STDs

Question 1

What organism causes gonorrhoea

Answer 1

N. gonorrhoea

Question 2

What organism causes cervicitis

Answer 2

C. trachomatis

Question 3

Which organism causes syphilis

Answer 3

T. pallidum

Question 4

What is gonococcal disease defined as

Answer 4

Demonstration of N. gonorrhoea in clinic samples

Question 5

What does gonococcus do and what does it cause in men, women and children

Answer 5

Infects mucosal surfaces
men- urethritis
women- endocervicitis
children-ophthalmic disease

Question 6

What does gonorrhoea do to HIV

Answer 6

Amplifies HIV infection (increases likelihood of acquiring HIV)

Question 7

How does gonorrhoea infect mucosal cekks

Answer 7

Pilli attach onto the mucosal cells

Pilli shorten and becomes closer to mucosal cells.

Engulfed in phagosomes

Question 8

How does gonococcus avoid immune surveillance

Answer 8

POsesses multiple mechanisms to alter the expression of surface -exposed proteins through phase and antigenic variation

Wide variability in surface exposed structures allows the organisms to maintain divergent antigenic types

Question 9

What are the outcomes of a direct mucosal infection of gonococcus

Answer 9

Opthalmia neotorum 
Urethritis 
Pharyngitis 
Cervicitis 
Vulvovaginits (children0
Proctitis

Question 10

What are the outcomes of a local extension of a gonococcus infection

Answer 10

Prostatitis
Vesiculitis
Epididymitis

Endometritis
Salpingitis
Oophoritis
Pelvic peritonitis

Question 11

What can gonococcus infection cause if it enters the blood

Answer 11

Dermatitis 
Arthritis 
Endocarditis
Meningitis
Perihepatitis 
Tenosynevitis

Question 12

Why is gonorrhoea a bigger issue in women

Answer 12

IT is usually asymptomatic so easier to spread

Question 13

How is gonococcus diagnosed

Answer 13

NAA tests
Microbiological diagnosis requires urethral swabs in males and speculum examination in women

Point of care testing

Material obtained from sampling is Gram stained and cultured on enriched media

Question 14

Treatment of gonorrhoea

Answer 14

Third generation cephalosporins

Question 15

What does chlamydia exist as

Answer 15

Exist as obligate intracellular parasites of eukaryotic cells.

• Extracellular elementary bodies (EB)
• Intracellular reproductive particle called the reticulate body (RB)

Question 16

How is diagnosis of chlamydia made

Answer 16

Almost exclusively by PCR

Question 17

Treatment of a chlamydia infection

Answer 17

Doxycycline bd for 7 days
or
Azithromycin stat
or
Erythromycin 4x/day for 7 days

Question 18

What can pelvic inflammatory disease be caused by

What is it the leading cause of

Answer 18

Gonococcus or chlamydia

Pelvic inflammatory disease is the leading cause of infertility and ectopic pregnancy

Question 19

What does pelvic inflammatory disease present with

Answer 19

Pelvic and abdominal pain, fever, vaginal discharge and cervical tenderness

Question 20

What is the treatment of pelvic inflammatory disease

What would you do if it is a severe case

Answer 20

Doxycycline for 14 days, plus metronidazole for 5 days plus ceftriaxone

Prescribe the same things but for longer and higher dose

Question 21

How is syphilis classified

Answer 21

Acquired: primary, secondary, latent and tertiary

Congenital: early (diagnosed in first 2 years of life) and late (after age 2)

Question 22

What is primary syphilis characterised by

What is its incubation time

Answer 22

Ulcer and regional lymphadenopathy (disease of lymph nodes

9-90 days

Question 23

What is secondary syphilis characterised by

When are we able to see the characteristics

Answer 23

Skin lesions most common-macular to nodular, condylomata lata (wart-like on genitals)

Anterior uveitis, meningitis, cranial nerve palsies, glomerulonephritis

Usually appears within 8 weeks of infection

Question 24

What are the the signs of tertiary syphilis

Answer 24

Neurosyphilis
Cardiovascular syphilis
Gummatous syphilis

Question 25

How do you diagnose syphilis

Answer 25

Use two kinds of test -

1) treponemal (specific to syphilis antigen)
2) Non-treponemal (non-specific)

Both of these need to be positive in order to make a diagnosis

EIA for IgG/M is not the most widely used specific test

Question 26

What should patients with neurosyphilis have

Answer 26

Lumbar puncture and CSF examination including VDLR and treponemal specific tests

Question 27

Treatment of early syphilis

Answer 27

Procaine penicillin for 10 days

Question 28

Treatment for late disease of syphilis

Answer 28

Procaine penicillin for 17 days or benzathine penicillin or doxycycline

Question 29

Treatment for neurosyphilis

Answer 29

Procaine penicillin for 17 days or benzylpenicillin in divided doses daily for 17 days

Question 30

When is transmission of HIV more likely

Answer 30

With:
genital ulcers and STDs
High viral loads

Question 31

What are the anti-retroviral drugs used to treat HIV and their modes of action

Answer 31

Nucleoside analogues- inhibits reverse transcriptase

Non-nucleoside analogues

Protease inhibitors

Fusion inhibitors- prevents fusion of HIV with cell membrane

Question 32

How many drugs are required for prolonged benefit when treating HIV

Answer 32

3

Question 33

When first starting treatment of HIV, which drugs should be given (first phase)

Answer 33

Two nucleoside reverse transcriptase inhibitors (tenofovir and emtricitabine) plus one of the following:

• Ritonavir-boosted protease inhibitor
• Non-nucleoside reverse transcriptase inhibitor
• Integrase inhibitor

Question 34

What drugs should be given in the second phase of HIV treatment

Answer 34

Obtain genotypic resistance testing

Ritonavir boosted protease inhibitor + Non nucleoside reverse transcriptase inhibitor

Question 35

can latent memory T cells be eradicated by antiviral therapy

Answer 35

No