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MFSRH 2021 > GUM > Flashcards

GUM Flashcards

1
Q

Typical finding on microscopy for gonorrhea?

A

Gram negative diplococci. Intracellular

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2
Q

Anatomical sites infected by gonorrhea?

A

Urethra, endocervix, rectum pharynx, conjunctiva

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3
Q

Signs and symptoms of gonorrhoea in males?

A

Urethral discharge (80% within 2-5/7 of infection), dysuria, asymptomatic (10%), rectal discharge/perianal pain, 90% pharyngeal are asymptomatic. Mucopurulent discharge, epididymal tenderness (rare)

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4
Q

Signs and symptoms of gonorrhoea in females?

A

Asymptomatic, vaginal discharge (50%), lower abdo pain (25%), dysuria (12%), rectal and pharyngeal are generally asymptomatic. Cervical contact bleeding, occasionally IMB/menorrhagia.

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5
Q

Complications of gonorrhoea?

A

PID, epididymal orchititis, SARA, haematogenous dissemination (skin lumps, arthralgia, arthritis, tenosynovitis)

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6
Q

Diagnosis of gonorrhoea?

A

Microscopy 90-95% sensitive in males with urethral discharge. NAAT 96% sensitive in symptomatic and asymptomatic.

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7
Q

In people who have undergone gender affirming surgery what sampling should be taken?

A

Neovaginal NAAT swab and urine, neo-penis first void.

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8
Q

Coinfection rate for chlamydia with gonorrhoea positive individuals?

A

19%

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9
Q

Gonorrhoea window period?

A

2 weeks.

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10
Q

Treatment of gonorrhoea 1st line?

A

Patient info, full screen, culture and naat all exposed sites, ceftriaxone 1g/im/stat (ciprofloxacin 500mg stat is sensitivities known, abstain 7/7 after completing tx. ToC 2/52.

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11
Q

Complications of ciprofloxacin?

A

Joint/MSK/tendonitis – avoid if previous problems or >60 yo/CKD/corticosteroid user

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12
Q

Ciprofloxacin resistant gonorrhoea %

A

UK? 36% in 2017

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13
Q

A male has a positive gonorrhoea NAAT, cultures show ceftriaxone sensitive, ciprofloxacin resistant, and macrolide sensitive. He had breathing difficulties after penicillin based treatment for tonsilitis in the past. What antibiotic would you offer him?

A

Gentamycin 240mg/IM and azithromycin 2g stat. Cephalosporins contraindicated in penicillin anaphylaxis

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14
Q

Treatment of disseminated gonorrhoea infection?

A

IV ceftriaxone 1g for 7/7 but PO switch after 24-48hrs of symptom improvement.

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15
Q

PO switch for disseminated gonorrhoea infection?

A

Cefixime 400mg BD or ciprofloxacin 500mg BD or ofloxacin 400mg BD depending on sensitivities.

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16
Q

Pregnancy treatment for gonorrhoea?

A

Ceftriaxone, spectinomycin or azithromycin

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17
Q

Partner notification for symptomatic males gonorrhoea?

A

All in past 2/52 or most recent partner if >2/52 since LSI

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18
Q

Gonorrhoea partner notification for females or asymptomatic males?

A

3/12

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19
Q

A male partner of a gonorrhoea positive male patient attends as a contact, they last had sex 17 days ago, what would you advise with respect to testing and treatment?

A

NAAT only if asymptomatic, and await results. If symptomatic test and treat. 14 days is the cut off for the LSI for treatment and testing on the same day.

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20
Q

When is the test of cure done for gonorrhoea?

A

2/52 after treatment (can have culture at 72 hours), treatment failures should be reported to PHE.

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21
Q

Prevalence of mycoplasma genitalium?

A

1-2% males more than females.

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22
Q

Risk factors of M.gen?

A

<25, smoker, multiple partners, BAME origin.

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23
Q

% NCNGU which is m.gen +ve?

A

10-35%

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24
Q

% PID m.gen positive?

A

10-13%

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25
Q

Signs and symptoms of m.gen

A

Asymptomatic 90% men and 95% women. Otherwise discharge, dysuria, urethral irritation, urethritis, IMB/PCB, cervicitis, low abdo pain in women/PID, fertility impact, SARA, epididymal orchitis.

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26
Q

When to test of m.gen?

A

NGU/PID, current partner of m.gen positive patient, consider in proctitis, epididymal orchitis, cervicitis

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27
Q

% macrolide resistance in m/gen in uk?

A

40%

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28
Q

Window period for m.gen?

A

not known

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29
Q
  1. Treatment for m.gen?
A

Patient info, test for other STI, abstain 14/7 after start of tx and until symptoms resolve. TOC 5/52 (no sooner than 3/52). If macrolide resistance not known or sensitive doxycycline 7/7 100mg BD then 1g azithromycin stat and 2 x 500mg for 2/7, if macrolide resistant moxifloxacin 400mg 10/7 or if tx failure.

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30
Q

Partner notification for m.gen?

A

test current partner only treat if +ve, same antibiotics as index case.

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31
Q

M.gen treatment in pregnancy?

A

Azithromycin 3/7 (moxi/doxy CI)

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32
Q

A patient with NGU was treated with azithromycin for 3/7 due to a doxycycline intolerance, their m.gen test has returned positive with macrolide resistance NOT found, what is the next step in their management?

A

ToC 5/52 post tx.

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33
Q

A patient with NGU was treated with azithromycin for 3/7 due to a doxycycline intolerance, their m.gen test has returned positive with macrolide resistance was found, what is the next step in their management?

A

Moxifloxacin then TOC

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34
Q

A patient with NGU was treated with doxycycline for 7/7, their m.gen test has returned positive with macrolide resistance NOT found, what is the next step in their management?

A

Azithromycin 3/7 then ToC 5/52 post tx.

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35
Q

A patient with NGU was treated with doxycycline for 7/7, their m.gen test has returned positive with macrolide resistance WAS found, what is the next step in their management?

A

Moxifloxacin then TOC 5/52

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36
Q

Abstinence period for m.gen?

A

14/7 after start of treatment

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37
Q

Complications of Moxifloxacin?

A

Achilles tendon rupture – inform patient of risk .

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38
Q

NSU causes?

A

Chlamydia 11-50% esp younger patient, m.gen 6-50%, uroplasma 11-26%, TV 1-20%, adenovirus 2-4%, HSV 2-3%, UTI 6%. Also EBV, candida, foreign bodies, urethral stricture.

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39
Q

Signs and symptoms of NSU?

A

Discharge, balanoposthitis, dysuria, irritation.

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40
Q

Complications of NSU?

A

SARA/ epididymal orchititis.

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41
Q

Investigation of NSU?

A

Only if symptoms. Microscopy >5 PMNLs/HPF over 5 fields. No microscopy discharge, 1+ leukocyte on udip, threads in urine. NAAT

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42
Q

Management of NSU?

A

Information, sti screen.

Doxy 7/7 100mg/po or azithromycin 3/7 (1g stat 2 x daily 500mg) or ofloxacin 40mg OD 7/7. Abstain 14/7 after tx started.

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43
Q

Abstinence period for NSU?

A

14 days

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44
Q

A man was treated for NGU with doxycycline 10 days ago, his symptoms persist and GC and C4 naats are negative, how would you manage him?

A

Ensure abstinence/ compliance, M.gen screen, azithromycin 3/7 and metronidazole 5/7 400mg/BD. If doxy>2 weeks ago treatment with doxy then azithro and metro (reduces m.gn burden for azithromycin to work).

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45
Q

A man was treated for NGU with azithromycin 10 days ago, c4 and GC naats are negative, his symptoms persist, how would you manage him?

A

Ensure abstinence and compliance, moxifloxacin 400mg bd 10/7 and metronidazole

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46
Q

Look back period for NGU?

A

4/52.

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47
Q

Partner tx for NGU?

A

Doxycycline 7/7 or azithromycin 1g stat.

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48
Q

%persistent NGU

A

15-25%

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49
Q

Recurrent NGU within 3/12 of tx %?

A

10-20%

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50
Q

A man was treated for NGU with azithromycin 10 days ago, c4 and GC naats are negative, his symptoms persisted and he reattended, your colleague ensured abstinence and compliance screen him for m.gen and gave him moxifloxacin 400mg bd 10/7 and metronidazole. His symptoms persist, mgen is negative, what next?

A

Ensure no psychological overlay, abstinence and give 1g azithromycin, then 4/7 500mg and 5/7 metronidazole 400mg BD.

If that fails moxiflocacin 10-14/7 400mg bd, consider 3/52 erythromycin 500mg qds or clarithromycin 500mg BD 3/52.

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51
Q

Incubation periods for LGV?

A

3-30/7

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52
Q

Most common serovar of LGV in UK?

A

L2

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53
Q

Classic location of primary LGV infection?

A

Painless pustule/ulcer on coronal sulcus, posterior vaginal wall, perianal area or lip.

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54
Q

Left untreated what are the sequalae of LGV?

A

Lymphadenitis, lymphadenopathy, bubo (unilateral grove sign), chronic prostatitis, fistulae, strictures, sara, fevers, pneumonitis, deranged LFTs.

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55
Q

Diagnosis of LGV?

A

Clinical suspicion esp HIV+ve/MSM, culture ulcer or pus (on cycloheximide treated mccay cells), NAAT, rectal slide >10 PMNL.

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56
Q

Histology of LGV?

A

Lymph nodes show follicular hyperplasia and abscesses.

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57
Q

Treatment of LGV?

A

Doxycycline 21/7 100mg BD

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58
Q

2nd and 3rd line tx for LGV?

A

Tetracycline 2g/po/od 21 days or erthyromycin 21 days 500mg/QDS, or azithromycin 1g weekly for 3 weeks. (azithromycin and erythromycin are safe in pregnancy and breast feeding)

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59
Q

Partner notification for LVG?

A

4/52 before symptoms onset or 3/12 if asymp, treat with 21/7 doxy.

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60
Q

TV symptoms/signs in male and females?

A

Males usually asymptomatic, occasionally mild urethral discharge/irritation, dysuria or urinary frequency. Females discharge, frothy/yellow, itch, urethral irritation, dysuria, strawberry cervix (2%), vulvovaginitis. Asymp 10-50%.

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61
Q

What type of pathogen is TV?

A

A flagellated protozoon

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62
Q

Diagnosis of TV?

A

NAAT is gold standard 88-97% sensitive and 98% specific.

Culture 100 specific, 75-95% sensitive, Microscopy 45-60% sensitive, needs to be done quickly so the TV doesn’t die.
POC 80-94% sensitive, 95% specific.

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63
Q

Partner notification for TV?

A

Current and 4/52 prior.

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64
Q

Abstinence following tv treatment?

A

1/52 or until negative toc

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65
Q

Treatment of TV?

A

Metronidazole 5-7/7 40-5mmg mg PO BD or 2g stat.

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66
Q

What should patients be adviced regarding metronidazole and alcohol?

A

Avoid, disulfram like reaction 48hrs for metro, 72hrs for tinidazole

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67
Q

2nd line tx for TV?

A

Tinadzoe 2g/po/stat

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68
Q

Breast feeding and metronidazole?

A

Impacts on taste, discard for 12-24hrs after finishing.

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69
Q

Tinadazole and pregnancy?

A

No

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70
Q

Causes of TV treatment failure?

A

Inadequate therapy (compliance/vomiting), reinfection, resistance

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71
Q

Treatment for partners of TV infection?

A

Metronidazole 400-500mg/po/bd 5-7/7

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72
Q

If tx failure of first line what next in TV?

A

High dose metro or tinidazole 2g 5-7/7 or 800mg metro TDS 7/7

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73
Q

Persistent failure TV

A

2g BD tinidazole 14/7 +/- intravaginal tx.

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74
Q

Definition of recurrent thrush according to BASHH?

A

4 or more episodes in 12/12. 2 confirmed on culture/micro (at least 1 positive culture)

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75
Q

Non-albicans species of candida?

A

C. Glabrata (especially in diabetics), C. tropicalis, C. krusei, (intrinsically resistant to fluconazole), C. parapsilosis, Saccharomyces cerevisiae

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76
Q

First line treatment of acute candida?

A

PO fluconazole 150mg stat or 500mg PV clotrimazole PV stat

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77
Q

% women colonized with candida who are asymptomatic and do they require treatment?

A

10-20% no treatment needed.

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78
Q

% clearance rate of candida of vaginal imidazole and oral azoles?

A

80%

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79
Q

What can all vaginal medications do to condoms and diaphragms?

A

Weaken them, avoid SI whilst on tx.

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80
Q

% increase in candida colonisation and symptoms in pregnancy?

A

30-40%

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81
Q

Treatment of candida in pregnancy?

A

7/7 500mg PV clotrimazole

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82
Q

Why a longer course of treatment of candida in pregnancy?

A

Cure rate 90% for 7/7 and 50% after 4/7

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83
Q

Risk of prescribing fluconazole PO and erythromycin together?

A

Long QT risk

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84
Q

Fluconazole induces with enzyme pathway?

A

CYP450

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85
Q

Risk of what with statins and fluconazole?

A

myopathy and rhabdomyolysis If concurrent treatment is necessary, monitor for symptoms of myopathy and rhabdomyolysis, and monitor creatine kinase.

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86
Q

Treatment of recurrent candida?

A

Culture for sensitivities and speciation, examine, micro, general advice, baseline LFTs and U&E (consider TFT/FBC although evidence poor for this), udip for glucosuria, ensure no risk immune compromise. Fluconazole 150mg x 3 72hrs apart then weekly for 6/12.

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87
Q

2nd line pharmacological tx for recurrent candida?

A

Clotrimazole 500mg 7-14 days, then weekly.

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88
Q

First line tx of severe but not recurrent candida?

A

Fluconazole 150mg day 1 & 4, clotrimazole HC topically BD 7 days.

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89
Q

Second line tx of severe but not recurrent candida?

A

Clotrimazole 500mg day 1 and 4 and clotrimazole HC topically BD 7 days.

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90
Q

Third line tx for severe but not recurrent candida?

A

Miconazole PV 1200mg day 1 and 4 and clotrimazole HC topically BD 7 days.

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91
Q

Describe role of high oestrogenic states in recurrent candida?

A

Possible link, prepubertal and post menopausal women get less thrush. HRT is linked to more thrush, CHC may be. Worth a try on something else if acceptable to patient and suppression not helping.

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92
Q

Link to IUC and recurrent candida?

A

possible biofilm formation and colonisation of device reducing in poorer clearance, worth trying without if acceptable to patient and alternative contraception can be found.

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93
Q

Risk of recurrent candida?

A

5% of women of reproductive age with a primary episode will develop recurrent disease.

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94
Q

% reduction in recurrence from suppressive therapy for candida immediately, 3/12 and 6/12?

A

88%, 65 and 60% respectively

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95
Q

Additional non-azole tx which may be useful in recurrent candida?

A

Cetirizine

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96
Q

Which immune-deficiency condition associated with recurrent infections is associated with recurrent candida?

A

Mannose binding lectin deficiency

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97
Q

A woman with poorly controlled diabetes presents having been treated by your colleague for presumed candida, she had had a poor response to treatment. Microscopy reveals multiple spores but no hyphae – what is the likely causative pathogen?

A

Candida glabrata and requires higher dose fluconazole

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98
Q

A woman has been treated for candida with fluconazole to no avail, microscopy reveals long grains of rice appearance, which species of candida is it likely to be?

A

Krusei which is intrinsically resistant to fluconazole but responds to voriconazole

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99
Q

Treatment options for non-ablicans species of candida?

A

1st line: Nystatin pessaries daily for 2 weeks.
Alternatives include Amphotricin B pessary 50mg od for 14 days, Boric acid 600mg vaginal suppository daily for 2-3 weeks. ?teratogenic risk, Intravaginal flucytosine 1 g pessary +- amphotericin to reduce chances of resistance

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100
Q

Signs and symptoms of vulvovaginal candida?

A

Itch, white discharge, superficial dyspareunia, satellite lesions, dysuria, fissuring, hyperkeratosis

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101
Q

Differential diagnosis for vulvovaginal candida?

A

Eczema, lichen, TV, vulvodynia, aerobic vaginitis, cytolytic vaginitis

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102
Q

Bacteria associated with BV?

A

Gardnerella vaginalis, Prevotella sp, Mycoplasma hominis, Mobiluncus sp.

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103
Q

Normal vaginal pH?

A

<4.5

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104
Q

Risk factors for BV?

A

vaginal douching, receptive cunnilingus, black ethnicity, recent change of sex partner, smoking, presence of an STI

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105
Q

Signs and symptoms of BV?

A

Thin homogenous discharge, fishy smell, rare to have itch/pain. Asymptomatic in 50%

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106
Q

Complications of BV?

A

Increased risk of HIV acquisition, high prevalence in women with PID, post TOP endometritis

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107
Q

BV related complications in pregnancy:

A

late miscarriage, preterm birth, PPROM, postpartum endometritis

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108
Q

Amsel’s criteria for BV?

A

thin, white, homogenous discharge, clue cells on microscopy of wet mount, vaginal pH >4.5, Wiff test: 10% KOH releases a fishy odour

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109
Q

Hay-Ison criteria for BV grade 1-4?

A

Grade 0: No bacteria present

Grade 1: Normal flora – lactobacillus morphotypes predominate

Grade 2: Mixed flora with some lactobacilli present bur Gardnerella or Mobiluncus morphotypes also present.

Grade 3: BV. Predominantly Gardnerella and/or Mobiluncus morphotypes. Few/absent lactobacilli,

Grade 4: Gram positive cocci only

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110
Q

Pregnancy & Breastfeeding does BV need treating?

A

No evidence that screening asymptomatics will prevent preterm birth/misc, but treating before 20 weeks may reduce risk, so symptomatic women should be treated and women with additional risk factors for preterm birth may benefit from treatment before 20 week gestation

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111
Q

Recurrent BV treatment?

A

Suppressive metronidazole (0.75%) vaginal gel twice weekly for 16 weeks. May get candida (43 vs 21%). Probiotics: daily on days 1-7 and 15-21 (antibiotics & probiotics in combination may have increased cure rates), no evidence but lactic acid washes eg balance activ and reduce recurrence but not induce remission.

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112
Q

Treatment for BV?

A

all have 70-80% cure rates;
Metronidazole 400mg bd for 5-7 days,

Metronidazole 2g

intravaginal metronidazole gel (0.75%) od for 5 days

intravaginal clindamycin cream (2%) od for 7 days

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113
Q

Lifecycle of adult public lice?

A

15-25 days (hence tx day 1 and day 7 to catch them all)

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114
Q

Incubation time of public lice eggs?

A

5 days (can be longer)

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115
Q

Treatment for public lice?

A

Malathion 0.5% min 2hrs ideally over night, retreat day 7.

Permethrin 1% 10mins then wash off day 0&7.

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116
Q

Treatment for public lice in pregnancy?

A

Permethrin 1% 10mins then wash off day 1&7.

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117
Q

Treatment of public lice in eye lashes?

A

Permethrin 1% 10mins then wash off day 1&7 or yellow paraffin BD for 8-10 days (suffocates them)

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118
Q

Partner notification for public lice?

A

Treat current partner and 3/12 lookback.

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119
Q

How long is the life cycle of scabies?

A

4-6weeks

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120
Q

How long do scabies eggs take to hatch?

A

10-15 days

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121
Q

How long can scabies mites live off host?

A

24-34hrs

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122
Q

How long does it take to become symptomatic after primary scabies infection?

A

3-6 weeks (type 4 delayed hypersensitivity)

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123
Q

How long does it take to develop symptoms following reinfection of scabies?

A

1-3 days (already sensitised)

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124
Q

Symptoms and signs of scabies?

A

Distribution: finger webspaces, sides of fingers and under nails, flexor wrists, extensor elbows, axillary folds, nipple in women and penis/scrotum in men, umbilicus, medial thighs, buttocks, sides and back of feet.

Puritis worse at night.

Pathognomonic lesion: burrow (linear intra-epidermal tunnel) made by moving mite.
Nodular lesions, on penis ad scrotum, buttocks, groin and axillae – intensely itchy.
May persist after Tx

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125
Q

Tx for classic scabies?

A

Permethrin 5%, leave on 12hr, reapply 1 week (safe in pregnancy and breastfeeding)

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126
Q

Alternative tx for classic scabies not permethrin?

A

Malathion 0.5% leave on 24rs and reapply 1 week.

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127
Q

Treatment for Norwegian/crusted scabies?

A

Premethrin daily 7 days, then twice weekly until cure +/- ivermectin PO day 1,2,8,9,15

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128
Q

How long may the scabies itch last for?

A

Up to 2 weeks even if treated, persistent symptoms after this should consider retreatment as failure or reinfection

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129
Q

Lookback period for scabies?

A

1/12

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130
Q

Partner notifications for scabies?

A

Treat all close contacts, sexual and household.

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131
Q

What causes molluscum contagiosum?

A

Pox DNA virus.

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132
Q

Which subtype of the Pox DNA virus is most common in molluscum contagiosum?

A

M1 (M2 more common in HIV+ve)

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133
Q

Transmission of molluscum contagiosum?

A

kin to skin, sharing towels/bedding

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134
Q

Appearance of molluscum contagiosum?

A

Smooth, domed, firm 2-5mm lumps with central umbilicus, usually asymp.

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135
Q

Treatment for molluscum contagiosum?

A

Expectant – will spontaneously regress usually unless immunocompromised, skin care and avoid autoinoculation (shaving/waxing)

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136
Q

If HIV+ve treatment for molluscum contagiosum?

A

If on HAART will usually regress, but flare during initial tx whilst immune-reconstitution ongoing. Can try cryo or topical cidofovir or podophyllotoxin, skin care and avoid autoinoculation (shaving/waxing)

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137
Q

Genital warts cause (and subtype)?

A

90% caused by HPV subtype 6 & 11

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138
Q

Rapid growth to very large and erosion in a genital wart is likely to be what lesion?

A

Buschke-Lowenstein lesion (condyloma acuminata), need surgery to prevent destruction of adjacent structures.

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139
Q

Condoms can reduce transmission of genital warts by how much?

A

30-60%

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140
Q

Treatment of genital warts, keratinised on penile shaft?

A

Info, STI screen, stop smoking, expectant mx, cryo, imiquimod, podophyllotoxin, TCA, surgery/electrocautery. Cryo tends to work well in keratinised.

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141
Q

Cryo therapy protocol in genital warts?

A

3 cycles of cryo weekly for 4-6 weeks, if not improving try alternative tx.

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142
Q

Expectant management of genital warts – expected success rate over what time?

A

30% in 6/12

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143
Q

Incubation periods for genital warts?

A

3-8/12 (up to 18/12)

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144
Q

Podophyllotoxin regimen for genital warts?

A

Twice daily for 3 days, 4 day rest, 4 cycles

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145
Q

Imiquimod regimen in genital warts?

A

5%, OD for 3 days weekly, leave on for 6-10hrs, 16 cycles.

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146
Q

Mechanism of action of Imiquimod?

A

TLR7 agonist – promotes viral clearance.

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147
Q

Treatment options on pregnancy of genital warts?

A

Cryo or physical destruction (imiquimod and Podophyllotoxin teratogenic). Doesn’t warrant c-section.

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148
Q

Treatment options on breastfeeding of genital warts?

A

Cryo or physical destruction (imiquimod no advice in SPC)

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149
Q

Patients with immunocompromised are likely to need what duration of treatment for genital warts compared to immunocompetent?

A

Longer.

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150
Q

Intravaginal genital warts treatment options?

A

expectant, cryotherapy, electrosurgery and TCA. Podophyllotoxin has been used <2cm2 (not licensed)

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151
Q

Cervical genital warts treatment options?

A

expectant, cryotherapy, electrosurgery and TCA. Colp not required unless suspecting neoplasm.

152
Q

Urethral meatus genital warts treatment options?

A

Base of lesion visible - treat with cryotherapy, electrosurgery, laser ablation, podophyllotoxin or imiquimod. Deeper lesions - surgical ablation under direct vision, which may require urology referral or use of a meatoscope.

153
Q

Treatment options for intra-anal warts?

A

Expectant, cryotherapy, topical imiquimod (unlicensed indication), electrosurgery, laser ablation and TCA.

154
Q

Genital warts in children?

A

<2yo can be vertical transmission, high index of suspicion for abuse.

155
Q

Tx of HIV+ve patient with genital warts?

A

Same as non-HIV +ve but will likely need longer tx, HARRT will help clearance.

156
Q

Cause and % of acyclovir resistant HSV in PLWHIV?

A

5-7% in HIV +ve, HSV thymidine kinase

157
Q

What if the difference between primary episode and primary infection?

A

Pimrary episode is first time symptoms, might not be the primary infection. Primary infection = 1st ever infection with no pre-existing antibodies.

158
Q

Which type of HSV is most common in UK on the genitals?

Typically how many episodes for HSV 1 and 2 are expected within a 12/12 period?

A

Type 1

1 for HSV 1
4 for HSV 2

159
Q

What proportion of people will not develop symptoms at time of HSV-2 acquisition?

A

2/3

160
Q

Incubation time for HSV?

A

2 days to 2 weeks

161
Q

What does HSV do once symptoms subside?

A

Lies dormant in sensory ganglia.

162
Q

% asymptomatic shedding?

A

10%

163
Q

Condoms can reduce transmission by how much?

A

Up to 50%

164
Q

Symptoms and signs of HSV?

A

Genital ulcers, pain, dysuria, uriary retention, fever/malaise, asymp

165
Q

Complications of HSV?

A

Superadded infection, autoinoculation to fingers ect, proctitis, aseptic meningitis.

166
Q

How is HSV diagnosed?

A

DNA PCR

167
Q

What type of virus is HSV?

A

Double stranded DNA

168
Q

Detection rate of HSV on DNA PCR?

A

11-71%

169
Q

Management of HSV first episode?

A

Info, skin care, saline bath, STI screen, analgesia (oral and lidocaine 5% topical), antivirals if within 5 days of start of episode (acyclovir 400mg TDS PO 5/7)

170
Q

Alternative antiviral to acyclovir in treatment of 1st episode of HSV?

A

Valaciclovir 500mg BD 5/7 or famciclovir mg TDS 5/7

171
Q

Treatment of recurrent episode of HSV?

A

Skincare, saline bathe, analgesia, antiviral can reduce duration 1-2 days. Standard antiviral tx or short course (ACV 800mg TDS 2/7 or famciclovir 500mg-1g one day or valaciclovir 500mg BD 3/7

172
Q

Partner notification and look back period for HSV?

A

No lookback, should encourage to tell partner but partner doesn’t need screening if asymp

173
Q

HIV +vet x for HSV?

A

Same as standard if CD4 ok and not severe, but if severe ACV 400mg x 5 times daily for 7-10 days and continue until lesions epithelializing.

174
Q

What information regarding sex with pregnant women should people with HSV be told?

A

Avoid SI with pregnant women esp in 3rd trimester and esp if that woman has not had HSV before.

175
Q

Criteria for suppression therapy for HSV?

A

6 or more episodes in a year or significant distress.

176
Q

Suppression treatment options in HSV?

A

6-12 months of tx, with plan to stop, likely to get outbreaks on stopping but should settle. ACV 400mg BD or famciclovir 250mg BD or valciclovir 500mg OD

177
Q

Treatment of outbreak of HSV whilst on suppression?

A

400mg tds 5/7 ACV.

178
Q

Risk of transmission of HSV for vaginal delivery if recurrent HSV?

A

0-3%

179
Q

Recommendation for all pregnant women with known HSV regarding ACV use?

A

36/40 400mg TDS until delivery and plan vaginal birth, if genital HVS at delivery 24hrs observation of neonate.

180
Q

Management of primary episode of HSV in pregnancy at 26/40?

A

All under 27+6 tx as normal, inform obs team, offer suppression from 36/40 and plan vaginal delivery

181
Q

Management of HVS first episode in pregnancy at 32/40?

A

Information, ACV as normal and swabs, and suppression therapy until delivery, recommend c/s (41% reduction in transmission),

serology (may take a couple of weeks to come back) - Type-specific HSV antibody (IgG) testing is advisable to distinguish between primary and recurrent genital HSV infections.
The presence of antibodies of the same type as the HSV isolated from genital swabs would confirm this episode to be a recurrence rather than a primary infection and elective caesarean would not be indicated

182
Q

Management of a woman in labour who’s never been known to have HSV lesions?

A

Hx to find out if recurrent or not, swab lesions, inform neonatal team, c/s where possible. Consider intrapartum IV aciclovir for the mother (5 mg/kg 8 hourly) and the neonate (20 mg/kg 8 hourly) if opting for vaginal delivery, avoid invasive procedures eg foetal blood sampling.

183
Q

Risk of transmission of HSV to neonate if primary genital lesions at time of delivery?

A

41%

184
Q

Management of babies born to mothers with recurrent HSV infection in pregnancy with or without active lesions at delivery?

A

Maternal IgG will be protective this infection risk low. Conservative mx. Examination at 24hrs and no tx. General hygiene.

185
Q

Management of babies born by caesarean section in mothers with primary HSV infection in the third trimester?

A

infection risk low. Conservative mx. Examination at 24hrs and no tx. General hygiene.

186
Q

Management of babies born by spontaneous vaginal delivery in mothers with a primary HSV infection within the previous 6 weeks if baby well?

A

Swab skin, empirical ACV, and await swabs.

187
Q

Management of babies born by spontaneous vaginal delivery in mothers with a primary HSV infection within the previous 6 weeks if baby unwell?

A

Swab skin, LP, empirical ACV until active infection ruled out.

188
Q

Management of HIV +ve mothers with recurrent HSV?

A

ACV from 32/40 to reduce HIV transmission

189
Q

Management of HIV +v mothers with primary episode of HSV?

A

Same as non-HIV

190
Q

Management of primary genital herpes in preterm prelabour rupture of membranes (PPROM)?

A

IV ACV, MDT choice to delivery.

191
Q

Management of recurrent genital herpes in preterm prelabour rupture of membranes (PPROM)?

A

PO ACV TDS and management as per obs team for delivery/MDT input, limited evidence.

192
Q

Suppression therapy dose/frequency of ACV in HVS in pregnancy?

A

400mg TDS ACV (volume of distribution increased in pregnancy)

193
Q

Partners tx and look back for donovanosis?

A

Look back 6/12

Assess partners for symptoms and offer treatment

194
Q

In vertical transmission of donovanosis where is typically affected on the neonate?

A

The ear.

195
Q

Cause of donovanosis?

A

Klebsiella granulomatis

196
Q

Typical appearance of donovanosis?

A

Papule turns in to painless ulcer, beefy red, bleeds readily to touch, rolled edge, lymph nodes locally.

197
Q

Stains used to look for donovanosis in as smear slide?

A

Giemsa, wright or Leishman

198
Q

Stains used to look for donovanosis in as biopsy?

A

Giemsa or silver

199
Q

Histological findings for donovanosis?

A

Large histocytes, pleomorphic appearance, Bipolar densities and a capsule often seen, Gram negative inclusion bodies (Donovan bodies)

200
Q

First line tx of donovanosis?

A

Azithromycin 1g weekly po for 3 weeks or until lesion healed

201
Q

Alternatives tx other than azithromycin for tx of donovanosis?

A

Always for 3/52 or until lesion healed,

doxy 100mg bd,

Co-trimoxazole 160/800 mg bd PO,

erythromycin 500mg QDS

202
Q

Treatment of choice for donovanosis in pregnancy?

A

erythromycin 500mg QDS 3/52 or until lesion healed

203
Q

Follow up for donovanosis?

A

until lesion healed

204
Q

Lookback period for donovanosis?

A

All partners 6/12

205
Q

Partner notification for donovanosis?

A

Assess partners for symptoms and offer treatment

206
Q

% extra genital site infection in donovanosis?

A

6%

207
Q

% donovanosis infections affecting the genitals?

A

genitals 90%, inguinal area in 10%

208
Q

Cause of chancroid?

A

Haemophilus ducreyi

209
Q

Incubation time of chancroid?

A

3-7 days

210
Q

Lookback period for chancroid?

A

10days

211
Q

Treatment of asymptomatic partners in lookback period with chancroid?

A

All partners examined AND treated regardless of symptoms

212
Q

Typical sites affected by chancroid male and female?

A

Frenulum and prepuce, cx/vulva/ perianal in women.

213
Q

Typically appearance of chancroid?

A

Ragged edge, granulomatous, grey ulcer, papule to pustule to ulcer. Can look like STS and HSV.

214
Q

Dx of chancroid?

A

NAAT better than culture 95% SENSITIVE vs 75%

215
Q

First line tx of chancroid?

A

Ceftriaxone 250mg IM stat or

Azithromycin 1g po stat.

216
Q

2nd line tx of chancroid?

A

Ciprofloxacin 500mg BD 3/7 or Erythromycin 500mg QDS 7/7

217
Q

Follow up for chancroid?

A

Until sx resolved, usually 3-7 days to see improvement. Abstain until partner tx and resolved.

218
Q

Microscopy findings of chancroid?

A

Gram negative, coccobacilli, with occasional chaining.

219
Q

Infectious period and look back period for Hep A ?

A

2/52 pre jaundice and 1/52 post jaundice

220
Q

What type of virus is hep A?

A

RNA

221
Q

Transmission route of Hep A?

A

faeco-oral

222
Q

Incubation time for Hep A?

A

28 days (15-42)

223
Q

Symptoms of Hep A and what time scale?

A

Day 3-10 flu like illness and RUQ pain, then 3/52 of jaundice, malaise, dark urine, pale stool, LFTs deranged.

224
Q

% people with Hep A requiring hospital admission and % severe illness?

A

15% admitted, 0.4% severe.

225
Q

Mortality rate of severe illness in hep A?

A

40%

226
Q

Ix for hep A?

A

Hep A IgM, LFTs and clotting

227
Q

Mx for hep a if mild/moderate?

A

Supportive, food workers must stay off 1/52 post resolution of jaundice. Notify PHE.

228
Q

Mx of H A if older, HIV +ve or chronic liver disease?

A

More likely to get severe illness, consider human normal immunoglobulin in addition to LFTs, clotting and supportive tx.

229
Q

Hep A vaccine schedule?

A

0 and 6 months

230
Q

How long after first hep A vaccine can send be given without restarting schedule?

A

36 months

231
Q

HIV+ve Hep A vaccine special considerations?

A

Booster when CD4> 500

232
Q

P/N for hep A?

A

Household contacts, food workers.

233
Q

What type of virus is hepatitis B?

A

DNA

234
Q

Transmission rotes for hep B?

A

Sex, vertical, parenteral

235
Q

When is Hep b infectious?

A

2/52 before jaundice until 1/52 after HBsAG negative

236
Q

Incubation time for hep B?

A

40-160 days

237
Q

% people with hep b who are asymptomatic?

A

10-50%

238
Q

How many subtypes of hepatitis b are there?

A

8 (A-H)

239
Q

Symptoms of Hep B?

A

longer version of hep a: flu like illness and RUQ pain, then jaundice, malise, dark urine, pale stool, LFTs deranged.

240
Q

Ix for hep b?

A

Serology, LFTs, STI screen

241
Q

Mx of Hep B?

A

supportive, refer hepatology, advice to avoid toothbrush, needle, razor sharing, blood and organ donation until 1/52 post HBsAG negative

242
Q

Partner notification for acute hep b?

A

2/52 before jaundice until 1/52 after HBsAG negative

243
Q

Partner notification for chronic hep b?

A

2/52 before jaundice or 3 years.

244
Q

Post exposure tx options for Hep B?

A

HBIH 12-48hrs post exposure, ultrarapid vaccine, babies at birth get HBIG and vaccine at birth.

245
Q

Standard vaccine schedule for hep B and efficacy?

A

0/1/6 months, 95% 20mcg engerix

246
Q

Ultrarapid hep b schedule and efficacy?

A

0/1/3 weeks booster at year. 80% before booster, 95% after

247
Q

Response check to hep b vaccine time and value meaning immunity?

A

4-8 weeks, anti-HBs or HBsAb >100iu.

248
Q

If anti-HBs or HBsAb 10-100 iu/l response to hep b, what do you offer?

A

Booster and check response 4-8 weeks, if still low, repeat standard schedule

249
Q

HIV +ve hep b schedule and dose/brand?

A

0/1/2/6 months 40mcg (double standard) engerix or 20mcg fendrix

250
Q

HIV+ve patient with anti-HBs or HBsAb 10-100 response to hep b vaccine?

A

1 x booster recheck 4-8 weeks

251
Q

HIV+ve patient with anti-HBs or HBsAb <10 response to hep B vaccine?

A

3 x monthly doses and check response 4-8 weeks.

252
Q

Patient has HbSAG negative, Anti HBC negative and Anti HBs (HBsAb) negative, what do these results mean?

A

Never vaccinated and susceptible.

253
Q

Patient has HbSAG negative, Anti HBc postive and Anti HBs (HBsAb) negative, what do these results mean?

A

Resolved infection

254
Q

Patient has HbSAG negative, Anti HBC negative and Anti HBs (HBsAb) positive, what do these results mean?

A

Vaccinated

255
Q

Patient has HbSAG positive, Anti HBC positive and Anti HBs (HBsAb) negative, what do these results mean?

A

Active infection

256
Q

How long after starting hep b vaccination can missed doses be given without restarting schedule?

A

4 years.

257
Q

What type of virus is hepatitis C?

A

RNA

258
Q

Incubation time for Hep C

A

4-20 weeks

259
Q

% patients with hep C asymptomatic?

A

60%

260
Q

Which type of hepatitis is most strongly associated with risk of hepatocellular carcinoma?

A

Hep C

261
Q

what serology is positive first and how soon following infection with Hep C?

A

HCV RNA, 2 weeks

262
Q

How long does it take Anti-HCV to become positive following infection with hep c?

A

3/12 (up to 9/12)

263
Q

What % of hep c infected become chronic carriers?

A

50-85%

264
Q

HPV vaccines are offered to whom in a sexual health setting?

A

MSM <45 yo.

265
Q

HPV vaccine schedule for adult MSM?

A

0, 1 & 4-6 months

266
Q

Missed does of HPV vaccine?

A

don’t restart but give at 3/12 interval

267
Q

What % under 25s have chlamydia?

A

5-10%

268
Q

Time of lifecycle of chlamydia?

A

48-72hrs

269
Q

Serovars causing anogenital chlamydia?

A

L1-L3

270
Q

% concordance of infection of chlamydia between partners?

A

75%

271
Q

Risks factors for chlamydia?

A

<25, >1 sexual partner in past year, no condom use.

272
Q

% chlamydia that can resolve spontaneously?

A

50% in 12 months

273
Q

Sites affected by chlamydia trachomatis?

A

Eyes, pharynx, genitals, rectum.

274
Q

Signs and symptoms of chlamydia in females?

A

Vaginal discharge, PCB, IMB dysuria, dyspareunia, lower abdo pain, cx excitation, PID. Asymptomatic

275
Q

Signs and symptoms of chlamydia in males?

A

Asymptomatic, urethral discharge, dysuria, recal discomfort or discharge.

276
Q

% males and females asymptomatic of chlamydia?

A

75% females, 50% males

277
Q

Complications of non-lgv chlamydia?

A

SARA <1%, epidydimalorchitis , PID, endometritis/salpingitis, perihepatitis (fitz hughes Curtis)

278
Q

% infertility in females with 1 episode of chlamydia?

A

8%

279
Q

% infertility in females with 2 episodes of chlamydia?

A

20%

280
Q

% infertility in females with 3 episodes of chlamydia?

A

40%

281
Q

What % <25s are reinfected with chlamydia?

A

10-30% therefore retest 3/12

282
Q

Window period for chlamydia?

A

2/52

283
Q

Investigation to look for chlamydia in males and females?

A

Vulvovaginal NAAT female, first void urine male. Rectal NAAT if MSM or only anal SI if female.

284
Q

Sensitivity in NAAT for chlamydia?

A

96-98%

285
Q

1st line tx of chlamydia?

A

Patient info, partner notification, doxycycline 100mg BD 7/7

286
Q

Abstinence period following doxy for chlamydia?

A

Until tx complete

287
Q

Abstinence period following azithromycin for chlamydia?

A

7/7 after first dose

288
Q

2nd line tx for chlamydia?

A

Azithromycin 1g stat then 2 days of 500mg daily.

289
Q

Tx of chlamydia in pregnancy?

A

Azithromycin 1g stat then 2 days of 500mg daily (erythromycin 500mg BD 10-14 days if unable to have azithromycin or amoxicillin if unable to have macrolides amox 500mg TDS 7days)

290
Q

When is a ToC required following chlamydia treatment?

A

In pregnancy only 3-5 weeks after tx

291
Q

Side effects of macrolides?

A

GI upset, hepatotoxic, rash, long QT risk, exacerbates myasthenia gravis.

292
Q

Complication of ofloxacin use?

A

Tendon rupture

293
Q

Side effect of doxycycline?

A

GI upset, sunlight sensitivity

294
Q

Congenital chlamydia symptoms/types?

A

Conjunctivitis 5-12 days post delivery, pneumonia 1-3 months after delivery

295
Q

Partner notification for chlamydia males with and without symptoms?

A

Symptoms 4/52, 6/12 without

296
Q

Partner notification for chlamydia in females with and without symptoms?

A

6/12

297
Q

Define epididymo-orchitis?

A

Clinical syndrome consisting of pain, swelling and inflammation of epididymis +/- testes

298
Q

Causes of epididymo-orchitis?

A

STI, enteric, mumps, post vasectomy, TB

299
Q

A 23 yo presents with dysuria and unilateral testicular pain and swelling, he had a new sexual partner 10 days ago. What is the most likely diagnosis and cause?

A

epididymo-orchitis, STI cause as <35.

300
Q

Most likely cause of epididymo-orchitis in 40yo male?

A

Enteric, UTI pathogens.

301
Q

A 19yo uni student presents with 10/7 headache, fever and a neck swelling, he’s now developed unilteral testicul pain, you exclude torsion, what is the most likely cause of this man’s epididymo-orchitis?

A

Mumps

302
Q

Complications epididymo-orchitis?

A

Reactive hydrocoele, abscess formation and infarction of the testicle, infertility: obstructive azoospermia secondary to previous infection. mumps may lead to testicular atrophy.

303
Q

First line treatment of epididymo-orchitis in a 28yo male?

A

Ceftriaxone 1g, doxycycline 100mg BD 10-14 days.

304
Q

First line treatment of epididymo-orchitis in a 28yo male unable to have doxycycline?

A

Ceftriaxone and ofloxacin.

305
Q

First line treatment of epididymo-orchitis in a 28yo male at low risk of GC?

A

doxycycline 100mg BD 10-14 days.

306
Q

Lookback period for epididymo-orchitis?

A

Unknown. Based on the pathogen found. (used to be 6/12 screening, not treating but would consider tx partner if in long term relationship and reinfection risk.

307
Q

First line treatment of epididymo-orchitis in a 50yo male?

A

Ofloxicin 200mg BD 14/7 (cover enteric/UTI causes)

308
Q

What % males with epididymo-orchitis related testicular swelling will resolve by 3/12?

A

80%

309
Q

If epididymo-orchitis related testicular swelling persists beyond 3/12 what should you do?

A

USS to assess, consider urology referral

310
Q

Ix for suspected epididymo-orchitis?

A

Udip, MSU, STI screen, gram stain, culture urethra.

If suspecting TB: x3 early morning urine for AFB. if needed intravenous urography, renal tract USS and biopsy, CXR.

Mumps: IgM/IgG serology if risks

311
Q

Follow up for male with epididymo-orchitis started on abx?

A

3/7 (can be phone) and 2/52. ToC if GC.

312
Q

Causative organisms in PID?

A

CT & GC only account for 25%; Gardnerella vaginalis, anaerobes (inc prevotella, Atopobium, Leptotrichia) may also be implicated. Mgen also implicated

313
Q

Signs and symptoms of PID?

A

Lower abdo pain – typical bilateral, deep dyspareunia, abnormal vaginal bleeding inc PCB/IMB/HMB, abnormal vaginal discharge; purulent, lower abdominal tenderness – bilateral, adnexal tenderness on bimanual, cervical motion tenderness, fever >38

314
Q

Complications of PID?

A

Fitz-Hugh-Curtis syndrome – perihepatitis, right upper quadrant pain, Removal of IUD can be considered and may have better short term outcome BUT weigh against risk of pregnancy, infertility 8% one episode

315
Q

Differential Dx for PID?

A

Ectopic, Appendicitis, Endometritis, Ovarian cyst complication, UTI, functional

316
Q

Ix for PID?

A

Swabs: microscopy (low vaginal, wet slide for TV, endocervical), NAATs (C4/GC/TV +/- M Gen) and GC cultures (endo cx and urethra). Pus on cervical slide not diagnostic – poor PPV ~17% but its absence has high NPV ~95%. PT, BP/HR/temp (if systemically unwell).

317
Q

Treatment of PID?

A

Info, analgesia, drink/fluids if needed, Ceftriaxone 1g IM stat + oral doxycycline 100mg bd for 14 days + metronidazole 400mg bd for 14 days

318
Q

2nd line tx for PID of pen anaphylaxis?

A

ofloxacin 400mg BD and metronidazole 400mg bd for 14 days or moxifloxacin 400mg OD for 14 days

319
Q

Tx of choice for PID due to m.gen?

A

Moxifloxacin 400 OD 14 days.

320
Q

F/U of woman managed as outpatient with PID?

A

72hrs and 2-4 weeks.

321
Q

Does a coil need removing in a woman being manged as an outpatient for PID?

A

No, 72hrs abx and r/v if still not improving remove (locus for infection).

322
Q

A patient is treated for PID empirically, her m.gen returns positive what do you need to do for her?

A

If macrolide susceptible azithromycin 1g, 2 x 500mg or moxifloxacin.

323
Q

P/N for PID?

A

Current partner and tracing of sexual contacts within 6/12 of symptom onset is recommended but can be amended according to sexual history.

324
Q

Tx of partner of woman with PID?

A

Doxycycline 100mg BD 7/7 unless pathology known eg GC/TV. If m.gen test and treat if +ve.

325
Q

Abstinence period in PID?

A

Partners should be advised to avoid intercourse until they and the index patient have completed the treatment course

326
Q

Infertility risk with 1/2/3 episodes of PID?

A

infertility risk 20% with 2 episodes, 40% with 3

327
Q

Inpatient IV abx for PID?

A

iv therapy should be continues until 24 hours after improvement Ceftriaxone 2g iv daily + iv doxycycline 100mg bd followed by oral doxycycline 100mg bd + oral metronidazole 400mg bd for a total of 14 days or Clindamycin 900mg tds iv + iv gentamicin 2mg/kg (loading) followed by 1.5mg/kg tds followed by oral clindamycin 450mg qds OR oral doxycycline 100mg bd + oral metronidazole bd for a total of 14 days.

328
Q

Is PID common in pregnancy?

A

No it is rare

329
Q

Average incubation period for STS and range?

A

21 days (9-90)

330
Q

How long does a primary STS chancre take to resolve?

A

3-8 weeks

331
Q

What % of untreated STS develop secondary STS?

A

25%

332
Q

typical time from chancre to secondary STS signs developing?

A

4-10 weeks

333
Q

Typical symptoms of secondary STS?

A

Macocutaneous rash, generalised lymphadenopathy, mucus patches, conylomata lata

334
Q

Time frame to be considered early latent STS?

A

<2yrs

335
Q

Time frame to be considered late latent STS?

A

> 2yrs

336
Q

Symptoms of late latent STS?

A

Gummatous disease (skin/bone lesions), CVD (usually affects ascending aorta – dilation and aortic regurgitation), neurological (menigovascular; infections arteritis  stroke, general paresis; forgetful, personality changes, psychosis, seizures and hemiparesis, tabes dorsalis; sensory ataxia, argyll Robinson pupi, charcot joints, dorsal column loss (absent reflexes, join position sense and vibration sense))

337
Q

Hx for sts?

A

Sexual, symptoms, previous test and treatment, and results, risk of jaw/pints/bejel, obs hx, examine genitals/skin/eyes/mouth, neuro exam if symptoms.

338
Q

Ix for STS chancre?

A

Dark ground micro or PCR

339
Q

Ix for STS bloods?

A

EIA screen, TPPA/VDRL to confirm, RPR to assess activity, IgM for sort of early disease.

340
Q

Tx for primary, secondary or early latent sts?

A

1 x benzathine penicillin (2.4 megaunits) IM

341
Q

Tx for late latent sts?

A

3 x benzathine penicillin (2.4 megaunits) IM day 0/7/21.

342
Q

Follow up bloods for any STS?

A

0/3/6/12 months

343
Q

What is considered a good response to tx in RPR in STS tx?

A

4 fold reduction

344
Q

What reaction can take place after tx STS?

A

Jarisch-Herxheimer (febrile illness 4hrs after tx, can feel really ill for 24hrs)

345
Q

If penicillin allergy what are the treatment options for sts?

A

Desensitisation or doxycycline

346
Q

2nd line therapy for early latent STS tx where penicillin allergy is reported?

A

Doxycycline 100mg/BD for 14 days

347
Q

2nd line theray for late latent STS tx where penicillin allergy is reported?

A

Doxycycline 100mg/BD for 28 days

348
Q

If a person is treated with something other than penicillin based therapy for sts what follow up do they require?

A

0/3/6/12 months then annual for life

349
Q

What should be given before treating cardiovascular sts?

A

Oral steroids 40-60mg prednisolone to reduce SE of tx. (same for neurosyphilis)

350
Q

Treatment of early or secondary sts in a woman who’s 16/40 gestation?

A

1 x benzathine penicillin (2.4 megaunits) IM

351
Q

Treatment of a women with early STS at 18/40?

A

2 x benzathine penicillin (2.4 megaunits) IM

352
Q

Treatment of a women who is 30/40 with STS?

A

3 x benzathine penicillin (2.4 megaunits) IM, neonatal alert.

353
Q

Treatment options for a penicillin allergy pregnant woman with STS?

A

Desensitisation therapy if time, amoxicillin, ceftriaxone azithromycin or erythromycin but tx failure more likely with macrolides.

354
Q

If a person presents with high risk of sts but has negative serology what should be recommended?

A

Retest 6 and 12 weeks, ideally abstain

355
Q

Abstinence period after STS tx?

A

Until 2 weeks after tx finished

356
Q

Look back period for primary sts?

A

3/12

357
Q

Look back period for secondary or early latent sts?

A

2 years

358
Q

Lookback period for late latent STS?

A

Life long or until last neg test

359
Q

Ix and Tx of ocular sts?

A

LP, serology, prednisolone 3 days starting 24hrs before tx with Procaine penicillin 1.8-2.4 MU IM OD plus probenecid 500mg qds for 14 days

360
Q

When should sts serology be taken after a suspicious ulcer was dark ground or prc negative?

A

2/52

361
Q

Adverse pregnancy outcomes for STS?

A

polyhydramnios, miscarriage, pre-term labour, still birth, hydrops, congenital abnormalities

362
Q

what causes balanitis xerotica obliterans (BXO).

A

lichen sclerosis in men

363
Q

treatment for balanitis xerotica obliterans (BXO).

A

information
skin care
steroids
annual f/u as minimum

364
Q

what type of HPV is linked to Bowenoid papulosis?

A

HPV 18

365
Q

a 60yo man presents complaining of skin changes to his penis, on examination you see a glazed orange area with red dots, it’s been there for a few weeks or so and isn’t particularly painful - what is the likely dx

A

zoon’s balanitis (plasma cell)

366
Q

what is the risk of balanitis xerotica obliterans (BXO) left untreated

A

loss of architecture, meatal stricture, scarring.

Risk of malignant transformation

367
Q

a 28 yo male presents with a sore and swollen penis and discharge. His last sexual intercourse was 6/12 ago.
O/E the glans is oedematous, and the discharge fowl smelling and hygiene standards suboptimal what is the likely dx and tx.

A

anaerobic balanitis
culture/sti screen
Tx with metronidazole (or co-amoxiclav)

368
Q

a 28 yo male presents with grey white patches on the end of his penis, he also has discharge and microscopy suggests GC, he also has a knee. What is the likely overarching syndrome and what is the name for his penile skin condition

A

SARA (Reactive arthritis)

Circinate balanitis

369
Q

more common drugs to cause a fixed drug reaction

A

tetracyclines, salicylates, paracetomol, phenolphthalein and some hypnotics

370
Q

management of a fixed drug reaction

A

hx taking to find the drug
stop the drug
can re-challenge with consent (may be worse)

rarely need biopsy

371
Q

what is the condition where the biopsy findings are of follicular hyperkeratosis. This overlies a band of dermal hyalinisation with loss of the elastin fibres, with an underlying perivascular lymphocytic infiltrate

A

Lichen sclerosis and BXO

372
Q

what is the condition where the biopsy findings are:

early cases show epidermal thickening but this
is followed by epidermal atrophy, at times with
erosions. There is epidermal oedema (often mild) and a
predominantly plasma cell infiltrate in the dermis with
haemosiderin deposition and extravasated red blood
cells

A

zoon’s balanitis (plasma cell)

373
Q

tx of zoon’s balanitis

A

topical steroids, hygiene and skin care

consider circumcising

374
Q

a 28 yo male presents with grey white patches on the end of his penis, he also has discharge and microscopy suggests GC, he also has a knee. What would you investigate and treat this patient?

A

SARA and circinate balanitis
STI screen and treat as appropriate
Skin care/emollients
topical steroids

375
Q

a 28 yo male presents with scaly red patches on his penis, the a slightly itchy. He has psoriasis on his torso and you suspect penile psoriasis, what is the treatment

A

emollients, steroids, consider dermatology in put ? calcitriol.

376
Q

what are Erythroplasia of Queyrat, Bowen’s disease, Bowenoid papulosis and VIN all forms of

A

Pre-malignant penile conditions.

377
Q

three broad classifications of balanoposthitis

A

Infections (candida, TV, anaerobes, step A/B, staph aureus, STS, HSV, HPV, ect )

Dermatosis (lichen planus and sclerosis/zoons/psoriasis/circinate, fixed drug/SJS/contact allergy)

Miscellaneous (trauma, irritant, pre-malignant)

MFSRH 2021 (13 decks)

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