Genitourinary

Question 1

single-celled organism with flagella (protozoan)

Answer 1

Trichomonas vaginalis

Question 2

Trichomoniasis features

Answer 2

frothy and yellow-green, fishy smell discharge
associated with vulval itch and soreness, dysuria, abdominal pain and superficial dyspareunia

Question 3

“strawberry cervix”

Answer 3

Trichomoniasis
tiny haemorrhages across the surface of the cervix,

Question 4

Nucleic acid amplification test is used to diagnose

Answer 4

Trichomoniasis
Mycoplasma genitalium
chlamydia
gonorrhoea

Question 5

Tx Trichomoniasis

Answer 5

oral metronidazole

Question 6

Cause of Genital herpes

Answer 6

herpes simplex virus 1 & 2

Question 7

Epidemiology genital herpes

Answer 7

prevalence of both HSV-1 and HSV-2 is higher in women than men
HSV-2 is more likely to cause frequent recurrences than HSV-1.

Question 8

Features of genital herpes

Answer 8

symptoms of an initial infection with genital herpes usually appear within two weeks. multiple, painful, ulcerated genital lesions.small vesicles that progress to pustules, which subsequently ulcerate and crust over.Also tender lymphadenopathy
systemic symptoms, proctitis, urinary retention, dysuria

Question 9

Viral PCR swab is used to diagnose

Answer 9

Genital herpes

Question 10

Treatment of genital herpes

Answer 10

Aciclovir
should be offered to patients who present within 5 days of symptom onset, if new lesions are still appearing or systemic symptoms are ongoing

Question 11

Pregnancy and Genital Herpes

Answer 11

Primary genital herpes contracted after 28w gestation tx with aciclovir followed by regular prophylactic aciclovir to reduce the risk of genital lesions during labour and delivery.
C-section is recommended in all cases to reduce the risk of neonatal infection.
Recurrent genital herpes in pregnancy, Regular prophylactic aciclovir is considered from 36 weeks gestation

Question 12

Commanest cause of candidiasis

Answer 12

C. albicans

Question 13

RF for candidiasis

Answer 13

Increased oestrogen eg ocp
Poorly controlled diabetes
Immunosuppression
Broad-spectrum antibiotics alters the vaginal flora
Local irritants
Sexual activity
HRT

Question 14

Features of Candidiasis

Answer 14

Thick, white discharge ( cottage/cheese like) that does not typically smell
Vulval and vaginal itching,soreness
causes mild dyspareunia and dysuria

Question 15

Ix for candidiasis

Answer 15

hx
vaginal ph - bacterial vaginosis and trichomonas (pH > 4.5) and candidiasis (pH < 4.5)
A charcoal swab with microscopy can confirm the diagnosis

Question 16

Treatment of candidiasis

Answer 16

fluconazole 150 mg oral c
Advise clotrimazole 500 mg intravaginal pessary if oral therapy is contraindicated

Patients with thrush during pregnancy should avoid oral anti-fungal treatment

Question 17

Mycoplasma genitalium

Answer 17

a bacteria that causes non-gonococcal urethritis , sti
presentation is very similar to chlamydia, and patients may be infected with both organisms. Urethritis is a key feature

Question 18

Symptoms of non-gonococcal urethritis

Answer 18

a white or cloudy discharge from penis
dysuria
irritated and sore
Urine frequency
In a small number of cases the infection travels up the tube between the bladder and the end of the penis (the urethra) to the testicles (testes) and causes pain and swelling in one or both testicles. (epididymo-orchitis)
NGU rarely causes any symptoms in women

Question 19

Treatment for mycoplasma genitalium

Answer 19

doxycycline followed by azithromycin

Question 20

Consider chlamydia in women that are sexually active and present with:

Answer 20

Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding (intermenstrual or postcoital)
Painful sex (deep dyspareunia)
Painful urination (dysuria)

Question 21

Consider chlamydia in men that are sexually active and present with:

Answer 21

Urethral discharge or discomfort
Painful urination (dysuria)
Epididymo-orchitis
Reactive arthritis

Question 22

when a patient attends a GUM clinic for STI screening, as a minimum, they are tested for:

Answer 22

Chlamydia
Gonorrhoea
Syphilis (blood test)
HIV (blood test)

Question 23

Treatment of chlamydia

Answer 23

doxycycline 100mg
contraindicated in pregnancy and breastfeeding

Question 24

Lymphogranuloma Venereum

Answer 24

condition affecting the lymphoid tissue around the site of infection with chlamydia. . This is a tropical disease, rare in the UK,most common in MSM

Question 25

Lymphogranuloma Venereum primary stage

Answer 25

painless ulcer

Question 26

Lymphogranuloma Venereum secondary stage

Answer 26

lymphadenitis. This is swelling, inflammation and pain in the lymph nodes infected with the bacteria.

Question 27

Lymphogranuloma Venereum tertiary stage

Answer 27

inflammation of the rectum (proctitis) and anus.

Question 28

Lymphogranuloma Venereum tx

Answer 28

Doxycycline 100mg twice daily for 21 days

Question 29

chlamydial conjunctivitis

Answer 29

chronic erythema, irritation and discharge lasting more than two weeks. young adults. It can also affect neonates with mothers infected with chlamydia

Question 30

Gonorrhoea causative organism

Answer 30

Gram-negative intracellular diplococcus bacteria Neisseria gonorrhoeae.

Question 31

Gonorrhea epidemiology

Answer 31

15-24 y increasing rates MSM most common

Question 32

Gonorrhea Female genital infections can present with:

Answer 32

Odourless purulent discharge, possibly green or yellow Dysuria Lower Pelvic pain (25%), abnormal bleeding (rare)

Question 33

Gonorrhea Male genital infections can present with:

Answer 33

Penile discharge is observed in > 90% of men, Odourless purulent discharge, possibly green or yellow,usually occurs 2-5 days following infection. Dysuria Testicular pain or swelling (epididymo-orchitis)

Question 34

Treatment of gonorrhoea

Answer 34

single dose of IM ceftriaxone if sensitivities not known, single dose of oral ciprofloxacin 500mg if the sensitivities ARE known

Question 35

gonococcal conjunctivitis in neonate

Answer 35

medical emergency and is associated with sepsis, perforation of the eye and blindness.

Question 36

Disseminated Gonococcal Infection

Answer 36

bacteria spreads to the skin and joints.

Question 37

Bacterial vaginosis

Answer 37

overgrowth of bacteria in the vagina. It is not a sexually transmitted infection. It is caused by a loss of the lactobacilli that normally keep the vaginal pH low , a more alkali environment enables anaerobic bacteria to multiply.

Question 38

Epidemiology Bacterial vaginosis

Answer 38

commonest cause of abnormal discharge in women of childbearing age one third of women between the ages of 14-49 years old have evidence of BV. highest amongst women who are sexually active. It estimated to be around 10% in the UK female population BV is seen more commonly in black women Women who have sex with women are more at risk due to shared vaginal flora patterns.

Question 39

Features of bacterial vaginosis

Answer 39

fishy-smelling watery grey or white homogenous vaginal discharge. Half of women with BV are asymptomatic. no pain/irritation

Question 40

diagnosis of BV can be made when three of the four Amsel criteria are met:

Answer 40

Vaginal pH > 4.5 Typical discharge: thin, off-white/grey, homogenous and smoothly coats vaginal wall Positive whiff-amine test: development of fishy odour with addition of 10% potassium hydroxide to vaginal discharge Clue cells (on gram stain microscopy): vaginal epithelial cells studded with adherent coccobacilli

Question 41

Treatment of bacterial vaginosis

Answer 41

Metronidazole- specifically targets anaerobic bacteria

Question 42

HIV

Answer 42

RNA retrovirus. HIV-1 is the most common type. HIV-2 is rare outside West Africa. The virus enters and destroys the CD4 T helper cells.

Question 43

Primary HIV infection features

Answer 43

fever and lymphadenopathy. maculopapular rash mucosal ulcers

Question 44

PCP

Answer 44

commonest opportunistic infection affecting patients with undiagnosed HIV in this country , is a marker of advanced HIV. Patients will usually present with a CD4 count <200. It is caused by Pneumocysitis jirovecii

Question 45

PCP treatment

Answer 45

IV Co-Trimoxazole for 14-21 days (Trimethoprim plus Sulfamethoxazole or “Septrin”).

Question 46

Ix HIV

Answer 46

HIV Antibody blood test Testing for the p24 antigen PCR testing for the HIV RNA Monitor viral load and cd4 count

Question 47

Caesarean section should be used in HIV unless the mother has an undetectable viral load:

Answer 47

less than 50 copies/ml at 36 weeks.

Question 48

Newborns to HIV positive mothers should receive

Answer 48

ART for 4 weeks after birth

Question 49

Post Exposure Prophylaxis HIV

Answer 49

must be commenced within a short period (less than 72 hours). current regime is Truvada (emtricitabine / tenofovir) and raltegravir for 28 days. HIV tests should be done initially but also a minimum of 3 months after exposure to confirm a negative status.

Question 50

Symphilis causative organism

Answer 50

Treponema pallidum. spirochete, a type of spiral-shaped bacteria.

Question 51

Primary syphilis

Answer 51

painless ulcer called a chancre at the original site of infection.usually in conjunction with local lympadenopathy.

Question 52

Secondary syphilis

Answer 52

systemic symptoms, maculopauplar rash (palms of the hands and soles of the feet), alopecia

Question 53

Tertiary syphilis

Answer 53

Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones) Aortic aneurysms Neurosyphilis

Question 54

Argyll-Robertson pupil

Answer 54

constricted pupil that accommodates when focusing on a near object but does not react to light. They are often irregularly shaped.specific finding in neurosyphilis

Question 55

Treatment of syphilis.

Answer 55

benzathine benzylpenicillin IM

Question 56

Tx for pubic lice

Answer 56

malathion lotion and permethrin 5% cream Permethrin is NOT usually used if you are under 18. Follow up should be arranged 1 week after completion of treatment to ensure clearance of infestation.

Question 57

Anogenital warts are caused by

Answer 57

human papillomavirus (HPV), most commonly low-risk genotypes 6 and 11.