Sexual medicine

Question 1

What is bacterial vaginosis?

Answer 1

Growth of anaerobic bacteria in the vagina due to lactobacilli loss

Question 2

Examples of bacteria responsible for bacterial vaginosis x3?

Answer 2

Gardnerella vaginalis
Mycoplasma hominis
Prevotella

Question 3

What is the normal vaginal pH?

Answer 3

3.5-4.5

Question 4

What is seen on microscopy for BV?

Answer 4

Clue cells - epithelia from cervix that have bacteria stuck to them - usually G. vaginalis

Question 5

What is 1st line abx and alternative for BV?

Answer 5

Metronidazole

Clindamycin

Question 6

Why avoid alcohol when on metronidazole?

Answer 6

Disulfiram-like reaction w/ N/V, flush, severe shock symptoms, angioedema

Question 7

What is the standard symptomatic presentation for BV (note: 50% asymptomatic)?

Answer 7

Fishy swelling watery-grey or white vaginal discharge

Question 8

Will an increase or decrease in oestrogen act as a RF for thrush?

Answer 8

Increase e.g. during pregnancy

Question 9

What is the clinical presentation typical for a thrush infection?

Answer 9

Thick, white discharge, not smelly.

Itching, irritation and discomfort of the vulva and vagina

Question 10

What is a confirmatory investigation for thrush?

Answer 10

Charcoal swab with microscopy

Question 11

Thrush antifungal medication example?

Answer 11

Clotrimazole

Fluconazole

Question 12

Chlamydia trachomatis is a?

Answer 12

Intracellular gram negative bacteria

Question 13

STI minimum screen when attend GUM clinic?

Answer 13

Chlamydia, gonorrhoea, syphilis, HIV

Question 14

What do charcoal swabs facilitate?

Answer 14

Microscopy, culture, sensitivities

Question 15

What is the dx for chlamydia?

Answer 15

NAAT:

• vulvovaginal swab
• endocervical swab
• rectal swab
• pharyngeal swab
• 1st catch urine sample

Question 16

What is 1st line for uncomplicated chlamydia infection?

Answer 16

Doxycycline

Question 17

Doxycycline CI and alternatives if so?

Answer 17

Pregnancy and breastfeeding

Erythromycin, azithromycin, amoxicillin

Question 18

Neisseria gonorrhoea shape?

Answer 18

Gram negative diplococcus

Question 19

Why is it so important to take an endocervical charcoal swab?

Answer 19

Facilitates microscopy, culture, antibiotic sensitivities –> guides choice of abx use

Question 20

What are the treatments for n. gonorrhoea:
Sensitivity known
Sensitivity unknown

Answer 20

Not known:
Single dose IM ceftriaxone 1g
Single dose PO ciprofloxacin 500mg

Question 21

What can a neonate inherit from a gonorrhoea infected mother at birth?

Answer 21

Gonococcal conjunctivitis

Neonatal conjunctivitis: ophthalmia neonatorum

Question 22

Complication of untreated gonorrhoea?

Answer 22

Disseminated gonococcal infection (spreads to system, skin and joints)

Question 23

What is mycoplasma genitalium?

Answer 23

STI bacterium causing non-gonococcal urethritis

Question 24

Key clinical feature of mycoplasma genitalium?

Answer 24

Urethritis (often asymptomatic or similar to chlamydia)

Question 25

Management of mycoplasma genitalium?

Answer 25

- Doxycycline 100mg 2/day for 7 days THEN Azithromycin 1g stat 500mg 1/day for 2 days

Question 26

Management of alternative/complicated mycoplasma genitalium?

Answer 26

Moxifloxacin

Question 27

What is trichomoniasis vaginalis?

Answer 27

Trichomonas is classed as a protozoan, and is a single-celled organism with flagella - 4 at front and 1 at back

Question 28

Where does trichomoniasis lie in men and women?

Answer 28

Men: urethra Women: urethra and vagina

Question 29

Clinical pres of trichomoniasis?

Answer 29

Frothy yellow-green discharge with fishy smell and strawberry cervix

Question 30

Dx of trichomoniasis? Men and women

Answer 30

Men: urethral swab of 1st catch urine Women: charcoal swab w/ microscopy from posterior fornix of vagina

Question 31

Management for trichomoniasis?

Answer 31

Metronidazole

Question 32

What causes genital herpes?

Answer 32

HSV, most typically HSV-2 strain

Question 33

HSV lies latent in the sensory nerve ganglia - which ganglia are cold sores and genital herpes lying in?

Answer 33

Cold sores - trigeminal nerve ganglion | Genital herpes - sacral nerve ganglia

Question 34

Dx for HSV?

Answer 34

Viral PCR and clinical/sexual contacts

Question 35

Management for HSV?

Answer 35

Acyclovir

Question 36

Why is primary genital HSV infection problematic in pregnancy?

Answer 36

Neonatal herpes-simplex infection risk

Question 37

Treatment for primary genital herpes <28wks gestation?

Answer 37

Acyclovir and regular prophylactic acyclovir from 36wks. Consider section if symptomatic, otherwise vaginal delivery if >6wks from infection

Question 38

Treatment for primary genital herpes >28wks gestation?

Answer 38

Acyclovir and regular prophylactic acyclovir from 36wks. Section always recommended.

Question 39

Recurrent genital herpes?

Answer 39

Consider prophylactic acyclovir from 36wks

Question 40

Incubation period of syphilis?

Answer 40

~21 days

Question 41

What causes syphilis?

Answer 41

Treponema pallidum - spirochete spiral-shaped bacteria

Question 42

Stages of syphilis?

Answer 42

Primary – Painless ulcer called chancre Secondary – systemic Sx. Condylomata lata, fever, lymphadenopathy, alopecia, rash. Resolve after 3-12wks – patient enters latent stage Latent – Symptoms disappear despite still infected (w/in 2yrs of initial infection) Tertiary – gummas develop and CV and neuro complications such as neurosyphilis

Question 43

What should you look for in neurosyphilis?

Answer 43

Argyll-Robertson pull

Question 44

Management for syphilis?

Answer 44

Single IM benzathine benzylpenicillin