Sexually transmitted diseases

Question 1

STIs in adolescents - general management points (4)

Answer 1

educate about negotiating safe sex with partners
teach correct use of condoms
address contraception needs
offer vaccination for hepatitis a/b/HPV if not done

Question 2

anogenital ulcers - ddx

STD x5, nonSTD x5

Answer 2

STDs

• herpes simplex
• primary syphilis chancre
• lymphogranuloma venereum
• donovanosis
• chancroid

nonSTDs

• aphthous ulcers
• fixed drug eruptions
• trauma
• carcinoma
• Crohn’s disease

Question 3

lymphogranuloma venereum

• causative pathogen
• presentation
• demographics typically affected
• geographic regions affected
• treatment

Answer 3

chlamydia trachomatis, serovars L1-3
small ulcer or proctitis, not usually painful
usually MSM
common in north europe, north america. endemic in SE asia, S africa, India
treat with doxycycline 100mg BD for 21 days

Question 4

donovanosis

• causative pathogen
• presentation
• endemic regions
• treatment

Answer 4

klebsiella granulomatis
relatively painless ulcer
PNG, S africa, india, S America
azithromycin 500mg OD for 7 days

Question 5

chancroid

• causative pathogen
• presentation
• geographic regions affected
• treatment

Answer 5

haemophilus ducreyi
multiple deep painful ulcers
subsaharan africa, asia (except thailand), Latin america + caribbean
Azithromycin 1g PO stat

Question 6

STDs that cause ulcers - dx. that are painful vs painless

Answer 6

painful

• herpes
• chancroid

kinda painless

• donovanosis
• LGV

painless
- syphilis

Question 7

herpes simplex - nonmedication management (4)

Answer 7

• Simple analgesia and antipyretics
• Saline bathing
• Topical lignocaine reduces pain from erosions
• Urinating in a bath or shower relieves superficial dysuria
• review in 1 week for sex health screening

Question 8

pelvic inflammatory disease

- management of mild - moderate disease

Answer 8

ceftriaxone 500mg IM in 2mL 1% lignocaine
\+
metronidazole 400mg PO BD for 14 days
\+
doxycycline 100mg PO BD for 14 days

Question 9

pelvic inflammatory disease

- symptom that is highly predictive of PID

Answer 9

new onset pelvic pain in female <25yo

Question 10

pelvic inflammatory disease

- risk factors to consider (4)

Answer 10

uterine instrumentation
new partner
partner dx. with STI
pregnancy