Genitourinary

Question 1

What is the treatment for cervicitis?

Answer 1

N. gonorrhoeae
- IM Ceftriaxone 1g single dose
OR
- Oral ciprofloxacin 500 mg single dose

C. trachomatis
- Oral doxycycline 100 mg BD for 7 days (not in pregnancy)
OR
- Day 1: Oral azithro 1g OD
plus
- Day 2& 3: Oral azithro 500 mg OD

Question 2

DDx between:
- Syphilis;
- Genital herpes (HSV);
- Haemophilus ducreyi.

Answer 2

Syphilis
- Single ulcer
- Non-painful ulcer

Genital herpes (HSV)
- Multiple ulcers
- Painful ulcers
- Dysuria

Haemophilus ducreyi
- Single ulcer
- Painful ulcer

Question 3

What is the investigation and Rx of genital herpes?

Answer 3

Genital herpes (HSV)
- Multiple ulcers
- Painful ulcers
- Dysuria

➔ Investigation
- Viral culture
- PCR / NAAT
- If negative and recurent ulcers ➝ anti-HSV antibody

➔ Rx
- Aciclovir

Question 4

DDx of rash in palms and soles?

Answer 4

Hand, foot and mouth disease
- Coxsackie virus

Rock, mountain spotted fever
- Tick (rickettsia)

Secondary syphilis
- Treponema pallidum

Question 5

Describe the symptoms of syphilis.

Answer 5

1st stage
- Chancre, single painless genital ulcer
- Lymphadenopathy

2nd stage
- 6 weeks after chancre appearance;
- Fever
- Lymphadenopathy
- Malaise
- Rash on soles, palms and face
- Condyloma lata

3rd stage
- If untreated for long time
- Gummas (granulomas on skin and bones)
- Cardiovascular syphilis (Ascending aorta aneurysm / AR)
- Neurological syphilis (dementia / tabes dorsalis)

Question 6

What are the investigations done in syphilis?

Answer 6

Chancre present:
- PCR at GP clinic
- Dark microscopy at genitourinary clinic

Chancre has healed
Oral lesions present
- PCR of lesion

Oral lesions NOT present
- Syphilis serology

Question 7

What are the investigations done on MSM (men sleep with men)?

Answer 7

Bottom
- Rectal swab
- NAAT for chlamydia and gonorrhoea

Top
- Urethral swab
- 1st void urine