sexually transmitted infections

Question 1

gonorrhoea cause

Answer 1

neisseria gonorrhoeae

Question 2

male symptoms of gonorrhea

Answer 2

10% of males have no symptoms though might have clinical signs if examined.
Thick, profuse yellow discharge, dysuria. Rectal and pharyngeal infection often
asymptomatic.

Question 3

female symptoms of gonorrhea

Answer 3

> 50% have no symptoms.
vaginal discharge, dysuria or intermenstrual/post-coital bleeding

Question 4

possible complications of gonorrhoea

Answer 4

Male: Epididymitis

Female: Pelvic inflammatory disease. Bartholin’s abscess. [Gonococcal ophthalmia neonatorum.]

Both: Acute monoarthritis usually elbow or shoulder. Disseminated
Gonococcal Infection: skin lesions - pustular with halo

Question 5

incubation period of gonorrhea

Answer 5

average 5 to 6 days. Range 2 days to 2 weeks

Question 6

how is gonorrhea diagnosed

Answer 6

nucleic Acid Amplification Test (NAAT) on urine or swab from an exposed site – vagina, rectum,
throat. Could be self-obtained or clinician-obtained.

Gram stained smear from urethra/cervix/rectum in symptomatic people.

Culture of swab-obtained specimen from an exposed site using highly selective lysed blood agar in a
5% CO2 environment. Should be done for all confirmed cases to assess antibiotic sensitivity

Question 7

treatment plan and follow up for gonorrhea

Answer 7

blind treatment with ceftriaxone 1g im.
Can also treat according to antibiotic sensitivities.

Follow-up: Test of cure at 2 weeks and test of reinfection at 3 months

Question 8

Chlamydia cause

Answer 8

chlamydia trachomatis serovars D to K
[The rare Serovar L2b, which causes Lymphogranuloma venereum, usually gives symptoms of severe
proctitis. ]

Question 9

symptoms of chlamydia

Answer 9

Men: >70% asymptomatic
Slight watery discharge, dysuria,

Women: >80% asymptomatic
vaginal discharge, dysuria, intermenstrual/post-coital bleeding.

Both: Conjunctivitis

Question 10

complications of Chlamydia

Answer 10

Men Epididymitis.

Women: PID and hence ectopic pregnancy, pelvic pain and infertility. Probably only ~1% of women
who get chlamydia will develop a problem with their fertility

Both: Reactive arthritis/ Reiter’s syndrome – urethritis/cervicitis + conjunctivitis + arthritis

Question 11

how is Chlamydia diagnosed

Answer 11

first void urine in men. Self-taken or clinician-taken swab from cervix, urethra, rectum as appropriate.
All specimens tested using a NAAT

Question 12

treatment and follow up for Chlamydia

Answer 12

Doxycycline 100mg bd 1 week

Azithromycin 1g po once if pregnant

Follow-up: Test for reinfection at 3-12 months. Earlier test of cure not needed unless symptoms persist.

Question 13

herpes cause

Answer 13

herpes Simplex Virus types 1 and 2

Question 14

herpes symptoms

Answer 14

80% have no symptoms. The rest have recurring symptoms – monthly, annually.
Burning/itching then blistering then tender ulceration.
Tender inguinal lymphadenopathy. Flu-like symptoms.
Dysuria, Neuralgic pain in back, pelvis and legs,

Question 15

complications of herpes

Answer 15

autonomic neuropathy (urinary retention), neonatal infection, secondary infection.

Question 16

incubation period herpes

Answer 16

about 5 days to months. Some people never report symptoms

Question 17

diagnosis and treament for herpes

Answer 17

Clinical impression.
Swab from lesion tested using PCR.

Treatment: Primary outbreak: Aciclovir: various regimens – eg 400mg tds for 5 days
Lidocaine ointment
Infrequent recurrences: Lidocaine ointment. Aciclovir 1.2g once daily until symptoms gone (1-3
days)
Frequent recurrences: Aciclovir 400bd long-term as suppression.

Question 18

trichomoniasis cause

Answer 18

trichomonas vaginalis

Question 19

symptoms trichomoniasis

Answer 19

men: usually asymptomatic
Women: 10-30% asymptomatic
Profuse thin vaginal discharge - greenish, frothy and foul smelling. Vulvitis.

Question 20

complications trichomoniasis

Answer 20

miscarriage and preterm labour

Question 21

diagnosis trichomoniasis

Answer 21

PCR on a vaginal swab. NB not validated on urine yet so no test for men.
Point of Care - Microscopy of wet preparation of vaginal discharge.

Question 22

treatment trichomoniasis

Answer 22

metronidazole 400mg po bd for 5 days or 2g single dose.

Question 23

anogenital warts cause

Answer 23

Human Papilloma Virus types 6 and 11 (and occasionally type 1). (NB different strains from those that
cause cervical cancer.

Question 24

symptoms anogenital warts

Answer 24

lumps with a surface texture of a small cauliflower. Occasionally itching or bleeding especially if
perianal or intraurethral.

Question 25

complications anogenital warts

Answer 25

none common. Neonatal laryngeal papillomatosis.

Question 26

diagnosis and treatment of anogenital warts

Answer 26

appearance. Biopsy if unusual – to exclude intraepithelial neoplasia, but this is rarely needed.

Treatment: Podophyllotoxin (brands warticon and condyline), imiquimod (brand Aldara). Both home treatments.
Others – cryotherapy
Bulky warts – diathermy, scissor removal.

Question 27

syphyllis cause

Answer 27

treponema pallidum subspecies pallidum

Question 28

symptoms syphyllis

Answer 28

diverse – “He who knows Syphilis knows medicine” – Osler.
Often entirely asymptomatic or mild symptoms which go unreported.
Primary Local ulcer (chancre)
Secondary Rash, mucosal ulceration, neuro symptoms, patchy alopecia, other symptoms.
Early latent no symptoms but <2years since caught.
Late latent no symptoms but >2 years since caught.
Tertiary Neurological, cardiovascular or gummatous – skin lesions, (all v rare).

Question 29

complications syphyllis

Answer 29

neurosyphilis – cranial nerve palsies are commonest, cardiac or aortal involvement.
Congenital syphilis (extremely rare in Scotland).

Question 30

incubation period syphyllis

Answer 30

9 to 90 days until appearance of chancre. But can be asymptomatic