STIs

Question 1

anogenital warts

Answer 1

caused by HPV from direct skin to skin contact with apparent or subclinical lesions and contact with genital secretions
micro-abrasions in the recipients skin allow viral access to the basal cells of the epithelium
most HPV infections are asymptomatic

Question 2

symptoms and signs of anogenital warts

Answer 2

warty growths in and around anogenital skin or mouth
little discomfort, sometimes itchy
distorted urinary stream or bleeding with urethral lesions
rectal bleeding with anal lesions
cervical lesions should have cervical screening

Question 3

complications of HPV

Answer 3

penile, anal, oropharynx, vulvar, vaginal, cervical malignancy with oncogenic HPV genotypes

Question 4

treatment options for genital warts

Answer 4

patient applied topical paint or cream until resolution
clinical intiated cryotherapy weekly
treatment is cometic not curative

Question 5

are genital warts a notifiable condition

Answer 5

no

Question 6

chlamydia

Answer 6

caused by chlamydia trachomatiis
often asymptomatic
may cause dysuria, penile urethral discharge, vaginal discharge, testicular pain, pelvic pain

Question 7

complications of chlamydia

Answer 7

epiididymo-orchitis
PID
infertility
pregnancy
reactive arthritis
cervicitis
conjunctivitis
perihepatitis

Question 8

testing for chlamydia

Answer 8

nucleeic acid amplification test from
clinician collected endocervical swab is best if the patient is examined, or self collected vaginal swab
anorectal swab in any patient with anorectal symptoms and all men who have sex with men
pharyngeal swab in all men who have sex with men
FPU in people who do not have a vagina or if vaginal swab cannot be taken

Question 9

NAAT

Answer 9

nucleic acid amplification test
highly sensitive, only recommended test for chlamydia
concurrent gonorrhea testing should accompany chlamydia testing

Question 10

uncomplicated genital or pharyngeal infection of chlamydia

Answer 10

doxycycline 100mg PO 7 days or azithromycin 1mg PO stat

Question 11

anorectal infection chlamydia treatment

Answer 11

doxycycline 100mg PO 7 days if asymptomatic, but 21 days if symptomatic
or azithromycin 1mg PO stat and repeat in 12-24 hours

Question 12

when to use azithromycin to treat chlamydia

Answer 12

if adherance is likely to be poor

Question 13

advice following chlamydia

Answer 13

no sexual contact for 7 days or until course is completed and symptoms have cleared, whichever is later
no sex with partners from the last six months until they have all ben testd nd treated

Question 14

is chlamydia notifyable

Answer 14

yes

Question 15

chlamydia in pregnanct people

Answer 15

azithromycin 1g PO stat

Question 16

rectal co-infection with chlamydia and gonorhhea

Answer 16

treatment should be given for both infections ie. ceftriaxone 500mg IMI stat PLUS doxycycline 100mg PO BD 7 days but 21 days if symptomatic

Question 17

test of cure for chlamydiaa

Answer 17

by NAAT no earlier thaan 4 weeks after tretment for pregnanct poeple or people with anorectal infection treated with azithromycin

Question 18

donovanosis

Answer 18

rare cause of genital ulceration
consider in patients rturning from areas where disease is endemic

Question 19

donovanosis is caused by

Answer 19

klebsiella granulomatis

Question 20

clinicial presentation of donovanosis

Answer 20

relatively painless anogenital ulceration which may be ulcerative, proliferative or both
secondary anaerobic bacterial infection may result in offensive odour is association wiith the primary lesions

Question 21

complications of donovanosis

Answer 21

extra genital disease is common and may occur via auto-inoculation, contagious spread or haematogenous spread
untreated u,cers may lead to lymphatic destruction with subsequent pseudo-elephantiasis of genitalia
neoplastic trasformation is possible
vertical transmission to neonote during vaginal delivery is possible
increase in HIV transmission risk

Question 22

diagnosis of donovanosis

Answer 22

dry swab or punch bopsy for NAAT or histology

Question 23

treatment for donovanosis

Answer 23

azithhromycin or doxycycline
notify the state

Question 24

ectoparasite infections

Answer 24

most common are scabies and pubic lice
pubic lice = pediculosis pubis or crabs
scabiees aare associated with crowded living and sleeping conditions and institutional outbreaks

Question 25

clinical presentation of ectoparasite infection

Answer 25

pubic or genital itch
scabies will have genital papulonodule
crabs will have debris in underwear

Question 26

scabies complications

Answer 26

complications uncommon and mostly in crusted scabies
fever in children
pain on mopvement
sleep disturbance
secondary infection

Question 27

pubic lice complications

Answer 27

fever, lethargy, irritability

Question 28

diagnosis for pubic lice

Answer 28

direct visualisation +/- magnification of crab or eggs

Question 29

diagnosis of scabies

Answer 29

clinical diagnosis
dermatoscope can aid
characteristic nodule and silvery skin burrows sometimes seen

Question 30

treatment fro scabies

Answer 30

permethrin cream applied to dry skin with extra attention to hands and genitalia and leeave on for 8 hours
repeat in 1 week to improve success rate

Question 31

treatment for pubic lice

Answer 31

apply pyrethrin and piperonyl butoxide topiical foam to pubic and other hhair infested with lice and wash off after 10 minutes
repeat treatment in one week

Question 32

crusted scabies

Answer 32

occurs when the mite population is very high due to poor host immune response, such as people with HIV infection and people living in remote aboriginal communities.

Question 33

treatment advice for scabies

Answer 33

patient and recent partners should complete treatment
avoid close body contact
isolate clothes, towel and bedlinen from previous 3 days and launder
symptoms and signs may not clear for 2 weeks
antihistamines, calamine lotion and topical steroid may be helpful

Question 34

treatment advice for pubic lice

Answer 34

isolate clothes, towel and bedlinen from previous 3 days and launder
shaving pubic hair is not required
compared with head lice, resistance to permethrin treatment is pubic lice has not been demonstrated

Question 35

herpes

Answer 35

caused by herpes simplex viruses types 1 and 2
primary episodes may be severe with extensive anogenital ulceration and systemiic features of viraemia
recurrent genital fissures, ertyhema with itching and swelling
cervicitis, proctitis and tenesmus

Question 36

herpes CNS involvement

Answer 36

meningitis, transverse myelitis or sacral radiculopathy

Question 37

diagnosis of herpes

Answer 37

swab of base of ulcer or deroofed vessicle
HSV NAAT

Question 38

treatment for herpes

Answer 38

valaciclovir
aciclovir
other treatment:
- regular analgesia
- topical lignocaine to reduce pain from erosions
- urinating in a bath or shower
- neuropathic bladder requires urgent catheterisation and referral
- avoid immediate contact with partners until symptoms have resolved
- routine sexual health screening
- use of barriers ie. waterproof dressings