STIs

Question 1

Differentiate between the terms STI and STD

Answer 1

STI - symptomatic and asymptomatic causes

STD - symptomatic cases only

Question 2

List the most common sexually transmitted infections, identifying the infecting organism in each case

Answer 2

Chlamydia - chlamydia trachomatis (bacteria)
Genital herpes - herpes simplex virus (HSV2)
Gonorrhoea - neisseria gonorrhoea (bacteria)
Genital warts - HPV (6&11), (16&18 associated with cancer)
Bacterial vaginosus (rod shaped bacteria)
Syphillis - treponema pallidum (spiral bacteria)
Trichomonas vaginalis (protozoa)
Vulvovaginal candidiasis (fungi)
Scabies/pubic lice - sarcoptes scabiel (parasite)

Question 3

Describe recent trends in the incidence of STIs

Answer 3

Increased transmission
Increased GUM attendance
Greater national awareness
Improved diagnostic methods - screening programs

Question 4

Describe the clinical presentation, diagnosis and management of chlamydial infection

Answer 4

Clinical presentation:
Males - urethritis, epididymitis, prostatitis, proctitis
Females - urethritis, cervicitis, salpingitis, peri-hepatitis
Neonatal - inclusion conjunctivitis, pneumonia
Ocular inoculation - conjunctivitis
Diagnosis - endocervical/urethral swabs, 1st void urine, conjunctival swab, NAAT
Treatment - doxycycline/azithromycin, erythromycin in children
May be asymptomatic (especially in children)

Question 5

Describe the clinical presentation, diagnosis and management of gonorrhoea

Answer 5

Clinical presentation:
Males - urethritis, epididymitis, prostatitis, proctitis, pharyngitis
Females - endocervicitis, urethritis, PID
Diagnosis - urethral/cervix/throat/rectum swab or urine
Treatment - ceftriaxone IM (+ azithromycin for chlamydia)

Question 6

Describe the clinical presentation, diagnosis and management of genital herpes

Answer 6

Clinical presentation - extensive, painful genital ulceration, dysuria, inguinal lymphadenopathy, recurrent (due to latent infection)
Diagnosis - PCR of vesicle fluid/ulcer base
Treatment - aciclovir (prophylaxis)

Question 7

Describe the clinical presentation, diagnosis and management of genital warts

Answer 7

Clinical presentation - cutaneous, mucosal, anogenital warts, benign, painless, verrucous outgrowths
Diagnosis - clinical, biopsy analysis
Treatment - none (spontaneous resolution), cryotherapy, surgery
Management - screening (cervical Pap smear cytology), vaccine (offered to girls 12-13yrs)

Question 8

List and describe briefly, other STIs

Answer 8

Bacterial vaginosis - fishy odour, sting when urinating
Syphilis - ulceration, rash, gummas (form of granuloma)
Trichomonas vaginalis - urethritis, vaginitis, fishy discharge
Vulvovaginal candidiasis - thrush, itching, burning with urination, thick vaginal discharge
Scabies/pubic lice - itching, superficial burrows

Question 9

Explain the condition of pelvic inflammatory disease

Answer 9

The result of infection ascending from the endocervix, causing:
Tubo-ovarian abscess - pocket of puss during infection of Fallopian tube and ovary
Parmetritis - inflammation of ligaments around the uterus
Endometritis - inflammation and infection of endometrium
Salpingitis - inflammation of fallopian tube
Oophoritis - inflammation of ovary
Pelvic peritonitis - inflammation and infection of peritoneum

Question 10

Describe the aetiology/pathophysiology of PID

Answer 10

Disease of sexually active women caused by gonorrhoea and chlamydia
Gardetella, mycoplasma and anaerobes also implicated
Infection ascends from endocervix and vagina into uterus
Inflammation causes adhesions formation (chronic pelvic pain) and damage to tubal epithelium (loss of cilia)

Question 11

Describe some of the behaviour risk factors/predictors of PID

Answer 11

Sexual behaviour - young age, lack of use of barrier contraception, multiple partners
Type of contraception used - IUCD (increased in first or 1-2 weeks)
Alcohol/drug use, cigarette smoking
Polymicrobial - STIs, others

Question 12

Describe some of the clinical features of PID

Answer 12

Pyrexia
Pain - bilateral lower abdominal tenderness, adnexal tenderness, cervical excitation, deep dyspareunia)
Abnormal vaginal/cervical discharge
Abnormal vaginal discharge
Sexual history, prior STIs

Question 13

Describe the investigations, management and complications of PID

Answer 13

Investigations - triple swabs (endocervical, high vaginal), blood tests
Management - medical (analgesia, antibiotics 14 days - ceftriaxone, doxycycline, metronidazole), surgery (laparoscopy/laparotomy, US guided pelvic aspiration of fluid)
Complications - ectopic pregnancy, infertility, chronic pelvic pain, fitz-high-curtis syndrome (RUQ pain, peri-hepatitis, adhesions)

Question 14

Describe differential diagnoses for PID, what to tell the patient and when to admit the patient to hospital

Answer 14

Differential diagnoses - ectopic pregnancy, endometriosis, ovarian cyst complication, IBS, appendicitis, UTI, functional pain
Tell patient - diagnosis, treatment (side effects, complete antibiotics), complications, abstinence during treatment
Admit to hospital when - surgical emergency, HIV, clinically severe, tubo-ovarian abscess, in pregnancy, lack of response to oral therapy

Question 15

Describe the epidemiology of STIs and other infections of the genital tract

Answer 15

At risk groups - young people, certain ethnic groups, low socioeconomic groups, specific sexual behaviour (age at first sexual intercourse, number of sexual partners, orientation, unsafe activity)
Burden - chronic/relapsing conditions, stigma, consequent pathology e.g. PID, infertility, cancers