Sexually transmitted diseases

Question 1

What are risk factors for STIs

Answer 1

Unprotected sexual intercourse
multiple sexual partners
15-24 year olds
illicit drug use and alcohol use
men who have sex with men
sex workers
urban areas

Question 2

What organism causes chlamydia

Answer 2

Chlamydia trachomatis

Question 3

How can chlamydia be transmitted

Answer 3

Sexual contact

perinatal transmission during vaginal delivery which can lead to neonatal conjunctivitis and pneumonia

Question 4

How does chlamydia present in men and women

Answer 4

Asymptomatic in 80% of cases
Males: mucopurulent urethral discharge, dysuria, scrotal pain, proctitis

Females: mucopurulent vaginal discharge, cervicitis, cervical bleeding upon contact, proctitis, post-coital bleeding, intermenstrual bleeding

Question 5

How would you diagnose chlamydia

Answer 5

Nucleic acid amplification test (NAAT)

urethral swab and first pass urine in Males

endocervical, urethral and vulvovaginal swabs in females for testing.

Also consider oropharyngeal and rectal sites

Question 6

How is Chlamydia treated

Answer 6

Doxycycline
OR
azithromycin/erythromycin in pregnancy

Question 7

What are possible complications for chlamydia

Answer 7

Pelvic inflammatory disease (PID)- increases the risk of ectopic pregnancy and infertility
Epididymitis
Prostatitis
Reactive arthritis

Question 8

What organism causes gonorrhoea

Answer 8

Neisseria gonorrhoeae

Question 9

How is gonorrhoea transmitted

Answer 9

sexual contact

vertical transmission during childbirth can cause ophthalmia neonatorum

Question 10

How does gonorrhoea present

Answer 10

Male: mucopurulent urethral discharge, dysuria, orchitis

Female: mucopurulent cervical discharge with cervicitis, cervical bleeding upon contact, dyspareunia, pelvic pain

Rectal infection: rectal bleeding, rectal discharge, tenesmus, proctitis

oropharyngeal infection: pharyngitis, anterior cervical lymphadenopathy

Question 11

How is gonorrhoea diagnosed

Answer 11

Nucleic Acid Amplification Test (NAAT)- First pass urine in males and vulvovaginal, endocervical and urethral swabs in females are used for testing.

If oropharyngeal or rectal symptoms are present these sites can also be swabbed for NAAT.

In addition, cultures (urethral, cervical, anal or oropharyngeal) are taken prior to administering antibiotics to assess antibiotic susceptibility.

Question 12

How is gonorrhoea treated

Answer 12

ceftriaxone IM injection and Azithromycin

Question 13

What are the complications of gonorrhea

Answer 13

Pelvic inflammatory disease (PID)- increases the risk of ectopic pregnancy and infertility
Fitz-Hugh-Curtis syndrome- secondary to PID there is inflammation of the hepatic capsule leading to perihepatic adhesions
Chronic pelvic pain in females
Infertility in males secondary to epididymitis
Prostatitis
Bartholinitis

Question 14

What organism causes syphilis

Answer 14

Treponema pallidum

Question 15

How is syphilis transmitted

Answer 15

direct sexual contact with a lesion on the skin or mucosa

congenital syphilis from trans placental transmission which increases the chance of stillbirth and miscarriage

Question 16

What are the 5 stages of syphilis

Answer 16

Primary: Development of an indurated painless ulcer called a chancre forms most often on the genitals. This can form from 9-90 days.

Secondary: 6 weeks to 6 months following the primary infection a widespread non-pruritic maculopapular rash involving the palms and soles develops accompanied by alopecia, condylomata lata, generalised lymphadenopathy, oral snail-track lesions and constitutional symptoms (pyrexia, fatigue, malaise).

Early latent: Asymptomatic infection plus positive diagnostic serology obtained within two years of infection.

Late latent: Asymptomatic infection plus positive diagnostic serology obtained after two years of infection.

Tertiary: Untreated syphilis over many years can develop into:
Neurosyphilis – Tabes dorsalis, general paresis, strokes
Cardiovascular syphilis – Aortitis, aortic aneurysms
Gummatous syphilis – Formation of granulomas on bone, skin and mucosa

Question 17

How is syphilis diagnosed

Answer 17

Serological test for syphilis (STS)

Question 18

What are the signs of a trichomonas vaginalis infection

Answer 18

offensive, yellow/green frothy discharge.
vulval itching, inflammation and ulceration.
cervicitis - examination finding of the ‘strawberry cervix’

Question 19

How is trichomonas vaginalis detected

Answer 19

posterior fornix swab and NAAT

Question 20

How is trichomonas vaginalis treated

Answer 20

metronidazole

Question 21

What are the signs of a BV infection

Answer 21

offensive, thin grey discharge. presence of clue cells

Question 22

How is BV diagnosed

Answer 22

high vaginal swab for microscopy and culture

Question 23

How is BV treated

Answer 23

metronidazole or topical clindamycin

Question 24

What do vulval/high vaginal swabs detect

Answer 24

candida albicans and trichomonas vaginalis

Question 25

What do endocervical/urethral swabs detect

Answer 25

chlamydia trachomatis and neisseria gonorrhoeae