Sexual Health

Question 1

What virus causes anogential herpes?

Answer 1

herpes simplex virus 1 & 2

Question 2

Where are anogenital herpes lesions usually found?

Answer 2

Men / transwomen: glans penis, foreskin (prepuce), penile shaft and less commonly scrotum, thigh and buttocks. Rectal and perianal lesions seen in men who have sex with men (MSM).

Women / transmen: Vulva, labia, vaginal vestibule and introitus. The vaginal mucosa is usually inflamed and cervical involvement is seen in 70-90%

Question 3

What are the following symptoms associated with:

Asymptomatic
Painful vesicle, pustule or ulceration: usually multiple lesions of different ages
Vaginal/urethral discharge
Dysuria
Systemic symptoms: fever, headache, malaise, myalgia (more common in primary infection)
Proctitis: bleeding, tenesmus, pain, discharge (more common in MSM)

Answer 3

Anogenital herpes

Question 4

What are the following signs associated with:

Vesicles
Pustules
Ulceration: usually evidence of crusting over
Lymphadenopathy/lymphadenitis (inguinal): usually tender and bilateral. Seen in around 30%. Unilateral more common in recurrent infection
Urinary retention: if pelvic autonomic nerves affected

Answer 4

Anogenital herpes

Question 5

How is anogenital herpes managed?

Answer 5

Aciclovir anti viral therapy within 5 days of Sx onset
Saline bathing
Analgesia including topical anaesthetic agents (e.g. lidocaine)

Question 6

What are the two most common signs of bacterial vaginosis?

Answer 6

Thin off-white/ grey homogeneous discharge

Vaginal odour, particularly after intercourse (whiff test +ve)

Question 7

What are the cell type found on investigation, suggestive of bacterial vaginosis?

Answer 7

Clue cells

Question 8

What is the management for bacterial vaginosis?

Answer 8

Oral metronidazole 400mg, 2x daily, 5-7 days

Question 9

What is the causative agent of chlamydia?

Answer 9

Chlamydia trachomatis

Question 10

What is the main complication caused by chlamydia in women/ transmen?

Answer 10

Pelvic inflammatory disease (PID).

Abdominal pain, chronic scarring and infertility

Question 11

What is the main complication caused by chlamydia in men/ transwomen?

Answer 11

Epididymo-orchitis

Severe pain, swelling, linked to infertility and hypogonadism (low testosterone levels)

Question 12

What is the main diagnostic test for chlamydia?

Answer 12

Nucleic acid amplification test (NAAT)

Question 13

What is the NAAT test of choice for chlamydia in women?

Answer 13

Vulvo-vaginal swab

Question 14

What is the NAAT test of choice for chlamydia in men?

Answer 14

First catch urine sample

Question 15

What is the normal management for an uncomplicated chlamydia infection?

Answer 15

Doxycycline 100 mg twice daily for 7 days (first-line)
Azithromycin 1 g once only, followed by 500 mg orally for the next two days (second-line)
Erythromycin 500 mg twice daily for 10-14 days (if above two treatment contraindicated)

Question 16

What is the causative agent of gonorrhoea?

Answer 16

Neisseria gonorrhoeae

Question 17

The following signs and symptoms are characteristic of which sexually transmitted infection:

Sx
Women or transmen: Vaginal discharge, dysuria, lower abdominal pain (25%), abnormal bleeding (rare)
Men or transwomen: mucopurulent urethral discharge, dysuria, testicular pain or swelling (rarely)

Signs
Women or transmen: cervicitis with mucopurulent discharge +/- endocervical bleeding (on speculum examination). Pelvic or abdominal pain is uncommon unless co-infection with chlamydia.
Men or transwomen: Urethral discharge, testicular pain/swelling.

Answer 17

Gonnorhoea

Question 18

What is the diagnostic test for gonnorhea?

Answer 18

Nucleic acid amplification tests (NAATs)

Question 19

What is the management for an uncomplicated infection of gonnorhea?

Answer 19

Ceftriaxone 1 g intramuscularly (IM) as a single dose (unknown antibiotic susceptibility)
Ciprofloxacin 500 mg orally as a single dose (known antibiotic susceptibility)

Question 20

What is the main clinical feature of primary syphilis?

Answer 20

Development of a single, painless, indurated ulcer known as a chancre.

Sometimes lymphadenopathy regional to the site of the chancre.

Question 21

What is the recommended treatment for syphilis?

Answer 21

Early syphilis:
Benzathine penicillin 2.4 Million units, IM single dose.

Late syphilis (cardiovascular or gummatous):
Benzathine penicillin 2.4 million units, IM weekly for three weeks (3 doses)
Prednisolone 40-60 mg for three days if cardiovascular (see Jarisch-Herxheimer reaction)

Neurosyphilis:
Procaine penicillin 1.8-2.4 million units IM once daily plus probenecid 500 mg QDS for 14 days, OR
benzylpenicillin 10.8-14.4 g daily, given as 1.8-2.4 g IV every 4 hours for 14 days.
Prednisolone 40-60 mg for three days (see Jarisch-Herxheimer reaction)

Syphilis in pregnancy:
Benzathine penicillin 2.4 million units IM single dose in the first and second trimesters. Further dose in the third trimester followed by a second dose after one week.