STI's

Question 1

Gonorrhoea - What is it caused by?

Answer 1

Neisseria gonorrhoeae, inncubation period - 5/6 days.

Question 2

Gonorrhoea - sy/sx men

Answer 2

10% have no sy, sx - thick profuse yellow discharge, dysuria. Rectal and pharyngeal infeciton is often asymptomatic

Question 3

Gonorrhoea - sy/sx women

Answer 3

vaginal discharge, dysuria or intermenstrual/post-coital bleeding

Question 4

Gonorrhoea - dx/ix

Answer 4

Nucleic Acid Amplification Test (NAAT) on urine or swab from an exposed site – vagina, rectum, throat. Could be self-obtained or clinician-obtained.
Gram stained smear from urethra/cervix/rectum in symptomatic people.
Culture of swab-obtained specimen from an exposed site using highly selective lysed blood agar in a 5% CO2 environment. Should be done for all confirmed cases to assess antibiotic sensitivity.

Question 5

Gonorrhoea - tx

Answer 5

Ceftriaxone. Followup if tx is working after 2 weeks.

Question 6

Gonorrhoea - complications

Answer 6

Male: Epididymitis, Female: Pelvic inflammatory disease. Bartholin’s abscess. [Gonococcal ophthalmia neonatorum.] Both: Acute monoarthritis usually elbow or shoulder.

Question 7

Chlamydia - what is it caused by?

Answer 7

Chlamydia trachomatis, people under 25, sexually active teenage women

Question 8

Chlamydia - sy/sx men

Answer 8

> 70% asymptomatic, sx- Slight watery discharge, dysuria,

Question 9

Chlamydia - sy/sx women

Answer 9

> 80% asymptomatic, vaginal discharge, dysuria, intermenstrual/post-coital bleeding. Both men and women may get Conjunctivitis

Question 10

Chlamydia - dx/ix

Answer 10

First void urine in men. Self-taken or clinician-taken swab from cervix, urethra, rectum as appropriate.
All specimens tested using a NAAT

Question 11

Chlamydia - Tx

Answer 11

Doxycycline 100mg for 1 week (if pregnant give Azithromycin once), then followup at 3-12 months

Question 12

Chlamydia - complications

Answer 12

Men Epididymitis. Women: PID and hence ectopic pregnancy, pelvic pain and infertility. Probably only ~1% of women who get chlamydia will develop a problem with their fertility Both: Reactive arthritis/ Reiter’s syndrome – urethritis/cervicitis + conjunctivitis + arthritis

Question 13

Herpes - what is it caused by?

Answer 13

HSV1 and 2 (inncubation period of 5 days to months, some may nnever get symptoms), very common, HSV2 is an important cofactor for HIV transmission

Question 14

Herpes - sy/sx

Answer 14

80% have no symptoms. The rest have recurring symptoms – monthly, annually. Burning/itching then blistering then tender ulceration. Tender inguinal lymphadenopathy. Flu-like symptoms. Dysuria, Neuralgic pain in back, pelvis and legs,

Question 15

Herpes - dx/ix

Answer 15

clinical, swab from lesionn then PCR

Question 16

Herpes - tx

Answer 16

Primary outbreak: Aciclovir: various regimens – eg 400mg tds for 5 days, Lidocaine ointment.
Infrequent recurrences: Lidocaine ointment. Aciclovir 1.2g once daily until symptoms gone (1-3 days)
Frequent recurrences: Aciclovir 400bd long-term as suppression.

Question 17

Herpes - complications

Answer 17

Autonomic neuropathy, (urinary retention), neonatal infection, secondary infection.

Question 18

Syphilis - what is it caused by?

Answer 18

Treponema pallidum subspecies pallidum, >90% MSM

Question 19

Syphilis- sy/sx

Answer 19

Primary Local ulcer (CHANCRE), Secondary Rash, mucosal ulceration, neuro symptoms, patchy alopecia, other symptoms.
Early latent no symptoms but <2years since caught. Late latent no symptoms but >2 years since caught. Tertiary Neurological, cardiovascular or gummatous – skin lesions, (all v rare).

Question 20

Syphilis - dx/ix

Answer 20

Clinical signs, urethral swab then TPPA - Serology for TP IgGEIA, and RPR, PCR on sample from an ulcer

Question 21

Syphilis - tx

Answer 21

Early (<2 yrs and no neurological involvement): Benzathine penicillin 2.4 MU im once Or Doxycycline 100mg bd po 2 weeks
Late (>2 years) and no neurological involvement: Benzathine penicillin 2.4MU im weekly for 3 doses, Doxycycline 100mg bd po 28 days

Question 22

Syphilis - complications

Answer 22

neurosyphilis – cranial nerve palsies are commonest, cardiac or aortal involvement.

Question 23

infectious diseases wihich may be accquired from abroad on a buisniess trip…

Answer 23

HIV, HCV, chlamydia, genital or oral HSV, HBV, anal genital warts.

Question 24

Trichomoniasis - What is it caused by?

Answer 24

Trichomonas vaginalis, more common in middle aged women

Question 25

Trichomoniasis - sy/sx

Answer 25

Men: usually asymptomatic, Women: 10-30% asymptomatic, Profuse thin vaginal discharge - greenish, frothy and foul smelling. Vulvitis.

Question 26

Trichomoniasis - dx/ix

Answer 26

PCR on a vaginal swab. NB not validated on urine yet so no test for men.
Point of Care - Microscopy of wet preparation of vaginal discharge.

Question 27

Trichomoniasis - tx

Answer 27

Metronidazole 400mg po bd for 5 days or 2g single dose.

Question 28

Trichomoniasis - complications

Answer 28

miscarriage, preterm labour

Question 29

Anogenital warts - what is it caused by?

Answer 29

Human Papilloma Virus types 6 and 11 (and occasionally type 1)

Question 30

Anogenital warts - sy/sx

Answer 30

Lumps with a surface texture of a small cauliflower. Occasionally itching or bleeding especially if perianal or intraurethral.

Question 31

Anogenital warts - dx/ix

Answer 31

Appearance. Biopsy if unusual – to exclude intraepithelial neoplasia, but this is rarely needed.

Question 32

Anogenital warts - tx

Answer 32

Podophyllotoxin (brands warticon and condyline), imiquimod (brand Aldara). Both home treatments, Others – cryotherapy, Bulky warts – diathermy, scissor removal.

Question 33

Give examples of sexually transmitted bacteria, viruses and parasites

Answer 33

Bacteria - Chlamydia trachomatis, Klebsiella granulomatis, Mycoplasma genitalium
Viruses - HSV, HIV, HPV, Molluscum contagiosum virus
Parasites - Pthirus pubis, Sarcoptes scabei, Trichomonas vaginalis

Question 34

what are important features of STI’s

Answer 34

They’re transmissible, partner notification important, Asymptomatic most of the time, symptoms and screening, All manageable but not always curable, treatment/prevention of complications, Avoidable, primary prevention = education

Question 35

sy in general from sti’s

Answer 35

Morbidity, psychological distress and unpleasant symptoms: Ulceration, Lumps, Urethritis, Discharge, Rashes
Systemic symptoms: Fever, Rash, Lymphadenopathy, Malaise, Infertility