Sexual Health

Question 1

Most common STI?

Answer 1

Chlamydia

Question 2

Presentation of Chlamydia?

Answer 2

• Mainly asymptomatic
• Pus/White discharge
• Dysuria

Question 3

What kind of organism is Trachomatis?

Answer 3

Obligate, intracellular Gm neg

Question 4

Investigation for Chlamydia?

Answer 4

NAAT testing
F - vulvovaginal swab
M - first void urine

Question 5

Treatment of Chlamydia?

Answer 5

7 days of doxycycline
Azithro/Erythro if pregnant

Question 6

What organism causes Gonorrhoea?

Answer 6

Neisseria Gonorrhoea - gram neg diplococcus

Question 7

Symptoms of Gonorrhoea?

Answer 7

• Pus/White discharge
• Dysuria

Question 8

Risk factors for Chlamydia?

Answer 8

• <25
• New/Multiple sexual partners
• No condoms used

Question 9

Risk factors for Gonorrhoea?

Answer 9

• 20-29 years old
• MSM
• Black ancestry
• Current/Prior STIs

Question 10

Investigations for Gonorrhoea?

Answer 10

F - NAAT vulvovaginal swab
M - first void urine

Question 11

Treatment for Gonorrhoea?

Answer 11

IM Ceftriaxone if no cultures/sensitivity
Consider using ciprofloxacin if sensitive

Question 12

Complications for gonorrhoea in pregnancy?

Answer 12

• Premature labour
• Miscarriage
• Vertical transmission to child: Opthalmia neonatorum

Question 13

Presentation of Herpes?

Answer 13

Multiple, painful ulcers

Question 14

Symptoms of primary herpes infection?

Answer 14

• Fever and myalgia
• Painful blisters on genitals
• Lymphoedema
• Discharge and dysuria

Question 15

Investigation for Herpes?

Answer 15

NAAT

Question 16

Treatment for Herpes?

Answer 16

PO Aciclovir

Question 17

Syphillis Presentation?

Answer 17

Single, painless papule erodes deeper into an ulcer with clear base, clear serum and rounded edges (chancre)

Question 18

Investigation for Syphillis

Answer 18

Blood serology for virus

Question 19

Organism which causes syphillis?

Answer 19

Treponema Pallidum

Question 20

Tx for Syphillis?

Answer 20

IM Benzathine Benyzlpenicillin

Question 21

Presentation of Thrush/Candida?

Answer 21

• Cottage cheese discharge
• Itchy, red inflamed vulva/glans
• Superficial dyspareunia

Question 22

Risk factors for Candida?

Answer 22

• Diabetes
• Use of broad spec Abx
• AIDS

Question 23

Tx for Candida?

Answer 23

Oral fluconazole is first line
If pregnant, topical clotrimazole

Question 24

Presentation of Bacterial Vaginosis (Gardenerella)?

Answer 24

• Grey/Yellow, fishy thin discharge

Question 25

Ix for BV?

Answer 25

- +ve Whiff test - Microscopy: clue cells - Increased pH > 4.5

Question 26

Tx for BV?

Answer 26

PO Metronidazole 2g one off

Question 27

Presentation of Trichomonas Vaginalis?

Answer 27

- Yellow/Green, frothy discharge - Itchy - Dysuria - Offensive odour - Strawberry cervix

Question 28

Organism of Trichomonas?

Answer 28

- Flagella, protozoa parasite

Question 29

Investigations for Trichomonas?

Answer 29

- Wet microscopy - trophozoites

Question 30

Tx for Trichomonas?

Answer 30

PO Metronidazole 2g one off

Question 31

Abx of choice for Pneumocystitis Pneumonia in HIV patient?

Answer 31

Co-trimoxazole

Question 32

Lymphogranuloma venereum (LGV)

Answer 32

- MSM is risk factor - Associated with chlamydia - Painless ulcer which progresses to form painful buboes (groove sign) - Fever - Malaise - Doxycycline Tx

Question 33

What is Jarisch-Herxheimer reaction

Answer 33

Acute febrile reaction associated with syphillis Tx with paracetamol and reassurance

Question 34

RUQ pain in someone with PID/STI

Answer 34

Think Fitz-Hugh-Curtis syndrome -> treat with Abx for the underlying infection/pain relief

Question 35

Which viruses cause genital herpes?

Answer 35

HSV-1 (most common), HSV-2

Question 36

Which viruses cause genital warts?

Answer 36

HPV 6,11

Question 37

How do genital warts present?

Answer 37

Hard/soft painless lesions on the genitals

Question 38

How are genital warts managed?

Answer 38

- Can be managed conservatively - Podophyllotoxin/Imiquimod/Cryotherapy

Question 39

What malignancies can be associated with AIDS?

Answer 39

- Non-Hodgkins lymphoma - Invasive cervical cancer - HIV related Hodgkins - HIV related anal cancer

Question 40

What is molluscum contagiosum?

Answer 40

A skin infection caused by molluscum contagiosum - poxvirus

Question 41

How does molluscum present?

Answer 41

- Small, smooth pearly coloured papules with central area of umbilication - Common on genitals

Question 42

How is molluscum managed?

Answer 42

- STI screen if indicated - Cryotherapy/topical treatments - Curettage

Question 43

What are features of secondary syphillis?

Answer 43

- 6-10 weeks after primary infection - Fever, lymphadenopathy - Rash on trunk, palms - Snail track ulcers in mouth - Painless, warts on genitals

Question 44

What are features of tertiary syphilis?

Answer 44

- Gummas (granulomatous lesions of skin and bones) - Aortic aneurysms - Argyll-Robertson pupil

Question 45

How is syphilis investigated?

Answer 45

- Often a clinical diagnosis + serology - TP-EIA test is more complex but specific for syphilis

Question 46

Which organism causes BV?

Answer 46

Gardnerella vaginalis

Question 47

How is syphilis transmitted?

Answer 47

Through direct contact with sores/rash during sex

Question 48

How does tertiary syphilis present?

Answer 48

- Can be 20-40 years after the primary infection - Can cause aortitis, arteritis, aortic regurg - Dementia, Argyll-Robertson pupil (bilateral small pupils which do not constrict)

Question 49

How does congenital syphilis present?

Answer 49

- Can be after birth or during infancy - Rash of palms of soles/feet, lesions in mouth/genitals - Anaemia, hepatosplenomegaly - Seizures

Question 50

What is the treatment for neurosyphillis?

Answer 50

IV benzathine benzylpenicillin

Question 51

Gold standard investigation to diagnose Fitz-Hugh-Curtis?

Answer 51

Laparoscopy