STIs

Question 1

what four STIs are tested for in a regular STI screen?

Answer 1

chlamydia
gonorrhoea
HIV
syphilis

Question 2

besides STIs, what other conditions should be considered in a female presenting with vaginal discharge?

Answer 2

BV
candida
thichomonas vaginalis

Question 3

what is the ideal test for GC/CT in females?

Answer 3

vulvovaginal swab (VVS) for GC/CT NAAT

Question 4

what is the ideal test for GC/CT in males?

Answer 4

first void urine NAAT

Question 5

what other swabs may be performed for GC/CT depending on the sexual history?

Answer 5

throat swab

rectal swab

Question 6

what does GC/CT mean?

Answer 6

gonorrhoea and chlamydia

Question 7

how are HIV and syphilis tested for?

Answer 7

blood tests

Question 8

what symptomatic sampling is done for chlamydia?

Answer 8

cervical microscopy
vaginal microscopy + pH
urethral microscopy

Question 9

when is an Amies swab done?

Answer 9

recurrent or persistent discharge 
vaginitis of unknown cause 
pregnant 
postpartum 
post gynae surgery 
suspected PID

Question 10

what can high white cell count at the cervix suggest?

Answer 10

PID

Question 11

what is the management of chlamydia?

Answer 11

doxycycline 100mg BD for one week

OR

azithromycin 1G stat followed by 500mg daily for two days

Question 12

how is PID due to chlamydia treated?

Answer 12

cerftriaxone 1G IM
doxycycline 100mg BD for two weeks
metronidazole 400mg BD for two weeks

Question 13

what is the most commonly reported bacterial STI?

Answer 13

chlamydia

Question 14

what percentage of chlamydia cases are asymptomatic?

Answer 14

female - 70-80%

male - 50%

Question 15

what tissue is infected in chlamydia?

Answer 15

columnar epithelium at mucosal sites

Question 16

how is chlamydia transmitted?

Answer 16

vaginal, oral or anal sex

Question 17

what age group has the highest incidence of chlamydia?

Answer 17

20-24 year olds

Question 18

what do chlamydia serovars A-B cause?

Answer 18

ocular infectious

Question 19

what do chlamydia serovars D-K cause?

Answer 19

genital infection

Question 20

what do chlamydia serovars L1-L3 cause?

Answer 20

lymphogranuloma venereum (LGV)

Question 21

what are the symptoms of chlamydia?

Answer 21

milky urethral discharge
irregular vaginal bleeding
abdominal pai
dysuria

Question 22

what are the signs of chlamydia?

Answer 22

urethritis
cervicitis
epididymo-orchitis
proctitis

Question 23

what are some possible complications of chlamydia?

Answer 23

PID
ectopic pregnancy
reactive arthritis
conjunctivitis

Question 24

when should females be tested for chlamydia?

Answer 24

14 days following exposure

Question 25

in which group are cases of LGV mainly seen?

Answer 25

MSM

Question 26

what are the symptoms of LGV?

Answer 26

rectal pain discharge bleeding

Question 27

what are the four possible locations for gonorrhoea infection?

Answer 27

urethra pharyngeal rectal endocervical

Question 28

how does urethral gonorrhoea present?

Answer 28

discharge | dysuria

Question 29

how does pharyngeal and rectal gonorrhoea present?

Answer 29

usually asymptomatic

Question 30

how does endocervical gonorrhoea present?

Answer 30

discharge irregular bleeding external dysuria

Question 31

what investigations can be done for gonorrhoea?

Answer 31

NAATs microscopy culture

Question 32

what is the first line management of gonorrhoea?

Answer 32

cerftriaxone 1G IM

Question 33

what is the second line management for gonorrhoea?

Answer 33

cefixime 400mg oral plus azithromycin 2G

Question 34

when is second line treatment for gonorrhoea given?

Answer 34

if IM injection is contraindicated or refused

Question 35

what needs to be done for all patients with gonorrhoea after treatment?

Answer 35

test of cure

Question 36

what type of bacteria is gonorrhoea?

Answer 36

gram negative intracellular diplococcus

Question 37

what are the primary sites of infection of gonorrhoea?

Answer 37

mucous membranes of the urethra, endocervix, rectum and pharynx

Question 38

what is the incubation period for gonorrhoea in males?

Answer 38

2-5 days

Question 39

what are some possible lower genital tract complications of gonorrhoea?

Answer 39

``` bartholinitis tysonitis periurethral abscess rectal abscess epididymitis urethral stricture ```

Question 40

what are some possible upper genital tract complications of gonorrhoea?

Answer 40

``` endometritis PID hydrosalpinx infertility ectopic pregnancy prostatitis ```

Question 41

what is mycoplasma genitalium associated with?

Answer 41

non gonococcal urethritis | PID

Question 42

what test is done for mycoplasma genitalium?

Answer 42

NAAT test

Question 43

what is the management for genital herpes?

Answer 43

oral acyclovir 400mg TDS x5/7 saline bathing analgesia

Question 44

what can be given for genital herpes if very painful?

Answer 44

topical lidocaine 5% ointment

Question 45

what are the three possible presentations of genital herpes?

Answer 45

primary infection non-primary first episode recurrent infection

Question 46

what is the incubation period for a primary infection of genital herpes?

Answer 46

3-6 days

Question 47

how long does a primary infection with genital herpes last?

Answer 47

14-21 days

Question 48

how does primary genital herpes infection present?

Answer 48

``` blistering + ulceration pain external dysuria discharge lymphadenopathy prodromal symptoms ```

Question 49

which type of HSV is more commonly associated with recurrent episodes of genital herpes?

Answer 49

HSV 2

Question 50

how do recurrent episodes of genital herpes present?

Answer 50

unilateral small blisters and ulcers minimal systemic symptoms

Question 51

how long do recurrent episodes of genital herpes last?

Answer 51

5-7 days

Question 52

what causes syphilis?

Answer 52

treponema pallidum

Question 53

how is syphilis transmitted?

Answer 53

sex (acquired) | trans-placental/during birth (congenital)

Question 54

what are the five stages of syphilis?

Answer 54

``` primary secondary early latent late latent tertiary ```

Question 55

what stages of syphilis are "early infectious"?

Answer 55

primary secondary early latent

Question 56

what stages of syphilis are late non infectious?

Answer 56

late latet | tertiary

Question 57

what is the incubation period for primary syphilis?

Answer 57

9-90 days mean = 21

Question 58

what is the lesion in primary syphilis called?

Answer 58

primary chancre painless

Question 59

where do lesions appear in primary syphilis?

Answer 59

at the site of inoculation 90% genital

Question 60

what is the incubation period of secondary syphilis?

Answer 60

6 weeks - 6 months

Question 61

what is the most highly infectious lesion in syphilis?

Answer 61

condylomata lata

Question 62

how can syphils be detected?

Answer 62

dark field microscopy PCR serological testing

Question 63

what is the treatment for early syphilis?

Answer 63

2.4 MU benzathine penicillin stat

Question 64

what is the treatment for late syphilis?

Answer 64

2.4 MU benzathine penicillin weekly for three weeks

Question 65

when should serological follow up be done for syphilis?

Answer 65

until PRP is negative or serofast

Question 66

what is the most common viral STI in the UK?

Answer 66

HPV

Question 67

what are the most oncogenic types of HPV?

Answer 67

16 | 18

Question 68

what is the incubation period of HPV?

Answer 68

3 weeks - 9 months

Question 69

what type of HPV causes the majority of anogenital warts?

Answer 69

6 | 11

Question 70

what are the four treatment options for HPV?

Answer 70

podophyllotoxin imiquimod cryotherapy electrocautery