STDs

Question 1

infectious diseases act:

Answer 1

Mandatory reporting of STDs within 72 hrs of diagnosis for monitoring and evaluation of national control programmes
- no personal identifiers except for in the case of HIV where the sexual partner has to be contacted as well
demographic data for epidemiologic analysis is required

Question 2

Mode of transmission

Answer 2

Mainly by sexual contact with infected person
Direct contact of broken skin with open sores, blood or genital discharge
Receiving contaminated blood
Infected mother to child during pregnancy, childbirth or breastfeeding

Question 3

risk factors of STDs:

Answer 3

unprotected sexual intercourse
number of sexual partners 
men who have sex with men 
prostitution 
illicit drug use

Question 4

individual prevention methods against STDs:

Answer 4

abstinence and reduction in number of sexual partners
barrier contraceptive methods
avoid drug use and sharing of needles
pre exposure vaccination
post exposure prophylaxis
know signs of STDs and discuss them with partner
women should test for STDs before/during pregnancy
assist in tracing any contact who may be infected

Question 5

Importance of management and prevention of STDs

Answer 5

decrease related morbidity, progression to complicated disease
prevent HIV infection
Prevent serious complications in women
Protect babies

Question 6

pathogen associated with gonorrhea:

Answer 6

Neisseria gonorrhea

Question 7

Transmission of gonorrhea

Answer 7

sexual contact

mother to child during childbirth

Question 8

clinical presentation of gonorrhea:

Answer 8

males: purulent urethral discharge, dysuria, urinary frequency
females: pelvic inflammatory disease, ectopic pregnancy, infertility, disseminated disease, skin lesions, tenocynovitis, monoarticular arthritis

Question 9

Why are FQs seldom used for management of gonorrhea?

Answer 9

rapid increase in resistance rates

Question 10

Treatment regimens for gonorrhea

Answer 10

1st line:
IM ceftriaxone 250mg single dose
PO azithromycin 1g single dose

Allergy to azithromycin:
IM ceftriaxone 250mg single dose
IM doxycycline 100mg BD 7D

Allergy to ceftriazone:
IM spectinomycin 2g single dose/IM gentamicin 240mg single dose
PO azithromycin 2g single dose

Question 11

Pathogen responsible for chlamydial infections:

Answer 11

Chlamydia trachomatis

Question 12

Treatment regimens for chlamydia:

Answer 12

1st line: 
PO azithromycin 1g single dose 
PO doxycycline 100mg BD 7D 
Alternatives: 
PO erythromycin 500mg qds 7d
PO erythromycin ethylsuccinates 800mg qds 7d
PO levofloxacin 500mg OD 7d
PO ofloxacin 300mg BD 7d

Question 13

Pathogen responsible for syphilis

Answer 13

Treponema pallidium

Question 14

Syphilis diagnosis:

Answer 14

Darkfield microscopic exam of serous material from suspected lesion
Nontreponemal test – also used to check for improvement (VDRL/RPR tests)
Treponemal test

Question 15

Management of primary, secondary and early latent syphilis

Answer 15

1st line:
IM benzathine pen G 2.4MU single dose
Alternatives:
PO doxycycline 100mg BD 14D

Question 16

Management late latent (>1yr) or unknown duration/tertiary

Answer 16

1st line:
IM benzathine pen G 2.4MU q1wk 3 doses
Alternative:
PO doxycycline 100mg BD 28D

Question 17

Management of neurosyphilis:

Answer 17

1st line:
IV crystalline penG 3-4 MU q4h 10-14 D/ (IM procaine penG 2.4MU OD 10-14D+PO probenecid 500mg qds 10-14D)

Alternative:
IV/IM ceftriaxone 2g OD 10-14D

Question 18

Monitoring of response to syphilis treatment:

Answer 18

primary/secondary: quantitative VDRL/RPR 6 and 12 mths
Latent: 6, 12, 24 months
Neuro: CSF testing every 6 mths until CSF normal

Question 19

how is VZV transmitted:

Answer 19

inhaled and starts with infecting mucosal cells in nose and throat

Question 20

Varicella:

Answer 20

benign self-limiting illness
fever starts 1-2 days before rash appears and lasts for 4-5 days
Can be severe disease in adolescents, adults, immunosuppressed, immunocompromised

NOT AN STI

Question 21

Treatment of VSV:

Answer 21

Acyclovir PO 800mg 5x/day 7D
Valacyclovir PO 1g tds 7D

Start within 24-48 hr of rash

Question 22

Diagnosis of genital herpes:

Answer 22

Patient history
Presentation and symptoms
Virologic tests (viral cell culture, PCR)
Serologic tests (antibodies to HSV) – not useful for 1st episode infection – need 6-8 weeks for serological detection following 1st ep

Question 23

S/S of genital herpes:

Answer 23

Classical painful multiple vesicular/ulcerative lesions
local itching, pain, tender inguinal adenopathy
flu-like symptoms during first few days after appearance of lesions
prodromal symptoms seen in ~50% patients prior to appearance of recurrent lesions
symptoms less severe in recurrent diseases

Question 24

Tx for 1st occurrance of genital herpes:

Answer 24

PO acyclovir 400mg tds 7-10 d
PO acyclovir 200mg 5x/day 7-10d
IV acyclovir 5-10mg/kg q8h2-7d – complete with PO of total 10 days for severe
PO valacyclovir 1g BD 7-10d

Question 25

Chronic suppressive therapy for genital herpes:

Answer 25

PO acyclovir 400mg BD 6yr
PO valacyclovir 500mg OD 1yr
PO valacyclovir 1g OD 1yr

Question 26

Episodic therapy for genital herpes

Answer 26

PO acyclovir 400mg TDS 5D
PO acyclovir 800mg BD 5D
PO acyclovir 800mg TDS 2D 
PO valacyclovir 500mg BD 3D 
PO valacyclovir 1g OD 5D