St A - Sexually Transmitted Infections

Question 1

What are the top 3 most common STIs?

Answer 1

1) Chlamydia Trachomatis,
2) Human Papilloma Virus,
3) Neisseria Gonnorhoeae

Question 2

What are the risk factors for getting an STI?

Answer 2

• Young age,
• Failure to use barrier contraceptives,
• Non-regular sexual relationships,
• Men who have sex with men,
• IV drug use,
• African origin,
• Social deprivation,
• Sex workers,
• Poor access to advice and treatment of STIs

Question 3

What are some determinants of risky sexual behaviour?

Answer 3

Individual factors - low self-esteem, lack of skills, lack of knowledge of unsafe sex.

• External influences - peer pressure, attitudes and prejudices of society.
• Service provision - accessibility of sexual health services and/or lack of resources such as condoms

Question 4

What are three basic microbial testing for STIs?

Answer 4

1) NAAT - used for chlamydia and n.gonnorhoea and herpes.
2) Microscopy, culture and sensitivity -used for N.gonorrhoeae, candidam bacterial vaginosis and trichomonas,
3) Blood tests - syphilis, HIV and hepatitis

Question 5

What are the female and male symptoms of chlamydia trachomatis

Answer 5

female - Vaginal or anal discharfe, post-coital bleeding, abdo tenderness, pelvic tenderness, infertility, reactive arthritis, proctitis, pharyngitis and perihepatitis.
Male - Urethral/anal discharge, epididymal tenderness, prostatitis, reactive arthritis, proctitis, pharyngitis and perihepatitis.

Question 6

What are some of the complications of a chlamydia infection?

Answer 6

• Pelvic inflammatory disease (associated with infertility, ectopic pregnancies and chronic pelvic pain)
• Sexually acquired reactive arthritis (SARA) (urethritis, arthritis and conjunctivitis)
• Epididymo-orchitis,
• Peri-hepatitis

Question 7

What are some of the chlamydia investigations?

Answer 7

Women - Vulvo-vaginal swab (self taken)
Men - First catch urine
Extra genital sites - rectal and pharyngeal.

Question 8

How is chlamydia treated?

Answer 8

Doxycycline 100mg twice daily for 7 days whilst avoiding sexual contact and notify partner

Question 9

What is lymphogranuloma venerum?

Answer 9

It is caused by one of the three invasive serovars of chlamydia trachomatis. It presents with a solitary genital lesion, proctitis and lymphadenopathy. Treatment if doxycycline

Question 10

Describe features of the neisseria gonorrhoea infection

Answer 10

Gram negative bacteria that infections the epithelial cells of the mucous membrane of GU tract or rectum. Resulting in the development of localised infection with production of pus

Question 11

What are the symptoms of gonorrhoea in men and women?

Answer 11

Females - Dysuria, rectal infection, salpingitis, PID, pharyngeal infection, post-coital bleeding and septic arthritis.
Males - Urethral discharge, anal discharge (with/without pain and bleeding)
- Epididymal tenderness, pharyngeal infection and septic arthritis

Question 12

What are some of the investigations for Gonorrhoea?

Answer 12

• Light microscopy,
• NAAT,
• For men its First catch urine,
• For women its a vulvo-vaginal swab,
• For men who have sex with men take a rectal and pharyngeal sample

Question 13

What is the treatment for gonorrhoea?

Answer 13

Ceftriaxone 1g IM or ciprofloxacin 500mg orally however there is increasing resistance to antibiotics but most respond to ceftriaxone. Parner needs notified and tested

Question 14

How does a candida albicans (thrush) infection present?

Answer 14

Itch, vulval pain, superficial dyspareunia and curd like vaginal discharge.

Question 15

How is thrush diagnosed and treated?

Answer 15

Diagnosis - clinical and microscopy.

Treatment - Topical clotrimazole

Question 16

What are the stages of a treponema pallidum infection (syphilis)

Answer 16

Primary - Hard genital or oral ulcer at site of infection.
Secondary - Red maculopapular rash anywhere plus pale moist papules in urogenital region and mouth.
Tertiary - Degeneration of NS, aneurysms and granulomatous lesions in liver, skin and bones.

Question 17

How is syphilis diagnosed?

Answer 17

• From lesions or infected lymph nodes early on.
• Dark field microscopy,
• Direct fluorescent antibody (DFE) test,
• EIA for immunoglobin

Question 18

What is the treatment for syphilis?

Answer 18

Early syphilis - Benzathine penicillin (single dose).

- Late latent, cardiovascular and gummatous syphilis -Benzathine penicillin for 3 weeks

Question 19

What does the human papilloma virus cause?

Answer 19

• Urogenital warts,
• Cervical cancer,
• Laryngeal papillomas,
• Common, flat and plantar warts

Question 20

How can the HPV be diagnosed and treated?

Answer 20

Virus can be seen on colposcopy.

Treatment - Podophyllum, cryo, laser and surgery

Question 21

What are some prevention mechanisms for HPV?

Answer 21

Killed HPV vaccines which are given to girls aged 12-13, and MSM under age 45

Question 22

Describe the two types of herpes simplex virus?

Answer 22

HSV-1 which usually affects the oral region and causes cold sores.
HVS-2 which is associated with genital infection

Question 23

How does the primary genital herpes infectoin present?

Answer 23

Flu-like symptoms, tingling neuropathic pain in genital area, extensive bilateral crops of painful blisters in genital area, tender lymph nodes, local oedema, vaginal/urethral discharge

Question 24

What is the treatment of primary infection genital herpes

Answer 24

• Saline bathing,
• Local anasthetics,
• Aciclovir

Question 25

What is recurrant genital herpes

Answer 25

Occurs following primary infection as the virus can become latent in local sensory ganglia. Therefore there is periodic reactivation.

Question 26

How can you diagnose HSV?

Answer 26

• Clinical appearance,
• Viral culture,
• NAAT of a swab from base of ulcer,
• Serology