Sexual health

Question 1

What is the most common STI in the UK?

Answer 1

Chlamydia

Question 2

Describe the aetiology of Chlamydia

Answer 2

Bacterial infection caused by Chlamydia trachomatis (gram-negative cocci = pink stain)

Question 3

Describe the clinical features of Chlamydia

Answer 3

Mostly asymptomatic

If symptomatic:

• Women: cervicitis (discharge, bleeding), dysuria
• Men: urethral discharge, dysuria

Question 4

Describe the investigation of Chlamydia in men and women

Answer 4

• Women: vulvovaginal swab is 1st line

- Men: first void urine sample is 1st line

Question 5

Describe the management options for Chlamydia

Answer 5

• 1st line: doxycycline (7 day course)

- 2nd line: azithromycin if doxycycline is contraindicated, e.g. pregnancy

Question 6

Describe the aetiology of Gonorrhoea

Answer 6

Bacterial infection caused by Neisseria gonorrhoeae (gram-negative diplococci = pink stain)

Question 7

Describe the clinical features of Gonorrhoea

Answer 7

• Women: cervicitis (discharge, bleeding), dysuria
• Men: urethral discharge, dysuria
• Rectal and pharyngeal infection can also occur, but these are usually asymptomatic

Question 8

Describe the management options for Gonorrhoea

Answer 8

• 1st line: single dose of IM ceftriaxone 1g

Question 9

Describe the aetiology of Trichomoniasis

Answer 9

Protozoal infection caused by Trichomonas vaginalis

Question 10

Describe the clinical features of Trichomoniasis

Answer 10

Women:

• Offensive, frothy, yellow/green discharge
• Strawberry cervix
• pH > 4.5

Men:
- Usually asymptomatic but may cause urethral discharge/dysuria

Question 11

Describe the investigation of Trichomoniasis

Answer 11

Microscopy (wet mount)

Question 12

Describe the management options for Trichomoniasis

Answer 12

• Oral metronidazole for 5-7 days (or as a single 2g dose)

Question 13

Describe the aetiology of syphilis

Answer 13

Bacterial infection caused by Treponema pallidum (gram negative spirochete = pink stain)

Question 14

How long is the incubation period for syphilis?

Answer 14

9-90 days

Question 15

Describe the clinical presentation of syphilis

Answer 15

Primary, secondary and tertiary presentation

Primary features:

• Chancre (painless ulcer on genitals)
• Local non-tender lymphadenopathy

Secondary features (occurs 6-10 weeks after primary infection):

• Fever
• Lymphadenopathy
• Rash (trunk, palms and soles)
• Painless warty lesions on genitals

Tertiary features (occurs years after primary infection):
- Neurosyphilis

Question 16

Describe the investigation of syphilis

Answer 16

Blood test

Question 17

Describe the management options for syphilis

Answer 17

• 1st line: IM benzathine penicillin

- Alternatives: doxycycline

Question 18

Is bacterial vaginosis a sexually transmitted infection?

Answer 18

No, but it is seen almost exclusively in sexually active women

Question 19

Describe the clinical features of bacterial vaginosis

Answer 19

Offensive, thin, grey, ‘fishy’ discharge

Question 20

On microscopy, what kind of cells may you expect to find in bacterial vaginosis?

Answer 20

Clue cells

Question 21

Describe the management of bacterial vaginosis

Answer 21

Oral metronidazole for 5-7 days

Question 22

Give some examples of risk factors for developing vaginal candidiasis

Answer 22

• Pregnancy
• Diabetes mellitus
• Drugs: antibiotics, steroids
• Immunosuppression, e.g. HIV

Question 23

Describe the features of vaginal candidiasis

Answer 23

• Non-offensive, ‘cottage cheese’ discharge
• Itch
• Vulval erythema
• Dysuria, dyspareunia

Question 24

Describe the management of vaginal candidiasis

Answer 24

Options include local or oral treatment:

• Local = clotrimazole pessary or cream
• Oral: fluconazole

Oral treatment is contraindicated in pregnancy