Sexually Transmitted Infections of the Genital Tract

Question 1

What is a commensal micro-organism?

Answer 1

A micro-organism that derives food or other benefits from another organism without hurting or helping it

Question 2

What is a pathogen?

Answer 2

A micro-organism that can cause disease

Question 3

What is an infection?

Answer 3

The invasion and multiplication of an organism that’s not usually found in the body; if no symptoms - subclinical, if symptoms - clinical

Question 4

What is a sexually transmissible micro-organism?

Answer 4

A virus, bacteria or parasite which can be spread by sexual contact

Question 5

What is a sexually transmitted infection?

Answer 5

An infection by an organism which is sexually transmissible and which is less likely to be transmitted by other means e.g. Neisseria gonorrhoeae, HPV type 6

Question 6

What is a sexually transmitted disease?

Answer 6

A disease caused by an STI e.g. pelvic inflammatory disease, genital warts

Question 7

What are venereal diseases?

Answer 7

Syphilis
Gonorrhoea
Chancroid

Question 8

What are the common sexually transmitted bacteria in the UK?

Answer 8

Chlamydia trachomatis
Klebsiella granulomatis
Mycoplasma genitalium

Question 9

What are the common sexually transmitted viruses in the UK?

Answer 9

HSV
HIV
HPV
Molluscum contagiosum virus

Question 10

What are the common sexually transmitted parasites in the UK?

Answer 10

Pthirus pubis
Sarcoptes scabei
Trichomonas vaginalis

Question 11

What are the organisms/conditions which are controversial in terms of whether they are infection or colonisation?

Answer 11

Mycoplasma hominis
Ureaplasma urealyticum
Bacterial vaginosis
Genital candidosis

Question 12

What infections can be transmitted by genital contact only?

Answer 12

Pubic lice (pthirus pubis)
Scabies (sarcoptes scabeii)
Warts (HPV types 6 and 11) 
Herpes (HSV types 1 and 2)

Question 13

What sexually transmissible infection is transmitted by blood transmission or group sex?

Answer 13

Hepatitis C

Question 14

What are the effects of STIs on morbidity?

Answer 14

Cause unpleasant symptoms and psychological distress

Question 15

In what ways are STIs a drain on resources?

Answer 15

Managing infertility due to chlamydia
Cost of IVF
Cost of HIV medication and management of HIV-related conditions

Question 16

Why might the number of diagnoses of STIs have changed over time?

Answer 16

May be due to a true change in number of cases, or due to a change in diagnoses but no actual change in number of cases
Greater awareness of STIs so more people asking for tests and more doctors considering diagnosis of STI and testing for them
Better tests available e.g. nucleic amplification tests vs enzyme immunoassays for chlamydia

Question 17

According to the NATSAL study, what has causes the increase in diagnosis of STIs?

Answer 17

Increased numbers of partners/people
Increased concurrent partners
More people having anal sex
More men reporting sex with men

Question 18

What are the implications of transmissible STIs?

Answer 18

Partner notification

Question 19

What are the implications of STIs which are asymptomatic most of the time?

Answer 19

Symptom awareness and screening

Question 20

What should you do for STIs which are manageable but not curable?

Answer 20

Treatment and prevention of complications

Question 21

How can STIs be avoidable?

Answer 21

Primary prevention - education

Question 22

What are the common symptoms of STIs?

Answer 22

Ulceration
Lumps
Urethritis
Discharge
Rashes

Systemic

• Fever
• Rash
• Lymphadenopathy
• Malaise
• Infertility

Question 23

What is involved in the management of someone with symptoms suggesting an STI?

Answer 23

Good history
Partner notification
HIV testing
Health promotion

Question 24

What are the standard history components of someone with symptoms suggesting an STI?

Answer 24

Presenting complaint
HPC
PMH/SH 
DH 
Gynae history 
Direct questions about symptoms e.g. discharge and pain 
Sexual history

Question 25

What are the components of the sexual history?

Answer 25

When did you last have sexual contact?
Casual contact vs regular partner, how long you were with them for if regular partner
Contact male or female?
Asking about nature of sex is sometimes useful e.g. anxiety about a specific incident, if it is going to alter where you swab from
Did you use condoms?
Other contraception used
Nationality of contact

Question 26

What are the components of male risk assessment?

Answer 26

Have you ever had sexual contact with a man?
Have you ever injected drugs?
Sexual contact with anyone who has injected drugs or someone from outside the UK
Medical treatment outside the UK
Involvement with sex industry

Question 27

What are the possible modes of partner notification?

Answer 27

Patient tells contact - client referral

NHS tells contact - provider referral

Question 28

Why might an HIV test be offered/recommended?

Answer 28

Most STIs are risk factors for HIV acquisition and transmission
If someone has had one STI they could have another

Question 29

What should you cover in health promotion?

Answer 29

Condoms prevent transmission of some STIs e.g. HIV, chlamydia, gonorrhoea, but they aren’t very good at preventing transmission of other STIs e.g. herpes and warts
Oral sex also carries risks
Alcohol and other drugs