Sexually transmitted infections

Question 1

Chlamydia

• gram stain?
• transmission?
• presentation (female (4), male (4))
• complications (7)
• Dx?
• treatment?

Answer 1

• gram Neg
• vaginal, oral or anal

-post coital or inter menstrual bleeding
lower abdo pain
Dyspareunia
Mucopurulent cervicitis

-urethral discharge
Dysuria
Urethritis
Epididymo-orchitis

-PID
tubal damage 
chronic pelvic pain 
transmission to neonate 
adult conjunctivitis
sexually acquired reactive arthritis (SARA)/ Reiter's syndrome 
Fits-Hugh-Curtic Syndrome 

-test 14 days following exposure
Nuclear acid amplification test
females (vulvovaginal swab), males (first void urine)
MSM then rectal swab

-Azithromycin 1g Stat, Doxycycline 100mg BD x 1Wk

Question 2

Gonorrhoea

• gram stain?
• site of infection?
• incubation & transmission (2)?
• presentation (male (4), female (5))
• complications (6 lower genital, 6 upper)
• Dx? (3)
• treatment? (4)

Answer 2

• gram neg intracellular diplococcus
• mucous membranes, urethra, endocervix, recut, pharynx
• incub period in men 2-5 days
• 50-90% risk from infected man to female

-Male:
Asymptomatic <10%
Urethral discharge 
Dysuria
Pharyngeal/rectal infections 
Female:
asymptomatic
vaginal discharge
Dysuria
Pelvic pain
Pharyngeal and rectal infection 

-Lower:
bartholinitis
Tysonitis
Periurethral abscess
Rectal abscess
Epididymitis
Urethral stricture
Upper:
Endometritis
PID
Hydrosalpinx
Infertility
ectopic pregnancy 
Prostatitis

-Microscopy 
(urethral 90-95% sensitivity
Endocervical 37-50% sensitivity)
Culture > 95% sensitivity (male urethra)
80-92% sensitivity (female endocx)
Nucleic acid Amplification test 

• 1st line: Ceftriaxone 500mg IM
  2nd line: Cefixime 400mg oral
  Co-treatment: Azithromycin 1g
  + test of cure in all patients

Question 3

Genital Herpes

• Name the 3 different types?
• incubation & duration? (2)
• presentation? (6)
• presentation of recurrent episodes, misdiagnosed as? (4)
• management? (5)
• viral shedding, higher in which strain? prophylaxis? (1)
• what should be done in pregnancy?

Answer 3

-Primary infection
Non-primary first episode (exposed to one type then catch another)
recurrent infection

-Inc, 3-6 days
Duration, 14-21 days

-Blistering & ulceration of external genitalia 
Pain- severe 
External dysuria 
Vaginal or urethral discharge 
Local lymphadenopathy 
Fever and myalgia 

-More common with HSV-2
often misdiagnosed as thrush
unilateral, small blisters and ulcers
Minimal systemic symptoms, resolves within 5-7 days

-swab base of ulcer for HSV PCR
Give oral antiviral treatment (Acyiclovir)
Consider topical lidocaine 5%
saline bathing 
Analgesia 

-Higher viral shedding following HSV 2
give acyclovir as prophylaxis for a year

-First episode in 3rd trimester
Primary or non-primary
informO+G

Question 4

HPV

• name the low risk and high risk types?
• name of the HPV vaccine

Answer 4

-low-risk 6,11,42,43,44

High risk 16, 18, 31, 33, 35, 45, 51, 52, 66

Question 5

• What do HPV 6 & 11 cause?
• incubation period?
• treatment?

Answer 5

-genital warts

-3 wks to 9 months
CAN BE ACQUIRED FROM ASYMPTOMATIC PARTNER

-Podophyllotoxin (wart icon, Cytotoxic)
Imiquimod (Aldara, immune modifier)
Cryotherapy
Electrocautery

Question 6

Syphilis

• organism?
• transmitted in what ways? (4)
• give the 2 classifications?
• Name the 5 different stages of acquired syphilis? which are infections?

Answer 6

• Treponema pallidum (spirochete)
• sexual contact, trans-placental, blood transfusions, non-sexual contact
• Congenital, Acquired

-Primary (inf)
Secondary (inf)
Early latent (inf)
Late latent (non-inf)
Tertiary (non-inf)

Question 7

Primary syphilis

• incubation period?
• Lesion, where do they appear?
• other symptoms? (1)

Answer 7

• 9-90 days
• Chancre, thy are painless and appear at the site of infection
• non-tender local lymphadenopathy

Question 8

secondary syphilis

• incubation period
• presentation (5)

Answer 8

-6 wks to 6 months

-Macular, follicular or pustular rash on palms and soles
lesions on mucous membrane 
generalised lymphadenopathy
patchy alopecia
Condylomata Lata

Question 9

Syphilis diagnosis

• screening investigations? (3)
• If antibodies present then what?

Answer 9

Demonstrate presence of treponema Pallidum from lesions or infected lymph nodes
dark field microscopy
PCR

-serological testing  
Non-treponemal
(VDRL, RPR)
Treponemal
(TPPA, ELISA/EIA, INNO-LIA, FTA abs)

Question 10

Syphilis treatment?

• Early?
• Late?
• follow up?

Answer 10

• 2.4 MU Benzathine penicillin x1
• 2.4 Benzathine penicillin x3

-Until RPR is negative or serofast
Titres should decrease fourfold by 3-6 months