Sexually transmitted disease

Question 1

Describe the things to think about when taking a sexual history

Answer 1

Question 2

Cause of genital warts?

Answer 2

HPV 6, 11

Question 3

Treatment for genital warts?

Answer 3

• Topical podophyllin
• Imiquimod
• Ablation

Question 4

Name some causes of genital ulcers?

Answer 4

• Genital herpes
• Syphilis
• Lymphogranuloma venerum
• Tropical infections

Question 5

Describe Genital herpes?

Answer 5

• Herpes simplex virus
• Flu-like prodrome, then vesicles/papules around genitals, anus, throat
  
  • They burse, forming painful shallow ulcers
• Also urethral discharge, dysuria, urinary retention, proctatitis

Question 6

Describe the diagnosis and treatment of genital herpes?

Answer 6

• Diagnosis
  
  • Viral PCR (vesicle fluid)
• Treatment:
  
  • Analgesia
  • Topical lidocaine
  • Aciclovir, valaciclovir, famciclovir

Question 7

Cause of syphilis?

Answer 7

Treponema pallidum

Question 8

Describe the presentation of syphilis?

Answer 8

• Primary
  
  • Within 90days of infection.
  • Macule->papule->painless ulcer (chancre). Central slough, defined rolled edge
  • Highly infectious
• Secondary
  
  • Dissemination within 4-10 weeks after chancre
  • Maculopapular, flexor rash, mucous patches, fever, lymphadenopathy
• Tertiary
  
  • 20-40 years after infection
  • Neurosyphilis, gummatous syphilis

Question 9

Describe Neurosyphilis?

Answer 9

• Aseptic meningitis
• Focal neurological defects
• Argyll robtertson pupil
• Tabes dorsalis (areflexia, extensor plantar reflex, charcot joints)

Question 10

Describe the defect here?

Answer 10

• Argyll Robertson pupil

Question 11

Describe gummatous syphilis?

Answer 11

Destructive granuloma in skin, mucous membranes and viscera

Question 12

What effects can tertiary syphilis have on the cardiovascular system?

Answer 12

• Aortitis
• Aortic regurgitation

Question 13

Describe the diagnosis of syphilis?

Answer 13

• PCR
• Serology

Question 14

Describe the treatment for syphilis?

Answer 14

• Parenteral ben pen
• Boosted with probenicid in CSF disease

Question 15

Describe a reaction which can occur during syphilis treatment?

Answer 15

• Jarisch-Herxheimer reaction
  
  • fever, rash, tachycardia after first dose of antibiotic
  • due to the release of endotoxins following bacterial death
  • no treatment other than antipyretics

Question 16

Describe Lymphogranuloma venerum?

Answer 16

• Caused by chlamydia trachomatis
• MSM in UK
• Painless papule/ulcer -> lymphadenopathy, arthralgia, fever, pneumonitis
• Direct transmission to rectal mucosa causes haemorrhagic proctitis, rectal bleeding

Question 17

Diagnosis and treatment of Lymphogranuloma venerum?

Answer 17

• Diagnosis
  
  • PCR
• Treatment
  
  • Doxycycline

Question 18

Name 2 tropical STIs?

Answer 18

• Chancroid (haemophilis ducreyi)
• Donovanosis (klebsiella granulomatis)

Question 19

Describe the tropical sexually transmitted infections?

Answer 19

• Both cause genital ulceration and lymphadenitis
  
  • Spread of infection into overlying tissue (pseudobobo)
• Diagnosis: H. ducreyi PCR, donovan bodies in tissue
• Treatment: Azithromycin, ceftriaxone

Question 20

Overview of urethritis and vaginal discharge

Answer 20