Sexual Medicine

Question 1

What serology may you conduct in a suspected Hepatitis B patient?

Answer 1

HBsAg (production of anti-HBs, suggestive of infection) - present for <6 months

Anti-HBs (immunity through exposure either infection or innoculation)

Anti-HBc (previous or current infection)

LFTs

And a full liver screen:
ANA
SMA

Copper
Ceraluplasmin

Ferritin
Transferrin saturation

AFP
AAT1

Question 2

What is the risk of transmission of Hepatitis C during a needlestick injury in the UK?

Answer 2

2%

Question 3

What investigations would show Hepatitis C virus?

Answer 3

HCV RNA with anti-HCV Abs

Question 4

How is Hepatitis C treated?

Answer 4

Combination of protease inhibitors

Question 5

How is Hepatitis B treated?

Answer 5

Interferon-alpha

Question 6

How does HIV seroconversion present?

Answer 6

Glandular fever type illness 3-12 weeks after infection consisting of sore throat, lymphadenopathy, malaise and arthralgia and diarrhoea

Question 7

What tests are used in diagnosis of HIV?

Answer 7

Combination tests HIV p24 antigen and HIV antibody

Make sure to test asymptomatic patients 4 weeks after possible exposure and then 12 weeks repeat test

Question 8

What potential complications of HIV may exist?

Answer 8

Oral thrush
Shingles
Hairy leukoplakia
Kaposi sarcoma

Cryptosporidiosis
Cerebral toxoplasmosis
Progressive multifocal leukoencephalopathy
Pneumocystis jirovecii pneumonia
HIV dementia

Aspergillosis
Oesophageal candidiasis
Cryptococcal meningitis
Primary CNS lymphoma

CMV retinitis

Question 9

What are the main symptoms of Chlamydia in males or females?

Answer 9

Women: Cervitis - discharge and bleeding

Men: Urethral discharge, dysuria

Question 10

How do you test for Chlamydia?

Answer 10

Men: NAATs from first-void urine

Female: Vaginal swab

Question 11

What is the management of Chlamydia?

Answer 11

Doxycycline 7/7

If pregnant, Azithromycin or Erythromycin

Question 12

What are the main symptoms of Chlamydia in males or females?

Answer 12

Women: Cervitis - discharge and bleeding

Men: Urethral discharge, dysuria

Question 13

What is the main treatment of Gonorrhoea?

Answer 13

Ceftriaxone 1g IM

Question 14

What are the key features of disseminated gonococcal infection?

Answer 14

Tenosyvitis
Migratory polyarthritis
Dermatitis

Question 15

What are the main features of Syphilis?

Answer 15

Primary:
Chancre
Tender lymphadenopathy

Secondary:
Fever
Rash
Condylomata lata (painless, warty lesions on the genitalia)

Tertiary:
Gummas
Ascending aortic aneurysms
Paralysis
Argyll-Robertson pupil

Question 16

How do you manage Syphilis?

Answer 16

IM Benzyl Penicillin

Question 17

What may occur following treatment of Syphilis?

Answer 17

Jarisch-Herxheimer reaction - destruction of bacteria results in endotoxin release which causes fever, rash, tachycardia after dose of antibiotic

Question 18

What is the criteria for Bacterial Vaginosis?

Answer 18

Amsel criteria
pH > 4.5
Positive Whiff test
Thin, white discharge
Clue cells on microscopy

Question 19

How do you manage bacterial vaginosis?

Answer 19

Oral metronidazole 5/7

Question 20

What are the clinical features of Trichomonas?

Answer 20

Frothy yellow-green discharge
Strawberry cervix
Motile trophozoites

Question 21

How do you screen for Cervical cancer?

Answer 21

HPV screening

Screen from 25-64
30s = 3 years; 50s = 5 years
Negative = no FU

Positive

+ Cytology abnormal (dyskariosis)
- Colposcopy

+ Normal cytology
- Repeat at 12 months
- If repeat +ve at 24 months, Colposcopy

If sample is inadequate, repeat in 3 months

Question 22

How is cervical cancer managed?

Answer 22

LLETZ