Sexual Health - STI

Question 1

what are the 5Ps of taking a sexual history?

Answer 1

partner
preference 
protection 
practices 
past history of STI

Question 2

what are the tests for early syphilis

Answer 2

RPR (rapid plasma reagin) test
veneral disease research laboratory (VDRL) test
AND
treponema pallidum hemagluttanination assay
other tests:
PCR with swab of chancre/mucosal lesion

(tests may be negative in early infection and tests should be repeated if clinically indicated - usually in the 3,6,12 weeks period)

Question 3

describe the course and development of syphilis

Answer 3

latent for 2 - 4 weeks 
primary syphilis (about 3 weeks): painless, non itchy lesion that is found in the genital area 
secondary syphilis (about 6 - 8 weeks); maculopapular rash that is non itchy, with constitutional symptoms (may be mild), with mucous membrane lesions 
tertiary syphilis (late 2 years +): soft tissue destruction, gummas (granulomas), neurosyphilis, cardiovascular syphilis, gummas

Question 4

what is the medical treatment of syphilis?

Answer 4

Avoid sexual activity until lesions have resolved
Clinical and serological follow-up at 3,6,12 months (if non-treponemal RPR titres rise or fail to decline four fold within 6-12 months suspect re-infection or treatment failure)

early syphilis: benpen IM 1.8g stat dose OR procaine penicillin 1.5 IM daily for 10 days
late latent syphilis: given benzathine penicillin 1.8g IM, once weekly for 3 weeks
tertiary syphilis: benpen 1.8g (IV 4 hourly for 15 days) +/- 20mg prednisolone orally per 12 hourly 3 doses to reduce risk of Jarisch-Herxheimer reaction

doxycycline/tetracyclines can be used if patient is allergic or resistant

Question 5

what are the other preventive measures to take for syphilis?

Answer 5

avoid sex until ulcers healed (condoms do not completely prevent syphilis transmission)
contact tracing and treating sexual contacts in the past 3 months
repeat serology 3 monthly and then 3 monthly

Question 6

what are the clinical manifestations of tertiary syphilis?

Answer 6

gummatous syphilis (granulomatous, heaped up ulcer, w/ round irregular serpinginous shape) 
neurosyphilis
cardiovascular complications (aortic regurgitation, dilated aorta)

Question 7

what are the different manifestations of early and late neurosyphilis?

Answer 7

early neurosyphilis: asymptomatic or symptomatic meningitis
late neurosyphilis:
general paresis (progressive loss of memory, personality change, severe dementia, other psychiatric symptoms such as: depression, mania, psychosis)
tabes dorsalis (sensory ataxia/lancinating pain that affects face, back, limbs, argyll robertson pupil, absent lower extremity reflexes, impaired vibratory and position sensation, impaired touch and pain, sensory ataxia, optic atrophy)

Question 8

what is the treatment for chlamydia?

Answer 8

azithromycin 1g orally as a single dose OR doxycycline 100mg orally, 12 hourly for 7 days

if patient have complications, prolonged treatment may be reqreuied (arthritis, eye conditions)

Others: 
prevention (condoms) 
treat partner 
avoid intercourse until infection has cleared up 
contact tracing for past 6 months 
reportable disease

Question 9

what is the treatment for gonorrhea?

Answer 9

stat dose IM ceftriaxone 500mg in 2mL lignocaine
+ azithromycin 1g oral, single dose

azithromycin is always used concomittantly with ceftriaxone to delay cephalosporin resistance of gonorrhea

Others: 
prevention (condoms) 
treat partner 
avoid intercourse until infection has cleared up 
contact tracing for past 6 months 
reportable disease

Question 10

what are the differences between chlamydia and gonorrhea?
onset of duration
clinical presentation

Answer 10

chlamydia has long incubation period (1 - 2 weeks) vs gonorrhea has short incubation period (2 - 3 days)
chlamydia has milky white, clear discharge vs gonorrhea has creamy pus like discharge

Question 11

Offensive bubbly, profuse, odorous, yellow-green discharge, pH 5-6 (ref: 4-4.7), soreness

Answer 11

trichonomas vaginosis

Question 12

White thick cheesy non-odorous discharge, pH 4 (ref: 4-4.7), itchy, sore, redness

Answer 12

candidiasis

Question 13

Grey, malodorous, watery, profuse, bubbly pH 5-6 (ref 4-4.7), irritation

Answer 13

bacterial vaginosis

Question 14

Yellow green, thick, usually odorous, pH 4- 4.7 (ref 4-4.7) +/- signs of PID

Answer 14

cervicitis

Question 15

Anogenital painless ulcer with indurated edges

Answer 15

primary chancre of syphilis

Question 16

Acute systemic illness with rash, condylomata lata (clusters of soft moist lumps in skin folds of the anogenital area), mucosal lesions, hepatitis, meningitis

History of a painless ulcer a few months ago

Answer 16

secondary syphilis

Question 17

treatment of bacterial vaginosis

Answer 17

metronidazole 400mg oral 12 hourly for 7 days
OR
metronidazole 0.75% vaginal gel 1 application at bedtime for 5 nights

Question 18

multiple shallow, painful, moist ulcers on the penis. tender inguinal lymphadenopathy. what is the treatment?

Answer 18

HSV - give aciclovir/famciclovir

Question 19

Genital ulcers - Murtagh model

Answer 19

common: genital herpes (HSV)

must not miss: syphilis, SCC, parasitic infections