Sexual and Reproductive Health

Question 1

what does serovars A-c chalymidia cause?

Answer 1

trachoma (eye infection = not an STI)

Question 2

what does serovars D-K cause?

Answer 2

genital infectoin

Question 3

what does serovars L1-L3 cause?

Answer 3

Lymphogranuloma venereum

MSM, can present as proctitis (blood OR tenesmus, pain), and can look like Chrohn’s, therefore test if risk of STI

Question 4

what can be caused by women passing on chlamydia to their children at birth?

Answer 4

opthalmia neonaorum or chlamydia pneumonitis

Question 5

what is the incubation period for chlamydia?

Answer 5

3-21 days

Question 6

when should asymptomatic patients be tested for chalmydia?

Answer 6

14 days following exposure

Question 7

what is the first line and alternative treatment for chlamydia?

Answer 7

1. doxycycline 100mg BD x 1 week

2. azithromycin 1G on day 1, 500mg day 2 and 3

Question 8

what is gonorrohea caused by and what is it seen as under the microscope?

Answer 8

gram-negatice intracellular diplococcus (seen a two kidney beans facing each other) called Neisseria Gonorrhoea

Question 9

what is the treatment and dosage for Gonorrhoea?

Answer 9

ceftriaxone IM 1g stat

Question 10

what are the symtptoms of trichomonas vaginalis

Answer 10

vaginal discharge: offensive, yellow/green, frothy
vulvovaginitis: itch/discomfort
strawberry cervic (microhaemorrages)
vaginal pH >4.5

Question 11

how to treat trichomonas vaginalis?

Answer 11

oral metronidazole for 5-7 days

Question 12

what is the average incubation time for HPV?

Answer 12

3 weeks - 9 months

Question 13

what are the 3 types of different treatment options for HPV?

Answer 13

ablative - cryotherapy
topical - trichloroacetic acid, podophyllotoxin, imiquimod
surgical - diathermy, curretage, surgical excision

Question 14

describe the primary infection of syphillis

Answer 14

up to 3 months
presents with painless chancre (ulcer) at site of inoculation and non-tender lymphadneopathy (unlike herpes simplex which is painful)

Question 15

describe the secondary infection of syphilis?

Answer 15

up to 2 years
spreads across hte body
skin lesions and lesions on mucous membrnaes, pharyngitis, patchy alopecia, generalised lymphadenopathy, condylomata lata - infectious lesion secreting the bacteria
neurological and opthalamic involvement not uncommon

Question 16

describe the latent stage of syphilis?

Answer 16

no symptoms but low level multiplication of spirochete in intima of small blood vessles
can be divided into early and latent periods

Question 17

describe late stage syphilis?

Answer 17

cardiovascular, gummatous or neurovascualr complications many years later

Question 18

how do you diagnose syphilis?

Answer 18

PCR swab of 1 year and 2 year lesions, dark field microscopy

Question 19

how do you screen for syphilis?

Answer 19

EILSA / EIA for IgG / IgM antibodies (antibodies remain for life)

Question 20

if screening for syphilis is positive, what further tests are done?

Answer 20

treponema pallidum particle agglutination (TPPA) - specific for syphilis, remains positive lifelong but not helpful in monitoring

Question 21

how do you treat primary / secondary and early latent syphilis?

Answer 21

2.4MI benzathenepenicillin IM

Question 22

when are all pregnant woman offered syphilis screening?

Answer 22

8-12 week s

Question 23

describe genital herpes?

Answer 23

an enveloped virus containing double-stranded DNA

Question 24

what are the main symptoms of genital herpes?

Answer 24

blistering ulcers at external genitalia, pain, external dysuria, vaginal or urethrall discharge, local lymphadenopathy, fever and myalgia

Question 25

describe how herpes invades the body

Answer 25

• virus replicates in dermis and epidermis, getting into nerve endings of senosry and autonomic nerves
• inflammation at nerve endings = painful multiple small vesicles which are easily deroofed
• virus migrates to sacral root ganglion and hides from immune system
• virus can reactivate from there causing recurrent genital herpes

Question 26

what is the incubation period of herpes?

Answer 26

3-6 days

Question 27

what is the treatment of herpes?

Answer 27

oral aciclovir 400mg TDS x 5/7

Question 28

what are some risk factors for candidia infection?

Answer 28

• recent AB therapy
• high oestrogen levels (pregnancy, contraception)
• poorly controlled DM
• immunocompromised patients with CD4 counts below 100

Question 29

how to diagnose candida?

Answer 29

high vaginal swab for culture

Question 30

how to treat candida infection?

Answer 30

vaginal infeciton - fluconazole 150mg stat or clotrimazole 500mg pessary stat
- topical cream (without hydrocortisone) can be used for external symptoms

Question 31

what is the typical visible symptom of candida balanitis?

Answer 31

spotty rash

Question 32

what is prostatitis usually caused by and why do all suspicions get an STI check?

Answer 32

E.coli
sometimes by gonorrhoea or chlamydia
anyone < 35 should get an STI check

Question 33

what are the symptoms of prostatitis?

Answer 33

UTI symptoms

lower abdo pain / back / perineal / penile pain

Question 34

how is prostatitis tested for?

Answer 34

MSSU (middle stream) urine sample

+- first pass urniary sample

Question 35

how to treat prostatitis?

Answer 35

ofloxacin 400mg bd for 28 days

Question 36

what vaginal pH Is seen in BV?

Answer 36

> 4.5

Question 37

what will be seen in a wet mount sample from a vagina with BV?

Answer 37

clue cells - the absence of bacilli and their replacement with clumps of coccobacilli also leads to this diagnosis

Question 38

how to treat BV?

Answer 38

oral mentronidazole for 5 days

Question 39

how does HIV attach to the CD4 molecule?

Answer 39

via a protien called gp120

Question 40

when may patients with HIV start to get symptoms?

Answer 40

CD4 <200 cells / mm3

patients will start to get opportunistic infections eg pnuemocystitis pneumonia

Question 41

what are some examples of AIDS-defining conditions?

Answer 41

• recurrent bacterial pneumonia
• pneumocystis pneumonia
• fungal infections - candidiasis of the oesophagus
• Kaposi’s sarcoma