STIs

Question 1

What STIs to screen for in vaginal discharge?

Answer 1

chlamydia, mycoplasma genitalium, gonorrhoea,, trichomoniasis

Question 2

What STIs to screen for in anogenital ulcers?

Answer 2

herpes, syphilis, donovanosis, lymphogranuloma venereum

Question 3

Chlamydia first line management?

Answer 3

Doxycycline 100mg PO, BD 7 days

Question 4

How far back to contact trace in chlamydia?

Answer 4

6 months

Question 5

Which populations to do a test of cure in chlamydia?

Answer 5

Pregnant women

Rectal chlamydia

Question 6

Sally presents with her first episode of herpes simplex, how to treat?

Answer 6

Valaciclovir 500mg PO, BD for 5 - 10 days

Question 7

Sally has another episode of herpes a few months later, how to treat?

Answer 7

Valaciclovir 500mg PO, BD for 3 days

Question 8

What is the preferred oral antiviral in pregnant women?

Answer 8

Aciclovir is the preferred agent in pregnancy

Question 9

Benzathine penicillin 1.8g IMI, stat.

This is treatment for which condition?

Answer 9

Syphilis in the infectious satge (primary, secondary, early latent)

Question 10

What about treatment for latent syphilis?

Answer 10

Benzathine penicillin 1.8g IMI, weekly for 3 weeks

Question 11

What is the Jarisch-Herxheimer reaction that you should warn patients about when treating for syphilis?

Answer 11

A common reaction to treatment in patients with primary and secondary syphilis. It occurs 6-12 hours after commencing treatment, and is an unpleasant reaction of varying severity with fever, headache, malaise, rigors and joint pains, and lasts for several hours. Symptoms are controlled with analgesics and rest.

Question 12

What about the procaine reaction?

Answer 12

A rare reaction to procaine penicillin (an alternate medication to benzathine penicillin). It is characterised by a sensation of impending doom with hallucinations. The reaction is self-limiting and lasts about 30 minutes.

Question 13

In primary syphilis you must contact trace for? 
A- 2 months
B- 3 months
C- 4 months
D- 6 months

Answer 13

B- 3 months

Question 14

In secondary syphilis you must contact trace for? 
A- 2 months
B- 3 months
C- 4 months
D- 6 months

Answer 14

D- 6 months

Question 15

When to order syphilis serology?

Answer 15

• For men who have sex with men (MSM): at least annually, up to 4 times a year.
• For HIV positive MSM, up to 4 times per year or at least on each occasion of CD4/viral load monitoring
• Routine antenatal testing (repeat in late pregnancy if at risk of infection or reinfection e.g. Aboriginal women in context of current outbreak).
• Routine immigration testing
• A sexual contact of a person with syphilis
• Routine sexual health check
• Presence of any signs and symptoms of infectious syphilis.

Question 16

What syphilis serology to order when testing for cure?

Answer 16

reactive plasma regain (RPR) testing

Question 17

When to test for cure in syphilis?

Answer 17

3 months, then at 6 months and (if necessary) at 12 months after completing treatment

Question 18

Treatment for gonorrhoea?

Answer 18

Ceftriaxone 500mg IMI, stat in 2mL 1% lignocaine
PLUS
Azithromycin 1g PO, stat

Question 19

No sexual contact for how long whilst treating for gonorrhoea?

Answer 19

7 days

Question 20

Contact trace how far back in gonorrhoea? 
A- 2 months
B- 3 months
C- 4 months
D- 6 months

Answer 20

A- 2 months

Question 21

Retesting in gonorrhoea when?

Answer 21

Retest patients 3 months after exposure

Question 22

Treatment for genital warts?

Answer 22

Patient applied podophyllotoxin 0.15% cream or 0.5% paint topically applied, BD for 3 days, then 4 days off, repeated weekly for 4-6 cycles until resolution. Paint is more suited for use on external keratinised skin. Cream is best used in perianal area, introital area and under the foreskin.
OR
Patient applied imiquimod 5% cream topically, 3 times per week at bedtime (wash after 6-10 hours) until resolution (up to 16 weeks).
OR
Clinician initiated cryotherapy weekly

Question 23

Within how many hours of exposure can PEP be offered for HIV?

Answer 23

within 72 hours of potential HIV exposure

Question 24

What is the risk of developing chronic hepatitis B when exposed age less than 5?

A- 10%
B- 40%
C- 70%
D- 90%

Answer 24

D- 90%

Question 25

Donovanosis management?

Answer 25

Azithromycin 500mg PO, daily for 7 days
or
Doxycycline 100mg PO, BD for a minimum of 4 weeks,

Question 26

Chlamydia treatment in pregnant woman?

Answer 26

Azithromycin 1g PO, stat

Question 27

Mycoplasma management?

Answer 27

Doxycycline 100mg bd for 7 days

followed by

Azithromycin 1 g immediately then 500 mg daily for 3 days (total 2.5 g)

Question 28

ATSI population routine screening

Answer 28

Regular testing for chlamydia, syphilis and HIV is recommended

Hep C Offer testing if history of injecting drug use, incarceration or unsafe tattoos

Question 29

MWHSM routine screening

Answer 29

Chlamydia
Gonorrhoea

Syphilis serology

HIV antibody/antigen: If not known to be HIV-positive

Hepatitis A antibody: Test if not vaccinated. Vaccinate if antibody negative

Hepatitis B surface antigen, core antibody, surface antibody: Test if not vaccinated. Vaccinate if no history or documentation of full vaccination course

Hepatitis C: Test once a year in people living with HIV, on PrEP or with history of injecting drug use