Sexually Transmitted Diseases

Question 1

What does poor sexual health lead to

Answer 1

• poor maternity outcomes
• pregnancies/ abortions
• psychological consequences
• HIV transmission
• STDs
• cancers

Question 2

symptoms of chlamydia

Answer 2

mostly asymptomatic but may cause bleeding

Question 3

pathophysiology of chlamydia

Answer 3

attaches to mucosal surface and induces a strong inflammatory response

Question 4

Complications of chlamydia in male and female

Answer 4

M - epididymitis (inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm)

F - pelvic inflammatory disease (PID)

Question 5

tests used to diagnose chlamydia

Answer 5

urine sample and vaginal/urethral swab

Question 6

1st and 2nd line treatment for chlamydia

Answer 6

1st - doxycycline 100mg BD for 7 days

2nd - erythromycin 500mg BD for 10-14 days OR azithromycin 1g OD for 1 day then 500mg orally OD for 2 days

Question 7

symptoms of gonorrhoea

Answer 7

less asymptomatic than chlamydia

sometimes bleeding and pain on urination

Question 8

pathophysiology of gonorrhoea

Answer 8

attaches to mucosal surface and resists phagocytosis

Question 9

complications of gonorrhoea in M and F

Answer 9

M - epididymitis (inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm)

F - Pelvic inflammatory disease and possibility to pass from mum to baby during birth

Question 10

test to diagnose gonorrhoea

Answer 10

urine sample or urine/vaginal swab

Question 11

1st and 2nd line treatment for gonorrhoea

Answer 11

1st - ceftriaxone 1g IM injection as a single dose

2nd - ciprofloxacin 500mg orally as single dose

Question 12

pathophysiology of syphilis

Answer 12

helical structure of T. pallidum allows it to move through mucosal surface or enter breaks in skins

Question 13

5 stages and symptoms of each for syphilis

Answer 13

1. initial contact (2-10w)
   - primary genital ulcer (painless)
2. primary syphilis (1-3m)
   - swollen glands in neck, groin or armpits
3. secondary syphilis (2-6w)
   - small skin growths, red rash and flu-like
4. latent syphilis (3-30y)
   - infection lies dormant
5. tertiary syphilis
   - meningitis, stroke, dementia, numbness

Question 14

test to diagnose syphilis

Answer 14

blood sample

virology swab from active lesions - to exclude herpes simplex virus (HSV)

Question 15

treatment of syphilis

Answer 15

initiated at GUM clinic

antibiotic used but is unlicensed for syphilis treatment in UK

Question 16

Pathophysiology of genital warts

Answer 16

due to HPV types 6 and 11

replicates within basal cells of epithelium

Question 17

symptoms of genital warts

Answer 17

genital swelling and warts which may appear over a year after initial infection
can cause pain when peeing/ bleeding

Question 18

treatment for genital warts

Answer 18

no treatment
most disappear spontaneously within 6 months

patients can self-apply meds but this has significant failure/relapse rates so not recommended

• podophyllotoxin
• imiquimod
• sinecatechins

Question 19

pathophysiology of genital herpes

Answer 19

due to HSV types 1 and 2
passes through direct skin-to-skin contact and exposure to infected saliva, semen, vaginal fluid or fluid from herpetic blisters

Question 20

symptoms of genital herpes

Answer 20

discharge and pain on peeing
malaise
headache 
dysuria 
fever
tender lymph nodes in groin 
painful ulcers in genital area

Question 21

test to diagnose genital herpes

Answer 21

visual diagnosis
swab of lesion for viral culture
PCR test

Question 22

1st and 2nd line treatment for genital herpes

Answer 22

1st - aciclovir 400mg x3/day for 5-10 days OR 200mg x5/day for 5-10 days

2nd - valaciclovir 500mg BD for 5-10 days OR famciclovir 250mg x3/day for 5-10 days

patients can also use self-care to relieve symptoms

Question 23

name 3 screening programmes

Answer 23

National Chlamydia Screening Programme (NCSP) - free screening for young people (15-24y) available in range of settings (GP, GUM clinics, pharmacies and non-healthcare settings e.g. colleges)

National HPV Immunisation Programme - protects against 4 types of HPV (6, 11, 16 and 18)

Syphilis Action Plan - 4 aims: increase test frequency, partner notification, antenatal screening and sustain targeted health promotion