Sexually Transmitted Disease

Question 1

define a sexually transmitted disease

Answer 1

disorder of a structure or function caused by a sexually transmitted pathogen

Question 2

what is a sexually transmitted infection?

Answer 2

an infection by a pathogen which is sexually transmissible (unlikely to be transmitted by sexual means)

Question 3

what is a sexually transmitted microbe?

Answer 3

a virus/bacteria or protozoan that is spread by sexual contact

Question 4

what organism causes gonorrhoea?

Answer 4

Neisseria gonorrhoeae

Question 5

what is the male presentation of gonorrhoea?

Answer 5

> asymptomatic (10%) (rectal and pharyngeal)
dysuria
thick profuse yellow discharge

Question 6

what is the female presentation of gonorrhoea?

Answer 6

> dysuria
vaginal discharge
bleeding: intermenstrual and post coital

Question 7

what complications can arise form gonorrhoea in men?

Answer 7

> epididymitis

Question 8

what complications can arise form gonorrhoea in women?

Answer 8

> pelvic inflammatory disease

> Bartholin’s abscess

Question 9

what complications can arise form gonorrhoea in men and women?

Answer 9

> acute mono-arthritis (elbow and shoulder)

> disseminated gonococcal infection (skin lesions of pustular halo)

Question 10

what treatment is there for gonorrhoea?

Answer 10

> antibiotics according to sensitivities
> blind: azithromycin 1g or ceftriaxone 500mg
> follow up
 - test for cure at 2 weeks 
 - test for reinfection at 3 months

Question 11

how is gonorrhoea diagnosed?

Answer 11

> nucleic acid amplification (urine/swab)
gram stained smear
culture (checks sensitivity)

Question 12

what causes chlamydia?

Answer 12

chlamydia trachomatis

Question 13

what are the symptoms for chlamydia in men?

Answer 13

> dysuria
slight watery discharge
conjunctivitis
asymptomatic (70%)

Question 14

what are the symptoms for chlamydia in women?

Answer 14

> asymptomatic (80%)
> dysuria
> vaginal discharge
> bleeding (intermenstrual and post coital)
> conjunctivitis

Question 15

what complications can occur from chlamydia in men?

Answer 15

> epididymitis

Question 16

what complications can occur from chlamydia in women?

Answer 16

> pelvic pain
pelvic inflammatory disease (ectopic pregnancy)
infertility

Question 17

what complications can occur in both men and women from chlamydia?

Answer 17

> cervicitis
urethritis
reactive arthritis (reiters syndrome)

Question 18

how is chlamydia diagnosed?

Answer 18

> first void urine in men
swab (cervix, urethra, rectum)
NAAT test

Question 19

what is the management of chlamydia?

Answer 19

> azithromycin 1g
doxycycline 100mg for 1 week (rectal infection)
follow up at 3 -12 months for reinfection

Question 20

what causes herpes STI?

Answer 20

herpes simplex one and two

Question 21

how does herpes present?

Answer 21

> 80% have no symptoms
> burning/itching then blistering then tender ulceration
> tender inguinal lymphadenopathy
> flu like symptoms
> dysuria
> neurological pain (back, pelvis, legs)

Question 22

what complications can occur in herpes infection?

Answer 22

> autonomic neuropathy (urinary retention)
secondary infection
neonatal infection

Question 23

HSV2 is an important cofactor in the transmission of what?

Answer 23

HIV

Question 24

what is the incubation period of herpes?

Answer 24

5 days to months

Question 25

how is herpes diagnosed?

Answer 25

> clinically | > PCR of lesion swab

Question 26

what is the management for herpes?

Answer 26

> ACICLOVIR for primary outbreak - 400g twice a day frequent occurrence - 1.2g daily until symptoms have gone in in frequent occurrence > lidocaine ointment

Question 27

what causes syphilis?

Answer 27

treponema pallidum

Question 28

how does primary syphilis present?

Answer 28

local ulcer

Question 29

how does secondary syphilis present?

Answer 29

> rash > mucosal ulceration > neuro symptoms > patchy alopecia

Question 30

describe the early latent stage of syphilis

Answer 30

no symptoms but less than 2 years since infected

Question 31

describe late latent stage of syphilis

Answer 31

no symptoms but more than 2 years since infected

Question 32

how does tertiary syphilis present?

Answer 32

> neurological symptoms > gummatous skin lesions > cardiovascular symptoms

Question 33

what is the incubation period in syphilis?

Answer 33

9-90 days

Question 34

how is early syphilis managed?

Answer 34

> benzathine penicillin 2.4 Mu once | > doxycycline 100mg 2 times a day for 2 weeks

Question 35

how is syphilis diagnosed?

Answer 35

> PCR sample from ulcer > clinical signs > serology

Question 36

what complications can arise from syphilis?

Answer 36

> congenital syphilis | > neurosyphilis (cranial nerve palsies, aortal involvement, cardiac involvement)

Question 37

what are the symptoms of trichomonas vaginalis?

Answer 37

> asymptomatic in men > vulvulitis > frothy, foul and profuse vaginal discharge

Question 38

in what group is trichomonas vaginalis more common?

Answer 38

middle aged women

Question 39

what complications can trichomonas vaginalis lead to?

Answer 39

> miscarriage | > preterm labour

Question 40

how is trichomonas vaginalis diagnosed?

Answer 40

> PCR of vaginal swab | > microscopy of preparation of vaginal discharge

Question 41

how is trichomonas vaginalis managed?

Answer 41

metronidazole 2g single dose or 400mg twice a day for 5 days

Question 42

how do angiogenital warts present?

Answer 42

> cauliflower lumps | > perianal/intra-uthral bleeding/itching

Question 43

what causes angogenital warts?

Answer 43

human papilloma virus types 6-11

Question 44

what percentage of people infected with HPV get warts?

Answer 44

20%

Question 45

what complications can arise from angogenital warts

Answer 45

neonatal laryngeal papillomatosis

Question 46

how are angiogenital warts diagnosed?

Answer 46

> clinically | > biopsy (if unusual, to exclude intra-epithelial neoplasia)

Question 47

how are angioigenital warts managed?

Answer 47

> podophylootoxin > imiquimod > cryotherapy > diathermy or scissor removal if bulky