuss the ‘first antenatal booking bloods’ with her and obtain her consent to do them. She is surprised that everybody is screened for syphilis and asks you about the epidemiology of syphilis in Aotearoa. Of the following statements, which is the MOST CORRECT regarding the epidemiology of syphilis in Aotearoa?
Syphilis is increasing in Aotearoa. The majority of cases of syphilis are in the heterosexual community, particularly in women of Pākehā or Asian ethnicity. Most of this increase is among women of reproductive age.
Syphilis is increasing in Aotearoa. However, this is predominantly in men who have sex with men (MSM) and rates in heterosexual women remain static. However, as the consequences of syphilis in pregnancy are so devastating, everyone is screened.
Syphilis is increasing in Aotearoa. The main reason for the increase is that our refugee quota has increased and syphilis is common in refugee populations. As the consequences of syphilis in pregnancy are so devastating, everyone is screened.
Syphilis is increasing in Aotearoa. Most reported cases continue to affect men who have sex with men (MSM). However, there has been a rapid rise in syphilis amongst heterosexual men and women, particularly among Māori. Most of this increase is among women of reproductive age.
Syphilis is uncommon in Aotearoa and rates are declining. The at-risk groups are men who have sex with men (MSM) and refugees. However, as the consequences of syphilis in pregnancy are so devastating, everyone is screened.
Syphilis is increasing in Aotearoa. Most reported cases continue to affect men who have sex with men (MSM). However, there has been a rapid rise in syphilis amongst heterosexual men and women, particularly among Māori. Most of this increase is among women of reproductive age.
You are a trainee intern in a general practice who saw Kimberley, a 34 year old para 3 Pākehā woman who presented because of a one week history of an itchy vaginal discharge that has developed following a course of Augmentin for a chest infection. She has an IUCD in situ which was inserted 2 years ago. Kimberley had a negative STI screen at the time of her IUCD insertion and is in a long term relationship. On speculum examination, you had noted a white curd- like discharge and prescribed clotrimazole pessaries. The swab report has now returned showing candida albicans on both direct microscopy and culture. Which of the following is the MOST APPROPRIATE next management step?
Advise her to come in for a full STI screen
Advise her of her result and that the correct medication has been prescribed and no follow up is required
Advise her to ask her husband to come in for a penile swab
Advise her that she needs to be tested for underlying conditions such as diabetes and HIV
Advise her the infection is associated with sex, and her partner will require treatment too
Advise her of her result and that the correct medication has been prescribed and no follow up is required
You are a trainee intern in general practice with Amy, a 34 year old para 3, Asian woman who is presenting for a routine smear. Her obstetric history is unremarkable, and she has had an IUCD in situ since the birth of her last child 2 years ago. She mentions that for the last two years she often has a malodorous, grey/white, non-irritant discharge that occurs just after a period. Her periods are regular and painless. There is no irritation. The discharge is always self-limiting. Which of the following is the MOST LIKELY cause of her discharge?
Candidiasis
An endocervical polyp
A retained tampon
Normal physiological discharge
Bacterial vaginosis
BV
IUD is a risk factor for BV
You are a trainee intern in general practice and have been asked to arrange for the appropriate blood tests for STI screening for Amy, a 26 year old, nulliparous, Pākehā woman who has tested positive for chlamydia. The chlamydia swab was taken opportunistically (with her consent) when she had her first cervical smear test. Amy is using the oral contraceptive reliably and admits to two recent occasions of injecting drug use. Of the following options, what is the blood test you are LEAST likely to arrange?
Hepatitis C antibody
Syphilis serology (EIA/RPR/TPHA)
EBV serology
HIV testing
Hepatitis B serology
EBV serology
Not part of STI screen - saliva
You are a trainee intern in a sexual health clinic seeing Eve, a 22 year old nulliparous Australian woman who is in New Zealand on a back-packing holiday. She presents with vaginal and perineal pain and a four day history of clear, watery vaginal discharge. She has difficulty in initiating urination due to discomfort. She has a Mirena for contraception. On examination vesicles can be seen over the perineum. You suspect herpes and take viral swabs. Of the following, which is NOT appropriate management?
Prescribe Paracetamol and ibuprofen
Prescribe Augmentin orally
Recommend salt baths for comfort and skin care
Prescribe oral Valaciclovir
Offer a full STI screen including blood tests for HIV, Hepatitis B and syphilis
Prescribe Augmentin orally
You are a trainee intern in a gynaecological ward about to discharge Charlotte, a 24 year old nulliparous Pākehā woman after a diagnostic laparoscopy. Charlotte had a 3 year history of intermittent pelvic pain, and increasingly painful periods. She had been using the oral contraceptive since she was aged 18 years. The laparoscopy showed clubbing of the fallopian tubes, and peri-ovarian and peri-hepatic adhesions. Of the following, which organism was the MOST LIKELY cause of her pelvic inflammation?
Human papilloma virus (HPV) 18
Trichomonas
Group B streptococcus
Treponema pallidum
Bacterial vaginosis
Candida albicans
Chlamydia trachomatis
Chlamydia trachomatis
