Sexual Health

Question 1

what is the presentation of chlamydia?

what is the incubation period of it?

Answer 1

caused by Chlamydia trachomatis (obligate intracellular, gram negative bacterium)
7-21 days

most are asymptomatic
dysuria or discharge
intermenstrual or postcoital bleeding

can cause an ascending infection (acute salpingitis or PID)

Question 2

what is the life cycle of chlamydia?

Answer 2

1) elementary bodies (infectious particles which are released when infected cells rupture, attach to sperm and endocervical cells)
2) reticulate bodies (replicating intracytoplasmic form of chlamydia)

Question 3

what is the treatment of chlamydia?

what is the contact tracing?

Answer 3

PO doxycycline 100mg bd for seven days
or single dose oral azithromycin 1g stat

contact tracing: 4w for symptomatic male, 6m asymptomatic male, 6m asymptomatic female

Question 4

what investigations are used to diagnose chlamydia?

Answer 4

NAAT testing
urine: first void urine sample
swabs (LVS, endocervical)

Question 5

what type of bacterium is gonorrhoea? what is it’s incubation period? what are the symptoms?

Answer 5

gram negative diplococcus
2-5 days
green/yellow discharge within 2 weeks of infection, dysuria, intermenstrual bleeding

Question 6

what are the complications of gonorrhoea?

Answer 6

strictures
salpingitis
epididymitis
disseminated gonococcal infection (triad of tenosynovitis, migratory polyarthritis, dermatitis)

Question 7

what is the management of gonorrhoea?

Answer 7

ceftriaxone 1g IM

if ceftriaxone is refused =
PO cefixime 400mg + 2g azithromycin PO

diagnose using NAAT

Question 8

How does infection with Candida albicans present?

Answer 8

Cottage cheese (thick white) discharge
Vulvitis
Itch

Question 9

what is the management of thrush (candida albicans)

Answer 9

clotrimazole pessary 500mg stat
OR
fluconazole 150mg PO

Question 10

what is the presentation of trichomonas vaginalis?

Answer 10

offensive, yellow/green, frothy discharge
vulvovaginitis
strawberry cervix

Question 11

what is the treatment for trichomonas?

what is trichomonas associated with?

Answer 11

metronidazole 2g PO

low birth weight, PPROM and preterm birth

Question 12

What is the look back period for gonorrhoea?

Answer 12

symptomatic males: 2 weeks
asymptomatic males: 3m
all females: 6m

Question 13

how does bacterial vaginosis present?

what are the investigations?

Answer 13

(Gardnerella vaginalis)

offensive fishy grey/colourless thin discharge

do a microscopy to look for ‘clue cells’, a swab and culture

Question 14

what is the treatment for bacterial vaginosis?

Answer 14

metronidazole 2g

Question 15

how does primary HSV present?

Answer 15

multiple painful genital blisters
lymphadenopathy
urinary retention
may present with severe gingivostomatitis or cold sores

discharge has a pH <4.5

Question 16

what is the management of a primary HSV infection?

Answer 16

genital herpes: PO aciclovir 400mg 3x daily, 7 days
saline baths

if gingivostomatitis: oral aciclovir, chlorhexidine mouthwash

pregnant? = first attack of herpes in pregnancy >28w = elective caesarean at term
recurrent herpes? = prophylactic aciclovir at 36w

blisters are HIGHLY CONTAGIOUS and wait until symptoms pass/10-21 days to have sex

Question 17

how does primary, secondary, and tertiary syphilis present?

Answer 17

Treponema pallidum
incubation period 9-90 days

primary = painless chancre at the site of sexual contact

secondary = 6-10w after infection. fevers, lymphadenopathy, rash on palms, trunk, legs, soles. buccal ‘snail tracks’. condylomata lata

tertiary = gummas, ascending aortic aneurysms, tabes dorsalis, Argyll-Robertson pupil

Question 18

what are the features of congenital syphilis?

Answer 18

blunted upper incisor teeth
keratitis
saber shins
saddle nose
deafness

Question 19

what are the investigations of syphilis?

Answer 19

cardiolipin tests (becomes negative after treatment)
treponemal specific antibody tests

Question 20

what is the management of syphilis?

Answer 20

1) IM benzathine penicillin OR doxycycline

Question 21

what strains of HPV cause genital warts?

Answer 21

6 and 11

Question 22

how do genital warts present?

what is the treatment?

Answer 22

also known as condylomata accuminata

small fleshy painless lumps

topical podophyllotoxin or imiquimod

Question 23

what are the most common organisms in epididymo-orchitis?

how do you treat it?

Answer 23

E coli is the most common organism in older adults or those with BPH

N. gonorrhoea, C. trachomatis are the most likely cause in younger men

ceftriaxone 500mg IM + doxycycline 100mg