Sexually Transmitted Infections

Question 1

Which organism causes Gonorrhoea?

Answer 1

Neisseira gonorrhoae

Question 2

What are the symptoms of Gonorrhoea?

Answer 2

• Men: 10% asymptomatic, thick profuse yellow discharge and dysuria. (rectal and pharyngeal infection often asymptomatic)
• Women: >50% asymptomatic, vaginal discharge, dysuria or itermenstrual/post coital bleeding

Question 3

What are the potential complications of Gonorrhoea?

Answer 3

• Acute monoarthritis in elbow or shoulder and skin lesions (dessimated infection)
• Males: epididymitis
• Females: pelvic inflamm. disease and Bartholin’s abscess

Question 4

Which population group are most likely to get Gonorrhoea?

Answer 4

Men - particularly MSM

Question 5

How can Gonorrhoea be diagnosed?

Answer 5

• Nucleic acid amplification test on urine or swab
• Gram stained smear in symptomatic people
• Culture of swab obtained specimen

Question 6

How can Gonorrhoea be managed?

Answer 6

• Blind treatment with ceftriaxone (can also treat according to antibiotic sensitivities)
• Test of cure at 2 weeks and of reinfection at 3 months

Question 7

Which organism causes chlamydia?

Answer 7

Chlamydia trachomatis

Question 8

What are the symptoms of chlamydia?

Answer 8

• 70% of men and 80% of women are asymptomatic
• Men: watery discharge and dysuria
• Women: vaginal discharge, dysuria, intermenstrual/ post-coital bleeding
• Both: conjunctivitis

Question 9

What are the complications of chlamydia?

Answer 9

• Men: epidydymitis
• Women: PID
• Both: reactive arthritis/Reiter’s syndrome

Question 10

How is chlamydia diagnosed?

Answer 10

• First void urine in men
• Swab taken from cervix, urethra, rectum etc.
• All tested using NAAT

Question 11

How is a chlamydia infection managed?

Answer 11

• Doxycycline
• Azithromycin if pregnant
• Test for reinfection at 3-12 months

Question 12

What are the symptoms of herpes infection?

Answer 12

• 80% have no symptoms
• Burning/itching then blistering then tender ulceration
• Tender inguinal lymphadenopathy and flu-like symptoms
• Dysuria
• Neuralgic pain back, pelvis and legs

Question 13

What are the complications of herpes infection?

Answer 13

• Autonomic neuropathy (urinary retention)
• Neonatal infection
• Secondary infection

Question 14

How can herpes infection be diagnosed?

Answer 14

• Clinical impression

- Swab from lesion tested using PCR

Question 15

How can herpes infection be treated?

Answer 15

• Primary outbreak: aciclovir and lidocaine ointment
• Infrequent recurrences: lidocaine ointment and aciclovir (until symptoms are gone)
• Frequent recurrences: long term aciclovir

Question 16

Which organism causes trichomoniasis?

Answer 16

Trichomonas vaginalis

Question 17

What are the symptoms of trichomoniasis?

Answer 17

• Men are usually asymptomatic and 10-30% of women are also asymptomatic
• Women: profuse thin vaginal discharge (greenish, frothy and foul smelling) and vulvitis

Question 18

What are the potential complications of trichomoniasis?

Answer 18

-Miscarriage and preterm labour

Question 19

How can trichomoniasis be diagnosed?

Answer 19

• PCR on a vaginal swab
• Microscopy of wet preparation of vaginal discharge
• No test for men

Question 20

How is trichomoniasis treated?

Answer 20

Metronidazole

Question 21

Which organism causes anogenital warts?

Answer 21

HPV types 6 and 11

Question 22

What is a potential complication of anogenital warts?

Answer 22

Neonatal laryngeal papillomatosis (rare)

Question 23

How can anogenital warts be diagnosed?

Answer 23

• Appearance

- Biopsy if unusual to exclude intraepithelial neoplasia

Question 24

How can anogenital warts be treated?

Answer 24

• Podophyllotoxin or imiquimod
• Cryotherapy
• Diathermy or scissor removal for bulky warts

Question 25

Which organism causes syphilis?

Answer 25

Treponema pallidum

Question 26

What are the stages of syphilis?

Answer 26

• Primary: local ulcer
• Secondary: rash, mucosal ulceration, neuro symptoms, patchy alopecia etc.
• Early latent: no symptoms <2yrs since caught
• Late latent: no symptoms but >2yrs
• Tertiary: neurological, cardiovascular or gummatous - skin lesions

Question 27

What are the potential complications of syphilis?

Answer 27

Neurosyphilis: cranial nerve palsies, cardiac or aortal involvement

Question 28

How can syphilis be diagnosed?

Answer 28

• Clinical signs
• Serology foor TP IgG enzyme immunoassays, TPPA and RPR
• PCR on sample

Question 29

How can syphilis be treated?

Answer 29

Benzathine penicillin or doxycycline

Question 30

Give four examples of infections which only need genital contact to transmit

Answer 30

• Pubic lice
• Scabies
• Warts
• Herpes