Genital issues

Question 1

Treatment for bacterial vaginosis?

Answer 1

Oral metronidazole for 7 days (especially if pregnant or pre-termination of pregnancy)

Also avoid “overwashing” with soap/shower gel, bubble bath etc.

Question 2

Treatment for genital chlamydia infection?

Answer 2

Oral doxycycline for 7 days

Azithromycin previously used but stopped due to antibiotic resistance

Question 3

Treatment for syphilis?

Answer 3

Long acting, special intramuscular penicillin (benzathine penicillin)

Question 4

Recommended treatment for gonorhoea?

Answer 4

Intramuscular ceftriaxone

Refer to sexual health clinic

Full contact tracing and test of cure for patients.

Question 5

What can bacterial vaginosis increase the risk of?

Answer 5

Increased risk of pre-term delivery

Question 6

Features of bacterial vaginosis?

Answer 6

Offensive smelling vaginal discharge (fishy)

Microscopy reveals clue cells

Treatment is with metronidazole

Question 7

Primary syphilis features?

Answer 7

Presents with single painless ulcer in affected area around 21 days after infection.

Called a “chancre”

Question 8

Secondary syphilis features?

Answer 8

Usually occurs 4-10 weeks after primary stage of syphilis.

Systemic features such as widespread symmetrical rash, fever, oral ulcers and generalised lymphadenopathy.

Question 9

Tertiary syphilis features?

Answer 9

Can occur years after first 2 stages. Presents with severe, neurological, cardio and gummatous complications

Question 10

Neurosyphilis features?

Answer 10

Neurological signs i.e. weakness, paralysis and abnormal behaviour

Question 11

What is latent syphilis?

Answer 11

The asymptomatic period between secondary and tertiary stages of syphilis.

Question 12

What is the appearance of clue cells?

Answer 12

Fuzzy without sharp edges under a microscope.

Clue cells change to this fuzzy look when they are coated with bacteria.

Question 13

What does the appearance of clue cells on microscopy point to as a diagnosis?

Answer 13

Bacterial vaginosis

Question 14

What type of bacteria is neisseria gonnorhoea?

Answer 14

Gram-negative diplococci

Question 15

What type of bacteria is chlamydia trachomatis?

Answer 15

Intracellular, nonmotile (lack movement), gram-negative bacteria.

They are gram-negative cocci

Question 16

What is the most commonly transmitted sexual infection in the UK?

Answer 16

Genital chlamydia infection

Question 17

What people are gonorrhoea and chlamydia infections most prevalent in?

Answer 17

Young sexually active adults. Mainly those aged 15-24

Question 18

For pregnant women with chlamydia, what effect can it have on the neonate?

Answer 18

Neonates can develop pneumonia or conjunctivitis due to exposure to the bacterium during delivery from an infected mother’s genital tract.

Question 19

What is HSV (herpes simplex virus) responsible for?

Answer 19

Cold sores (herpes labialis) and genital herpes.

Question 20

How many main strains of HSV are there?

Answer 20

2 main strains

HSV-1 (cold sores)
HSV-2 (genital herpes)

Question 21

Signs and symptoms of genital herpes?

Answer 21

Ulcers or blistering lesions affecting the genital area

Neuropathic type pain (tingling, burning or shooting)

Flu-like symptoms (e.g. fatigue and headaches)

Dysuria (painful urination)

Inguinal lymphadenopathy

Question 22

What strains of HPV cause genital warts?

Answer 22

HPV strains 6 and 11

Question 23

HPV strains 6 and 11 can result in cervical cancer. True/false?

Answer 23

False

HPV 6 and 11 leads to genital warts.

Cervical cancer can be caused by HPV strains 16 and 18.

Question 24

What is a large differing feature between genital warts and genital herpes?

Answer 24

Genital warts caused by HPV. Genital herpes caused by HSV-2.

Genital warts: painless lumps on anal or genital area.
Genital herpes: presents with painful blisters or open sores in the genital area.

Question 25

What is Trichomoniasis infection?

Answer 25

A sexually transmitted infection (STI) caused by the flagellated protozoan parasite, Trichomonas vaginalis.

Question 26

Where does Trichomoniasis infection typically tend to infect?

Answer 26

Primarily infects the urogenital tract.

Question 27

Trichomoniasis infection is usually caused by a bacteria. True/false?

Answer 27

False

Caused by the flagellated protozoan parasite, Trichomonas vaginalis.

Transmission is predominantly sexual, with an incubation period of approximately 7 days.

Question 28

Symptoms that may be present for trichomoniasis infection in females?

Answer 28

Profuse, frothy, yellow vaginal discharge

Vulval irritation

Dyspareunia

Asymptomatic presentation is also common

Question 29

Symptoms that may be present for trichomoniasis infection in males?

Answer 29

Non-gonococcal urethritis

Asymptomatic presentation

Question 30

How does trichomoniasis differ from chlamydial and gonorrhoeal infections?

Answer 30

Chlamydial and gonorrhoeal infections may present with mucopurulent (pus-like) cervical discharge, cervical motion tenderness, and may also be asymptomatic.

Question 31

How is trichomoniasis infection typically diagnosed?

Answer 31

Primarily made via direct microscopy and culture of the causative organism, Trichomonas vaginalis.

Question 32

What antibiotic should be used in the treatment of trichomoniasis infection?

Answer 32

Oral metronidazole

Either 400-500mg twice per day for 5-7 days or 2g orally per day

Question 33

Apart from oral metronidazole, what else should be done for treatment of trichomonas vaginalis?

Answer 33

Advised to abstain from sexual activity for at least one week, or until the patient and all partners have completed treatment.

Screening for other sexually transmitted infections is recommended.

Contact tracing should be undertaken.

Question 34

What is the cause of genital warts and how is it often treated?

Answer 34

HPV (human papillomavirus).

A suitable treatment is imiquimod cream which is a topical immune response modifier that activates the patients immune system to fight against the virus.