Sexually Transmitted Infections

Question 1

When should you consider preforming a sexual health screen?

Answer 1

Anyone presenting with symptoms of:
- Vaginitis (change in discharge, dysuria, change in MB)
- Urethritis (Penile discharge, dysuria, meatal discomfort)
- Epididymo-orchitis (painful, swollen testies)
- PID (pelvic pain, fever, change in discharge, dyspareunia)
- Proctitis (rectal discharge/pain/bleeding)
- Ulcers/lumps
- Possible syphilis (rash on torso, palms and soles of feet)
- Possible HIV seroconversion

Question 2

What is included in a standard sexual health screen and how is it taken?

Answer 2

• NAAT testing for chlamydia and gonorrhoea. Blood tests for syphillus and HIV.
  Women - Self taken vulvovaginal swab.
  Men - Urine sample
  Men who have sex with men (MSM) - Urine sample, throat swab and a self taken rectal swab.

Question 3

Who are the high risks for gonorrhoea and what are its features.

Answer 3

High risk - MSM, afro-Caribbean, urban areas with deprivation and women < 25.
It is a gram negative diplococci which infects the mucous membrane of urethra, endocervix, rectum, pharynx and conjunctiva

Question 4

What are the signs and symptoms of Gonorrhoea?

Answer 4

Penile urethra - 90% get symptoms of urethral discharge (profuse and yellowy) and dysuria 2-5 days from exposure.
Vaginal/endocervix/urethra - 50% asymptomatic, change in discharge, abdo/pelvic pain, dysuria, may have altered bleeding
Pharynx - asymptomatic
Rectum - usually asymptomatic but can get anal discharge, pain or discomfort.

Question 5

Explain the diagnosis and treatment of Gonorrhoea

Answer 5

• NAAT testing (can take up to 1 week) or urethral sample microscopy and a culture plate to assess drug resistance.
• Treated with 1g ceftriaxone IM or ciprofloxacin if sensitive. Repeat tests after 2 weeks

Question 6

What are the complications which can arise from gonorrhoea?

Answer 6

• Epididymo-orchitis
• Prostatitis,
• PID
• Disseminated gonococcal infection (affecting skin and joints)
• Resistance (50% are resistant to at least 1 abx)

Question 7

What are is the epidemiology of chalmydia?

Answer 7

• Most common bacterial STI in UK.
• Risk factors include being under 25 years, having a new sexual partner, inconsistent condom use.
• Some people can clear the infection

Question 8

What are the signs and symptoms of chlamydia?

Answer 8

Penile urethra - Majority asymptomatic but can get clear urethral discharge, dysuria or meatal discomfort.
Vaginal - Most asymptomatic but can get IMB/PC bleeding, cervicitis or contact bleeding, change in discharge and pelvic pain.
Pharynx - Asymptomatic
Rectal - Usually asymptomatic but can get proctitis or lymphogranuloma venereum which can cause lymphadenopathy/ulcer disease

Question 9

What is the diagnosis and treatment of chlamydia?

Answer 9

• NAAT testing (too small for microscopy)
• Doxycycline 100mg BD for 1 week

Question 10

What are the complications of chlamydia?

Answer 10

• PID (pelvic pain/fever/dyspareunia), tubal infertility, ectopic pregnancy and fitz-hugh-curtis syndrome.
• Epididymo-orchitis

Question 11

Describe features of Mycoplasma Genitalium

Answer 11

• Bacteria which can exist asymptomatically on 1-2% of people. Some people can have an inflammatory response eg, urethritis/PID.
• Treatment is not indicated unless symptomatic/partner is symptomatic
• Investigations - NAAT
• Treatment - Depends on antibiotic resistance.

Question 12

Describe the symptoms of Trichomonas Vaginalis, the investigations and treatment.

Answer 12

Vaginal symptoms - Frothy, yellow discharge with an INTESE ITCH. Strawberry cervix in 2%.
Penile - Usually asymptomatic but can have urethritis
Diagnosis - Microscopy/culture.
Treatment - Metronidazole

Question 13

Describe features of syphilis and the clinical presentation of primary syphilis

Answer 13

• Caused by treponema pallidum which is a gram negative spirochete.
• More common in MSM
• Primary syphilis presents with a chancre which is usually single and painless with clear fluid.

Question 14

Describe the clinical presentation of secondary syphilis

Answer 14

• Can occur from 3 months -2 years after exposure
• Generalised rash affecting palms and soles but can appear on trunk.
• Can present very non-specific with muco-cutaneous lesion, condylomata lata, lymphadenopathy and fever.
• Less commonly anterior uveitis and hearing loss.

Question 15

Describe the tertiary presentation of syphilis

Answer 15

• Neurosyphilis which can present with neurological symptoms including cognitive.
• Cardiovascular syphilis which can cause aortic valve disease, aortic aneurysm.
• Gummatous syphilis - presents with punched out lesions

Question 16

Explain the diagnosis and treatment of syphilis

Answer 16

• If chancre present then do dark ground microscopy/viral PCR swab.
• Blood tests for antibodies,
• Rapid plasma reagin - quantitative marker
• Treated with Benzathine penicillin.

Question 17

Describe features of ano-genital warts

Answer 17

• Caused by HPV 6 and 11
• Incidence reduced dramatically with quadrivalent vaccine.
• Diagnosis based of clinical appearence,
• Treatment via cyrotherapy, topical treatments, surgical excision.
• Give reassurance that there is high prevalence and benign.

Question 18

Describe features of herpes simplex virus

Answer 18

• Caused by type 1 and 2.
• Often prodrome with first presentation. May have further episodes but first is the worst.
• Diagnosed via viral PCR swab

Question 19

What are the complications and treatment of HSV?

Answer 19

Complications - CNS involvement, balanitis, proctitis, urinary retention, risk of neonatal infection if first episode while mother is pregnant.
- Treatment: give advice about high prevalence, possible future recurrence. Treat flare ups with aciclovir.

Question 20

Describe features of scabies

Answer 20

• Itch especially at night cause by mite excrement. Burrows classically appear in web spaces, wrists, elbows and nipples.
• Diagnosis made on clinical appearence and treated with malathion 0.5% or permethrin 5%

Question 21

describe features of phthirus pubis

Answer 21

• Public lice transmitted by close bodily contact.
• Incidence decreasing but treated by malathion 0.5% or permethrin 1%