Sexually Transmitted Infections

Question 1

Causes of discharge

Answer 1

Gonorrhoea
Chlamydia
Trichomonas
Candida
BV

Question 2

Causes of ulceration

Answer 2

Syphillis - no pain
HSV - pain
LGV (chlamydia)
Chancroid (G- Haemophilus ducreyi)
Donovanosis (Klebsiella granulomatis)

Question 3

Causes of rashes, lumps

Answer 3

Genital warts - HPV
Molluscum contagiosum
Scabies
Pubic lice

Question 4

Causes of discharge

Answer 4

Gonorrhoea
Chlamydia
Trichomonas
Candida
BV

Question 5

Neisseria gonorrhoeae micro description

Answer 5

Obligate intracellular gram -ve diplococcus

Question 6

Most common STI in Europe

Answer 6

Gonococcal urethritis

Question 7

Neonatal complication of gonorrhoea

Answer 7

Opthalmica neonatorum - neonatal conjunctivitis

Question 8

Gonorrhoea Ix

Answer 8

Urethral/rectal smears and culture - GS

Question 9

Gonorrhoea Mx

Answer 9

250 mg ceftriaxone

Question 10

Chlamydia micro description

Answer 10

Obligate intracellular gram -ve pathogen, can’t be cultured on agar

Question 11

Chlamydia Serovars

Answer 11

A-C - trachoma
D-K - genital chlamydia, opthalmica neonatorum

Question 12

Chlamydia Dx

Answer 12

NAAT from genital swabs

Question 13

Chlamydia Mx

Answer 13

azithromycin 1g stat
OR
doxycycline 100mg BD 7d

Question 14

Chlamydia complications

Answer 14

PID → infertility
Epididymitis
Reiter’s syndrome - triad of conjunctivitis, reactivitis and urethritis
Eyes - conjunctivitis, opthalmica neonatorum

Question 15

LGV what is it

Answer 15

Lymphatic infection with Chlamydia serovars L1, L2, L3

Question 16

LGV progression

Answer 16

1. 1ary genital inflammation 3-12 days
2. 2ary 2wks - 6mths inguinal buboes + flu-like illness
3. Late - inguinal lymphadenopathy, genital elephantiasis

Question 17

LGV Ix

Answer 17

NAAT - genotypic identification of L1/L2/L3 serovars

Question 18

LGV Mx

Answer 18

Doxycycline 100mg BD 3 weeks

Question 19

Syphillis organism name and micro description

Answer 19

Treponema pallidum
Obligate gram negative spirochaete

Question 20

Primary Syphillis presentation

Answer 20

1-12 weeks post transmissions
macule → papule → painless ulcer → chancre
regional adenopathy

Question 21

Secondary Syphillis presentation

Answer 21

Systemic presentation
Disseminated rash
Genital warts
Mucosal lesions, uveitis
Neuro involvement

Question 22

Tertiary Syphillis presentation

Answer 22

3 syndromes
1. Gummatous
2. Cardiovascular
3. Neuro

Question 23

Gummatous Syphillis presentation

Answer 23

Skin/bone/mucosa
Scanty spirochaetes

Question 24

Cardiovascular Syphillis presentation

Answer 24

Aortic root dilatation / aortitis
Spirochaetes & inflammation +++

Question 25

Syphyllis Dx

Answer 25

1ary - dark-ground microscopy Non-treponemal antibody tests - false +ves Treponemal antibody tests

Question 26

Syphillis treatment

Answer 26

1x IM BenPen - Doxy if allergic

Question 27

Syphillis treatment monitoring

Answer 27

Rapid plasma reagin (RPR) - 4x reduction to consider Tx successful Jarisch-Herxheimer - flu/syphillis-like illness within hours, clears in 24 hrs

Question 28

Summarise chancroid

Answer 28

Haemophilus ducreyi Gram -ve coccobacillus multiple painful ulcers Dx - culture on chocolate agar and PCR

Question 29

Summarise Donavanosis

Answer 29

Klebsiella granulomatis Gram -ve coccobacillus Large, beefy red ulcers Dx - Giemsa stain - Donovan bodies Mx - azithromycin

Question 30

Summarise Trichomoniasis

Answer 30

Gram negative flagellated protozoa Men - asymptomatic, urethritis Women - discharge, strawberry cervix Dx - wet prep micro, PCR Mx - metronidazole Associated with increased risk of HIV infection

Question 31

Summarise BV

Answer 31

Abnormal vaginal flora, decreased lactobacilli Discharge, odour Dx - microscopy with gram stain, clue cells, raised pH Mx - water washing, PO/topical metronidazole

Question 32

Summarise Candidiasis

Answer 32

Thick, white cottage cheese discharge Candida albicans NOT STI Mx - Oral fluconazole / topical clotrimazole

Question 33

Summarise Molluscum contagiosum

Answer 33

Pox virus, dsDNA papules with central punctum Children - hands and feet, skin to skin contact Adults - genitals, sexual contact immunosuppressed/HIV - widespread Usually no treatment necessary, cryotherapy if persistent/extensive

Question 34

Summarise genital warts

Answer 34

dsDNA HPV 6 and 11 Appearance - papular, planar, pedunculated, pigmented, carpet, keratinised Home - Podophyllotoxin Clinic - cryotherapy , 2nd - Imiquimod

Question 35

Viral STIs

Answer 35

Hepatitis HSV HIV Monkeypox - lesions → scabs, Tecovirimat can be used