Sexual health

Question 1

Causes of urethritis/vaginal/cervical discharge

Answer 1

Neisseria gonorrhoea
- NAAT, gram stain and culture
- Ceftriaxone +/- azithromycin

Chalmydia trachomatis
- NAAT
- PO azithromycin

Trichomonas vaginalis
- Microscopy, NAAT
- Metronidazole

Mycoplasma genitalium
- Azithromycin

Candidiasis
- Topical/PO azole

BV
- Metronidazole

Question 2

Genital ulcer disease causes

Answer 2

Primary syphilis
Genital herpes
Lymphogranuloma venereum
Chancroid
Donovanosis

Question 3

What is LGV?

Answer 3

Lymphogranuloma venereum
Small transient ulcer/proctitis followed by lymphadenopathy
Can have systemic symptoms

Tertiary symptoms: Fibrosis, lymphoedema, rectal stricture

Question 4

What is chancroid?

Answer 4

Haemophilus ducreyi
Multiple painful ulcers with regional lymphadenopathy

Question 5

Donovanosis (Granuloma inguinale)

Answer 5

Beefy red genital/anal ulcers, usually painless. Treat with azithromycin

Question 6

Syphilis diagnostics

Answer 6

1. Rapid plasma reagin (RPR)/VDRL - detect antibodies, but not specific to syphilis
2. TPPA (T. pallidum particle agglutination) antibodies specifically against syphilis but remain positive for life

Question 7

Syphilis

Answer 7

Treponema pallidum

Question 8

Syphilis treatment

Answer 8

Benzathine penicillin IM (STAT or in late latent weekly x 3)

Question 9

Stages of syphilis

Answer 9

1. Primary - painless chancre 3 -6 weeks after exposure
2. Secondary - skin rash on palms and soles, flu symptoms, lymphadenopathy
3. Latent - silent phase
4. Tetiary
   - Without CNS involvement: syphilitic gumma (tumour0 /cardiovascular syphilis
   - Neurosyphilis - meningitis, cranial nerve/ocular involvement

Question 10

HPV and types

Answer 10

Human papilloma virus
- HPV 16/18 associated with cervical cancer
- HPV 6/11 associared with anogenital warts

Question 11

What factors determine how STIs spread within a population? (6 marks)

Answer 11

R0 determined by:
b- risk of transmission during an exposure which can be affected by the sex act (e.g vaginal, anal, oral) and co-existing infections (e.g. HIV)
c- The number of sexual partners and the rate of partner change
d- The duration of infection

Question 12

What public health measures can be used to control STIs? (6 marks)

Answer 12

R0 beta:
- Circumcision, HIV/herpes treatment, condom use

R0 c:
- Education

R0 d:
- Accessibility to sexual health clinics
- Early and effective treatments for cases
- Partner notification