STI

Question 1

What is the cause of chlamydia?

Answer 1

Chlamydia trachoma’s

Question 2

What are clinical features of chlamydia?

Answer 2

Incubation of 7-21 days
Asymptomatic in around 70% of women and 50% of men

Women:
Cervicitis (discharge, bleeding), dysuria
Intermenstrual or post-coital bleeding

Men:
Urethral discharge, dysuria

Question 3

What are complications of chlamydia?

Answer 3

Epididymitits
PID
Endometriosis
Increased incidence of ectopic pregnancies
Infertility
Reactive arthritis - Reiter’s syndrome (arthritis, conjunctivitis, urethritis)
Perihepatitis (Fitz-Hugh-Curtis syndrome)

Question 4

What investigation in chlamydia?

Answer 4

Nuclear acid amplification tests (NAATs)

• Urine (first void urine sample)
• Vulvovaginal swab
• Cervical swab

Question 5

Describe chlamydia screening

Answer 5

Open to all men and women aged 15-24 years
The 2009 SIGN guidelines support this approach, suggesting screening all sexually active patients aged 15-24 years
Relies heavily on opportunistic testing

Question 6

What is management for chlamydia? IF pregnant?

Answer 6

Doxycycline 7 day course
Azithromycin single dose - better for poor compliance

Treat partners
Abstain from intercourse
For women and asymptomatic men all partners from the lat six months or the most recent sexual partner should be contacted

If pregnant, azithromycin, erythromycin, amoxicillin

Question 7

What is the cause of gonorrhoea? Clinical features?

Answer 7

Neisseria gonorrhoea - gram negative diplococus

Often no symptoms
Lower abdominal pain, vaginal discharge, intermenstrual or post-coital bleeding

Question 8

What are complications of gonorrhoea?

Answer 8

PID
Bartholin’s or Skene’s abscess
Tubal infertility
Increased risk of ectopic pregnancy

In pregnancy:
Preterm rupture of membranes
Preterm delivery
Chorioamnionitis

Ophthalmia neonatorum

Question 9

What investigations in gonorrhoea?

Answer 9

Vulvovaginal or endocervical swab for NAAT
Urethra, pharyngeal and rectal swabs should be taken if appropriate

If NAAT +ve take further swabs for culture for sensitivities prior to treatment

Question 10

What is treatment of gonorrhoea?

Answer 10

Ceftriaxone 500mg IM stat
Azithromycin 1mg PO stat
Treat partners and contact trace
Treatment is small in prengancy