(ID)- STIs

Question 1

What is chancroid?

Answer 1

Infection of genital skin caused by Haemophilus ducreyi

Question 2

How does chancroid present?

Answer 2

Painful and potentially necrotic genital lesion which can bleed on contact

Associated with painful lymphadenopathy (bubo) which can rupture and discharge pus

4-10 days after exposure to bacterium

Question 3

How is chancroid diagnosed?

Answer 3

Culture (often difficult and time-consuming)
PCR (can be performed on genital ulcer specimens)

Question 4

Where are people affected by chancroid?

Answer 4

Tropical and subtropical regions
Poor living conditions
Sexual behaviour

Question 5

What are some differential diagnoses for chancroid?

Answer 5

Herpes Simplex Virus
- Multiple, small, vesicular lesions that become ulcers
- Systemic symptoms

Syphilis
- Painless ulcer (chancre)
- Generalised non-tender lymphadenopathy

Lympogranuloma Venerum
- Small painless ulcer or papule
- Followed by painful inguinal lymphadenopathy (bubo)

Question 6

How is chancroid managed?

Answer 6

Ceftriaxone
Azithromycin
Ciprofloxacin

Analgeisa
Incision and drainage of buboes

Question 7

What causes chlamydia?

Answer 7

Chlamyida trachomatis

Question 8

Who is affected by chlamydia?

Answer 8

Most common bacterial STI
Young adults between 15-24

Question 9

How does chlamydia present?

Answer 9

Urethral discharge
Dysuria in men
Intermenstrual bleeding
Vaginal discharge
Anal infections may manifest as dicharge or anorectal discomfort

Many cases, especially infection remains asymptomatic

Question 10

What can happen to neonates that are exposed to chlamydia during birth?

Answer 10

Pneumonia
Conjuctivitis

Question 11

How is chlamydia diagnosed?

Answer 11

NAATs on vaginal swabs for women
Urine or urethral swabs on men

Question 12

How is chlamydia treated?

Answer 12

7 day course of oral doxycycline

Question 13

What are some differential diagnoses for chlamydia?

Answer 13

Gonorrhoea
- Asymptomatic
- Urethral discharge
- Dysuria
- Intermenstrual or postcoital bleeding
- Lower abdominal pain

Trichomoniasis
- Pruritis
- Dysuria
- Discharge in men and women

Genital herpes
- Painful vesicular lesions
- Dysuria
- Flu-like symptoms

Question 14

What are some complications of chlamydia?

Answer 14

If left untreated

• PID
• Epididymitis
• Reactive arthritis
• Conjunctivitis and pneumonia in neonates
• Increased risk of acquiring or transmitting HIV

Question 15

What causes genital herpes?

Answer 15

HSV-1 and HSV-2

Clinically indistinguishable

Question 16

How do patients present with genital herpes?

Answer 16

May be asymptomatic or
- Multiple painful genital ulcers
- Dysuria
- Discharge vaginal or urethral
- Crusting and healing of lesions
- Systemic symptoms

Question 17

How is genital herpes diagnosed?

Answer 17

Swab from the base of the ulcer using NAATs

Question 18

What are the differentials of herpes?

Answer 18

Syphillis
Chancroid
Lymphogranula venereum

Question 19

What investigations are used for herpes?

Answer 19

Clinical history
Swab from ulcer base and NAATs

Question 20

How is herpes treated?

Answer 20

5 days after symptom onset
Aciclovir
Valaciclovir
Aciclovir
Famciclovir

Topical lidocaine for symptom relief

Question 21

How is herpes managed during pregnancy?

Answer 21

Referral to GUM clinic
Informing women that neonatals risk is low even with lesions present

Supportive treatment with saline bathing and paracetamol is sufficient

Question 22

What is vulvovaginal candidiasis?

Answer 22

Fungal infection caused by Candida Albicans

Question 23

How does vulvovaginal candidiasis present in women?

Answer 23

Itching
White curdy discharge
Burning sensation
Sour milk odour
Dyspareunia

Question 24

How does genital candidiasis present in men?

Answer 24

Soreness, pruritis, redness
Dry, red-glazed plaques and papules

Question 25

What are the risk factors for vulvovaginal candidiasis?

Answer 25

Pregnancy **Antibiotic use** Immunosuppression

Question 26

How is vulvovaginal candidasis investigated?

Answer 26

Only for unclear cases Microscopy and culture

Question 27

How is vulvovaginal candidiasis managed?

Answer 27

**Oral** Fluconazol Itraconazole **Intravaginal** Clotrimazole pessary **Vulval** Topical clotrimazol cream

Question 28

What causes genital warts?

Answer 28

HPV 6 and HPV 11

Question 29

How do genital warts present?

Answer 29

Painless Keratinised or non-keratinised in areas that undergo trauma during sex

Question 30

How are genital warts diagnosed?

Answer 30

Clinical diagnosis Biopsy may be performed in some cases

Question 31

How are genital warts managed?

Answer 31

Podophyllotoxin - antiviral that destroys wart tissue Cryotherapy Trichloroacetic acid High likelihood of recurrence after treatment

Question 32

What is molluscum contagiosum?

Answer 32

Viral skin infection caused by **Molloscum Contagiosum virus**

Question 33

How does molluscum contagiosum present?

Answer 33

Small pearly papules Central umbilication Can occur anywhere, commonly on genitals

Question 34

How is molluscum contagiosum diagnosed?

Answer 34

Visual inspection Full STI screen advised

Question 35

How is molluscum contagiosum managed?

Answer 35

Resolves spontaneously in 18 months Cryotherapy

Question 36

What causes gonorrhoea?

Answer 36

Neisseria gonorrhoeae

Question 37

What are the symptoms of gonorrhoea?

Answer 37

Genital discharge Dysuria Tender inguinal nodes in men Abnormal bleeding in women **Extragenital complications** Pharyngitis Rectal pain and discharged Disseminated infection

Question 38

How is gonorrhoea disagnosed?

Answer 38

NAAT with culture Presence of **monomorphic gram-negative diplococci with polymorphonuclear leukocytes**

Question 39

How is gonorrhoea treated?

Answer 39

Ceftriaxone

Question 40

What can gonorrhoea lead to if untreated?

Answer 40

Infertility due to PID Infertility due to epididymitis Increased susceptibility to HIV

Question 41

What causes syphilis?

Answer 41

Treponema pallidum

Question 42

How is syphilis transmitted?

Answer 42

Direct contact with syphilis sores of rash during sex Vertical transmission

Question 43

What are the signs of primary syphilis?

Answer 43

Single painless lesion **(Chancre)**, round with indurated bases heals in 3-8 weeks

Question 44

What are the signs of secondary syphilis?

Answer 44

Symmetrical maculopapular rash, involving palms, soles and face 4-10weeks after primary infection Some patients may get hepatitis, glomerulonephritis and neurological complications

Question 45

What are the signs of tertiary syphilis?

Answer 45

20-40 years after primary infection in untreated patients Gummatous disease CV complications Neurological complications

Question 46

What are the signs of congenital syphilis?

Answer 46

Rash on palms/soles of feet Mucuous patches/lesions in mouth/nose/genitals Hepatosplenomegaly **Saber shins** Seizures Developmental delay

Question 47

How is syphilis investigated?

Answer 47

Serological testing Dark-field microscopy CSF examination (tertiary syphilis for CNS involvement)

Question 48

How is syphilis managed?

Answer 48

**Primary, secondary and early latent** IM penicilin G (benzylpenicillin) **Tertiary and late latent** IM penicillin G for 2-3 weeks **Neurosyphilis** IV penicillin G for 10-14 days Doxycyclin if allergic

Question 49

What is trichomoniasis?

Answer 49

STI caused by flagellated protozoan **Trichomonas vaginalis**

Question 50

What are the signs and symptoms of trichomoniasis?

Answer 50

Profuse, frothy yellow vaginal discharge Vulval irritation Dyspareunia in women Urethritis in men **Strawberry cerix**

Question 51

What investigations are used to confirm trichomoniasis?

Answer 51

Microscopy and culture of causative organism

Question 52

What is the management of trichomoniasis?

Answer 52

Oral mentronidazole 5-7 weeks Abstrain from sexual activity for at least 1 week or until patient and partners have completed treatment Screening Contact tracing