Sexual Health (GUM)

Question 1

Risk factors for thrush/candidiasis

Answer 1

Diabetes Mellitus
Pregnancy
Immunosuppression (steroids, HIV)
Abx

Question 2

Mx of Thrush

Answer 2

Local - clotrimazole pessary

Oral - itraconazole 200mg bd or fluconazole 150 mg PO stat

Question 3

Differential diagnoses of a genital sore/ulcer

Answer 3

Infection

• • Syphilis (treponema pallidum) - all genital ulcers are syphilis until proven otherwise
• HSV (type 2)
• HZV

Dermatological

• Lichen sclerosis
• Lichen planus
• Pemphigoid (BP)
• Pemphigus (PV)
• Erythema multiforme (drug reaction or HSV reaction)

Neoplasm

• VIN
• Vulval SCC
• BCC
• Melanoma

Other

• Trauma
• Apthous ulcer
• Insect bite

Question 4

Differential diagnoses of genital discharge

Answer 4

• Candida Albicans (cottage cheese like, non-offensive)
• Bacterial vaginosis / Gardnerella Vaginalis (fishy, offensive, grey or colourless)
• Trichomonas vaginalis (fishy, thin and bubbly; strawberry cervix)
• Chlamydia Trachomatis
• Neisseria Gonorrhoea

PID

Question 5

How may candidiasis present

Answer 5

Thick, non-offensive, white ‘cottage cheese like’ discharge
Dysuria
Dyspareunia (vulval involvement)

Question 6

Ix for candidiasis

Answer 6

High vaginal swab

Question 7

What to test for if recurrent candidiasis?

Answer 7

HIV
Diabetes Mellitus
Adherence to treatment

Question 8

Name the organism responsible for chlamydia infection

Answer 8

Chlamydia Trachomatis

Question 9

What is the most common STI ?

Answer 9

Chlamydia Trachomatis

Question 10

How may chlamydia present ?

Answer 10

Asymptomatic (70%) cases
Dysuria
Discharge
IMB or PCB
Dyspareunia 
Epididymo-orchitis (testicular pain and swelling)

Question 11

Which STI has a national screening programme ?

Answer 11

Chlamydia

Question 12

List some complications of chlamydia infection

Answer 12

Fitz-Hugh-Curtis syndrome
Reiter’s syndrome
PID
Tubal infertility

Question 13

Mx of Chlamydia

Answer 13

Azithromycin (single dose)
or
Doxycycline (7 days)

Erythromycin in pregnancy

Question 14

Ix for Chlamydia

Answer 14

Vulvovaginal and endocervical swab for NAAT (nucleic acid amplification test)

Question 15

What is the gram staining of Neisseria Gonorrhoeae ?

Answer 15

Gram neg diplococcus

Question 16

Symptoms of Gonorrhoea infection

Answer 16

Asymptomatic 
Dysuria
Discharge (purulent penile)
Pelvic pain (women)
IMB / PCB 
Epididymo-orchitis (males) 
Proctitis

Question 17

Complications of gonorrhoea infection

Answer 17

Septic arthritis (monoarthritis)
PID
Bartholin’s abscess

Question 18

Ix for gonorrhoea infection

Answer 18

Endocervical swab for microscopy and nAAT (nucleic acid amplification test)

Question 19

Mx of gonorrhoea infection

Answer 19

Ceftriaxone (stat)
AND
Azithromycin (stat)

Question 20

Consequences of gonorrhoea infection in pregnancy

Answer 20

Chorioamionitis
Preterm delivery
PPROM
Ophthalmia neonatarum

Question 21

Consequences of chlamydia infection in pregnancy

Answer 21

Neonatal conjunctivitis
PPROM
Preterm delivery
Neonatal pneumonia

Question 22

What organism causes syphilis ?

Answer 22

Treponema Pallidum (spirochaete bacteria)

Question 23

How does syphilis present ?

Answer 23

Primary syphilis (within 9-90 days) -
Raised, painless, indurated ulcerated papule = chancre (often at the site of inoculation) 
Lymphadenopathy 

Secondary syphilis (6-8 weeks after chancre has healed)-
Seroconversion. Rash (widespread mucocutaneous lesions), malaise, fever, sore throat, headache and lymphadenopathy.
Enter late latency after 1 year.

Tertiary syphilis -
Characterised by the gumma (chronic granulomatous lesions) often seen on skin, bone and mucosa

Quaternary syphilis (10-20 years after infection)- 
Neurosyphilis (Argyll-Robertson pupil, tabes dorsalis)
Cardiosyphilis  (aortic aneurysms and regurgitation)

Question 24

Ix for syphilis

Answer 24

Dark ground microscopy (detect spirochaete in primary and secondary stages)

Can only test after 6 weeks (second stage)

• Cardiolipin antibody (VDRL test)
• TPHA test (treponema pallidum haemagglutination assay)

CXR
LP
CT / MRI

Question 25

What abx is used to treat syphilis ?

Answer 25

Benzathine penicillin / long acting procaine penicillin IM 10-12 days
Or
Benzylpenicillin 2 weeks

Can use doxycycline if early stage

Question 26

What may happen after staring treatment for syphilis ?

Answer 26

Jarisch- Herxheimer Reaction

(Rise in temp and HR, vasodilation due to release of endotoxins after first dose of Abx)

Seen in 50% pts with primary syphilis and 90% pts with secondary syphilis

Question 27

What can happen if maternal syphilis infection in pregnancy

Answer 27

Birth defects

Spontaneous abortion

Question 28

What organism is responsible for genital warts ?

Answer 28

HPV 6 and 11

Question 29

Mx of genital warts

Answer 29

Podophyllotoxin cream (warticon)

Cryotherapy with liquid nitrogen

Question 30

Offensive Fishy, thin and bubbly discharge with a strawberry cervix seen on examination
& urethritis / dysuria ?

Answer 30

Trichomonas vaginalis

Question 31

Mx of Trichomonas vaginalis

Answer 31

Metronidazole

Question 32

What kind of microorganism is trichomonas vaginalis

Answer 32

Protozoa

Question 33

Offensive grey/colourless fishy discharge?

Answer 33

Bacterial vaginosis

Question 34

Bacteria associated with bacterial vaginosis

Answer 34

Overgrowth of gardnerella vaginalis (natural floral, but overgrown due to reduce lactobacillus)

Question 35

What can trigger bacterial vaginosis ?

Answer 35

Perfumed products

Insertion of an IUD

Question 36

Ix / diagnosis of bacterial vaginosis

Answer 36

Whiff test

Clue cells seen on microscopy

Question 37

Mx of bacterial vaginosis

Answer 37

Metronidazole STAT
Or
Topical clindamycin for 7 days