Sexual health

Question 1

What percentage of chlamydia is asymptomatic

Answer 1

50% in men

70% in women

Question 2

Symptoms of chlamydia in men

Answer 2

Urethral discharge
Dysuria
Urethral itch or discomfort
Rectal discharge and bleeding

Question 3

Symptoms of chlamydia in women

Answer 3

Vaginal discharge
Dysuria
Pelvic pain
Post-coital and intermenstrual bleeding
Rectal discharge and bleeding

Question 4

Investigations for chlamydia

Answer 4

Men = first catch urine for NAAT (nucleic acid amplification)
Women = vaginal swab for NAAT

Question 5

1st line treatment for chlamydia

Answer 5

Doxycycline 100mg BD 7/7`

Question 6

Complications of chlamydia in women

Answer 6

PID (leads to):
Tubo-ovarian abscess
Ectopic pregnancy
Perihepatitis
Chronic pelvic pain
Infertility

Question 7

Complications of chlamydia in men

Answer 7

Epididymitis

Question 8

What percentage of gonorrhoea is asymptomatic

Answer 8

10% (penis) in men
93% (rectum) in men
50% in women

Question 9

Symptoms of gonorrhoea in men

Answer 9

Urethral discharge
Dysuria
Urethral itch or discomfort
Rectal discharge and bleeding

Question 10

Symptoms of gonorrhoea in women

Answer 10

Vaginal discharge
Dysuria
Pelvic pain
Post-coital and intermenstrual bleeding
Rectal discharge and bleeding

Question 11

Investigations for gonorrhoea

Answer 11

Men = first catch urine for NAAT
Women = vaginal swab for NAAT

Question 12

How does gonorrhoea appear on a gram stain

Answer 12

Gram-negative intracellular diplococci within polymorphonuclear cells

Question 13

1st line treatment for gonorrhoea

Answer 13

Ceftriaxone 1g IM stat with 3.5ml lidocaine

No sexual intercourse for 1 week and symptoms resolved

Question 14

Which antibiotic is having resistance issues with gonorrhoea

Answer 14

Azithromycin

Question 15

Complications of gonorrhoea in women

Answer 15

Bartholin’s abscess

PID leading to: tubo-ovarian abscess, ectopic, infertility, perihepatitis, chronic pelvic pain

Question 16

Complications of gonorrhoea in men

Answer 16

Epididymitis

Urethral strictures

Question 17

Signs of disseminated gonococcal infection

Answer 17

Arthritis
Tenosynovitis
(Rare) endocarditis, hepatitis, meningitis

Question 18

Aetiology of PID

Answer 18

60% = idiopathic, BV related (anaerobes)
20% = chlamydia 
10% = mycoplasma genitalium
1-3% = gonorrhoea

Question 19

Symptoms of PID

Answer 19

Lower abdo pain
Abnormal vaginal discharge
Intermenstrual bleeding (painful)
Post-coital bleeding
Dyspareunia

Question 20

Signs of PID

Answer 20

Lower abdo tenderness
Cervical excitation
Uterine/adnexal tenderness
Temp +/-

Question 21

Differentials for PID

Answer 21

Ectopic
UTI
Haemorrhagic ovarian cyst
Torsion ovarian cyst
Appendicitis
Constipation/IBS

Question 22

Treatment for PID

Answer 22

Must cover chlamydia and anaerobes

1st line = ceftriaxone 1g IM + doxycycline 100mg BD 2/52 + metronidazole 400mg BD 10-14/7