Sexually Transmitted Infections

Question 1

What can cause genital ulcers?

Answer 1

Herpes and syphilis - STD
Candida

Question 2

What can cause vaginal discharge?

Answer 2

Chlamydia, M genitalium, gonorrhoea, trichomoniasis and herpes
BV and candida

Question 3

What can cause urethral discharge?

Answer 3

Chlamydia, m genitalium, gonorrhoea and trichomoniasis
H. influenza and adenovirus

Question 4

What can cause genital lumps?

Answer 4

Warts, molluscum and scabies
Folliculitis and calcinosis

Question 5

What can cause genital itching?

Answer 5

Scabies, lice, herpes and trichomoniasis
Candida and eczema

Question 6

What can cause a genital rash?

Answer 6

Scabies and syphilis

Question 7

What is gonorrhoea caused by?

Answer 7

Neisseria gonorrhoeae

Question 8

What symptoms does gonorrhoea cause in men?

Answer 8

10% have no symptoms
Thick, profuse yellow discharge and dysuria
Rectal and pharyngeal infection are often asymptomatic

Question 9

What are the symptoms of gonorrhoea in women?

Answer 9

More than 50% have no symptoms
Vaginal discharge, dysuria and intermenstrual bleeding

Question 10

What are the complications of gonorrhoea?

Answer 10

Men - epididymitis
Women - Pelvic inflammatory disease and Bartholin’s abscess
Both - rectal symptoms and conjunctivitis
Acute monoarthritic of elbow or shoulder and disseminated gonococcal infection

Question 11

What is the incubation period of gonorrhoea?

Answer 11

Average is 5 to 6 days but ranges from 2 days t 2 weeks

Question 12

How is gonorrhoea diagnosed?

Answer 12

Nucleic acid amplification test (NAAT) on urine or swab
Microscopy of gram stained sample
Culture using highly selective lysed blood agar

Question 13

What is the treatment for gonorrhoea?

Answer 13

Blind treatment with ceftriaxone 1mg IM
Also can treat according to antibiotic sensitivities

Question 14

When is the follow up to test for cure in gonorrhoea?

Answer 14

3 weeks

Question 15

What is chlamydia caused by?

Answer 15

Chlamydia trachomatis serovars D to K

Question 16

What are the symptoms for men in chlamydia/

Answer 16

More than 70& asymptomatic
Slight watery discharge and dysuria
Rectal symptoms and conjunctivitis

Question 17

What are the symptoms for women with chlamydia?

Answer 17

More than 80% asymptomatic
Vaginal discharge, dysuria and intermenstrual bleeding
Rectal symptoms and conjunctivitis

Question 18

What are the complications of chlamydia?

Answer 18

Men - epididymitis
Women - PID and ectopic pregnancy, pelvic pain and infertility
Both - reactive arthritis/ Reiter’s syndrome

Question 19

How is chlamydia diagnosed?

Answer 19

First void urine in men
Swab from cervix, urethra and rectum as appropriate

Question 20

What is the treatment for chlamydia?

Answer 20

Doxycycline 1 week
Azithromycin 1g once if pregnant

Question 21

What is the follow up for chlamydia?

Answer 21

Test for re-infection at 3-12 months
Earlier test not need unless symptoms persist

Question 22

What are the symptoms for men with mycoplasma genitalium?

Answer 22

More than 90% asymptomatic
Slight watery discharge and dysuria
Conjunctivitis

Question 23

What are the symptoms of mycoplasma genitalium in women?

Answer 23

More than 50% asymptomatic
Vaginal discharge, dysuria, intermenstrual/ post coital bleeding
Conjunctivitis

Question 24

What are the complications of mycoplasma genitalium?

Answer 24

Men - none confirmed
Women - PID, preterm birth, miscarriage and infertility
Both - rectal symptoms

Question 25

How is mycoplasma genitalium diagnosed?

Answer 25

First void in men Swab from cervix, urethra and rectum as appropriate NAAT

Question 26

What is the treatment of mycoplasma genitalium?

Answer 26

Doxycycline 100mg 1 week then Azithromycin 1g on day 8 and 500mg once daily on days 9-10 If resistant to macrolides then moxifloxacin

Question 27

When is the follow up for mycoplasma genitalium?

Answer 27

5 weeks

Question 28

What is herpes caused by?

Answer 28

Herpes simplex virus types 1 and 2

Question 29

What are the symptoms of herpes?

Answer 29

80% are asymptomatic and rest have recurring symptoms (annually, monthly) Burning/ itching then blistering then tender ulceration Tender inguinal lymphadenopathy Flu like symptoms Dysuria, neuralgic back, pelvis and leg pain

Question 30

What is the complications of herpes?

Answer 30

Autonomic neuropathy (urinary retention), neonatal infection and secondary infection

Question 31

What is the incubation period for herpes?

Answer 31

5 days to months Some people never report symptoms

Question 32

How is herpes diagnosed?

Answer 32

Clinical impression Swab lesion tested using PCR

Question 33

What is the treatment for herpes?

Answer 33

Aciclovir - 400mg for 5 days Lidocaine ointment or oral Infrequent recurrences - Aciclovir 800mg 3 x daily Frequent recurrences - Aciclovir long term

Question 34

What is trichomoniasis caused by?

Answer 34

Trichomonas vaginalis

Question 35

What are the symptoms of trichomoniasis?

Answer 35

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

Question 36

What are the complications of trichomoniasis?

Answer 36

Miscarriage and preterm labour

Question 37

How is trichomoniasis diagnosed?

Answer 37

PCR on vaginal swab Microscopy of wet preparation of vaginal discharge

Question 38

What is the treatment for trochomoniasis?

Answer 38

Metronidazole 400mg for 5 days

Question 39

What are anogenital warts caused by?

Answer 39

Human papilloma virus types 6 and 11

Question 40

What are the symptoms of anogenital warts?

Answer 40

Lumps with surface texture of small cauliflower Occasionally itching or bleeding esp. if perianal or intraurethral

Question 41

What is a complication of anogenital warts?

Answer 41

None common Neonatal laryngeal papillomatosis

Question 42

How is anogenital warts diagnosed?

Answer 42

Appearance Biopsy is unusual

Question 43

What is the treatment for anogenital warts?

Answer 43

Podophyllotoxin and imiquimod - both home treatments cryotherapy Bulky warts - diathermy and scissor removal

Question 44

What is syphilis caused by?

Answer 44

Treponema pallidum subspecies pallidum

Question 45

What are the symptoms/ signs of syphilis?

Answer 45

Primary - local ulcer Secondary - rash, mucosal ulceration, neuro symptoms and patchy alopecia Early latent - no symptoms but under 2 years since caught Late latent - more than 2 years since caught Tertiary - neuro, cardio and gummatous

Question 47

What is the incubation period of syphilis?

Answer 47

9 to 90 days until appearance of chancre

Question 48

What is a complication of syphilis?

Answer 48

Neurosyphilis - cranial nerve palsies are commonest Congenital syphilis

Question 49

How is syphilis diagnosed?

Answer 49

Clinical signs Serology for TP IgGEIA< TPPA and RPR PCR on sample

Question 50

What is the treatment for early syphilis?

Answer 50

Under 2 years and no neuro involvement Benzathine penicillin once MU or doxycycline for 2 weeks

Question 51

What is the treatment for late syphilis?

Answer 51

More than 2 years and no neuro involvement Benzathine penicillin IM weekly for 3 doses Doxycycline 100mg for 28 days