STIs

Question 1

Common Presentations in Men

Answer 1

Asymptomatic
Urethral discharge
Dysuria
Scrotal swelling/pain
Rash/sores
Systemic symptoms

Question 2

COmmon presentations in women

Answer 2

Asymptomatic
Vaginal discharge +/- urethral, rectal
Ulceration painful/painless
Itching/soreness, lumps/growths
Abnormal bleeding IMB PCB
Abdo pain, dyspareunia, Dysuria
Systemic symptoms

Question 3

COnditions that present with discharge

Answer 3

GOnorrhea
Chlamydia
Trichomonas
Candida
Bacterial Vaginosis

Question 4

COnditions that present with ulceration

Answer 4

Syphilis
HSV
LGV
Chancroid
Donovanosis

Question 5

Conditions that present with rashes, lumps/Growths

Answer 5

Genital warts - HPV
Molluscum contagiosum
Scabies
Pubic lice

Question 6

Painful genital ulcers

Answer 6

herpes > Chancroid

Question 7

Painless genital ulcers

Answer 7

Syphilis > Lymphogranuloma venerum/granuloma inguinale

Question 8

Obligate intracellular Gram -ve diplococcus

Answer 8

Gonorrhea

Question 9

Untreated Gonorrhea in neonates

Answer 9

Opthlamia neonatorum

Question 10

Pts with complement deficiency

Answer 10

disseminated gonococcal infection - septicaemia, rash, arthritis

Question 11

Diagnosis of gonorrhea

Answer 11

Urethral (95%)
Rectal (20%)
Produce from culture is gold standard

Question 12

Treatment of gonorrhea

Answer 12

Ceftriaxone IM - 250mg single dose
Cefixime PO - 400mg single dose
Resistant - Spectinomycin IM 2g single dose

Question 13

Complications of Gonorrhea in men

Answer 13

Non-gonococcal urethritis (mucoid discharge)
Post GOnococcal Urethritis (Tetracycline)
Rectal proctitis (MSM)

Prostatis

Question 14

COmplcations of gonorrhea in women

Answer 14

Mucopurulent cervicitis - erythema and oedema
- Urethra vaginal leakage
PID (Salpingitis) - Ascending infection - infertility

Question 15

Obligate intracellular pathogen that cannot be cultured on agar
Gram -ve

Answer 15

Chlamydia Trachomatis

Question 16

Features of Chlamydia

Answer 16

Assoc with younger age (10% of

Question 17

Serovars A, B, C or chlamydia

Answer 17

Trachoma - infection of eyes - blindness

Question 18

Serovars D-K

Answer 18

Genital chlamydia, opthalmia neonatorum

Question 19

COmplications of Chlamydia

Answer 19

PID, Tubal Factor infertility, ectopic risk, endometriosis risk, chronic pelvic pain, epididymitis, reiters syndrome, adult conjunctivitis, opthalmia neonatorum

Question 20

Diagnosis of CHlamyida

Answer 20

Nucleic Acid Amplification Test

GOld standard - high spec and sens

Question 21

Treatment of chlamydia

Answer 21

Azithromycin 1g stat
Doxycycline - 100 mg BD 7/7

Complicated
Erythromycin - 500mg QDS 7/7 or 500mg BD 2/52
SE: GI

Question 22

Side effects of chlamydia treatment

Answer 22

N&V, Photosensitivity

C/I in pregnancy (bone growth disturbance, tooth discolouration)

Question 23

Lymphatic infection with Chlamydia serovars L1, 2, 3

Answer 23

Lympho-granuloma venereum

Question 24

Demographic of LGV

Answer 24

ENdemic in developing world

More recently in MSM in developed world

Question 25

Symptoms of stages of LGV

Answer 25

Primary stage - 3-12 days - Genital ulcers, painless non-indurated. Balanitis, proctitis, cervicitis
Secondary Stage - 2-25 weeks - Inguinal buboes - painful 2/3 unilateral, may rupture
Fever, malaise, rarely (hepatitis, meningo-encephalitis, pneumonitis) Proctocolitis, Hyperplasia of lymphoid tissue
Late - Inguinal LNpathy, abscesses, genital elephantitis, genital ulcers, frozen pelvis, rectal strictures, perirectal ascesses + fistulae, lymphorroids
Current outbreak - Rectal symptoms - Pain, tenesmus, bleeding, mucous discharge O/E Proctitis

Question 26

Diagnosis of LGV

Answer 26

NAAT (unlicensed)
Sent to lab if +ve
Confirmation by real time PCR
Genotypic identification of L 1, 2, 3

Question 27

Treatment of LGV

Answer 27

Tetracyclines: Doxycycline 100mg BD for 3 weeks
Erythromycin - 500 mg QDS for 3 weeks
Azithromycin - 1g weekly for 3 weeks