Sexually transmitted diseases

Question 1

What are the clinical presentations of STIs?

Answer 1

vaginal discharge, urethritis, ulcerative genital lesions, pelvic inflammatory disease, epididymo-orchitis, infestations, warts

Question 2

What are the major systemic viral diseases transmitted via sexual contact?

Answer 2

hepatitis B, C, HIV

Question 3

Describe the epidemiology of Gonorrhoea.

Answer 3

People feared it could become untreatable due to antibiotic resistance
It became resistant -> Super-gonorrhoea

Question 4

Describe the epidemiology of Neisseria Gonorrhoea.

Answer 4

People feared it could become untreatable due to antibiotic resistance
It became resistant -> Super-gonorrhoea
2 cases of resistant gonorrhoea diagnosed in the U.K.
Very hard to treat with 4th/5th line of treatments

Question 5

Which STI is Azithromycin used to treat?

Answer 5

Chlamydia

Question 6

Describe the prevalence of Mycoplasma Genitalium (MG).

Answer 6

Already resistant to 2 agents

Resistance higher in those countries using azithromycin

Question 7

How can you diagnose Gonorrhoea? (2 methods - compare both)

Answer 7

1) Microscopy - gram-negative diplococci
Quick test, less sensitive than NAAT
Required skilled microscopist
Gives antimicrobial susceptibility result
Useful for individual treatment
2) NAAT - Nucleic acid amplification test
24-48 for result
High sensitivity and specificity
No antimicrobial susceptibility
Required non-inhibitory specimen (no body fluids)

Question 8

How can you diagnose Chlamydia?

Answer 8

NAAT diagnosis

Can’t do microscopy as its an obligate intracellular bacterium - will not grow in cell free culture (e.g. on agar plate)

Question 9

How can you diagnose syphilis? Can you culture it?

Answer 9

1) Michroscopy: dark ground
specific, low sensitivity, only for primary syphilis
Skilled technician, good quality specimen
Culture - not possible as Treponema Pallidum is unculturable
2) Nucleic acid detection: PCR
High specificity in primaru lesions
3) Serology (antibody detection)
active syphilis

Question 10

What are some key things to know about antibody detection of syphilis?

Answer 10

Serum: IgM indicates recent infection
IgG stays positive for years/life
+ve doesn’t mean active infection

Question 11

How can you prevent HIV?

Answer 11

1) Use condoms

2) PrEP (HIV prevention with just 1 pill a day)

Question 12

How can STI’s be transmitted? (sexual contact and non-sexual contact)

Answer 12

Sexual contact: Oral/vaginal/sextoys/douching
Skin/skin contact (HSV, HPV, molluscum)
Non-sexual contact: In utero - syphilis, BBV
Peripartum: gonorrhoea, chlamydia, BBV
blood.body fluid transfusion, recreational drug use

Question 13

What are the main principles of STI control?

Answer 13

Remove reservoirs & sources
Treat other infections/sources of inflammation
Interrupt transmission
Increase host resistance

Question 14

What is the difference between primary and secondary prevention of STIs?

Answer 14

Primary prevention
Safe sexual behaviours
Including but not limited to, barrier contraceptive methods
Immunisation: currently only available for HPV (warts), HBV. HAV
PrEP
Secondary prevention
Detect: screening, better access to SH services, targeted information (16-25s, MSM). If 1 STI, look for others!
Prompt effective treatment
Partner notification (contact tracing)

Question 15

What are the side effects of HIV meds?

Answer 15

Crix belly
Diarrohea
Facial wasting

Question 16

What are the clinical presentations of Urethritis?

Answer 16

Noticed discharge from penis, staining in pants
Pain on passing urine
No regular sexual partner
6 partners in last 2 weeks, 2 male, 4 female, no condoms, oral sex

Question 17

What are the clinical presentations of Vaginal discharge?

Answer 17

5 days vulval itching and soreness
Creamy discharge
1 sexual partner

Question 18

What are the clinical presentations of Genital ulceration?

Answer 18

2 days painful sores on vulva/ thighs, blisters which burst
Very painful dysuria
Headache
Myalgia
New sexual partner 6d prior 
Used condoms

Question 19

What are the clinical presentations of Pelvic inflammatory disease?

Answer 19

4 week history increasing lower abdo pain
Severe dyspareunia (pain during sex)
Mild dysuria
1d high fever
Stable partner, on depot contraceptive
Pregnancy test negative

Question 20

What are the clinical presentations of Epididymo-orchitis?

Answer 20

3 days of painful scrotum
Fever 39C
Ultrasound: no torsion
New partner 5d previously, no condoms