STIs

Question 1

RFx for STIs?

Answer 1

• Sexually active 2 sexual partners last 12 months
• Homeless
• Substance abuse

Question 2

What are the most common STIs in order of prevalence?

Answer 2

• Chlamydia
• Gonorrhoea
• HPV
• Genital herpes

Question 3

What are the less common STIs?

Answer 3

• Hep B
• HIV
• Syphilis
• Trichomoniasis

Question 4

What are non sexually transmitted genital tract infections?

Answer 4

• Vulvovaginal candidiasis

- Bacterial vaginosis

Question 5

Features of sexual history?

Answer 5

• Age of first intercourse
• Sexual orientation
• Sexual activity / type
• Sexual activity during travel
• Total number of partners and duration of involvement

Question 6

Features of STI history?

Answer 6

• Awareness
• Contraception
• Previous STIs and testing
• Partner communication regarding STIs
• Local symptoms
• Systemic symptoms

Question 7

What are local symptoms of STI to elicit on Hx?

Answer 7

• Burning
• Itching
• Discharge
• Sores
• Vesicles
• Testicular pain
• Dysuria
• Abdo pain

Question 8

What are systemic STI symptoms to elicit on Hx?

Answer 8

• Fever
• Lymphadenopathy
• Arthralgia

Question 9

Screening for at risk individuals (even if asymptomatic?

Answer 9

-Chlamydia
-Gonorrhoea
-Hep B
-HIV
-Syphilis
Pap if non previous 12mo

Question 10

Signs of gonorrhoea?

Answer 10

M: 
-urethral discharge, 
-unexplained pyuria, 
-dysuria
-conjunctivitis
F: 
-mucopurulent endocervical discharge -vaginal bleeding
-dysuria
-pelvic pain
-dyspareunia with cervicitis.
Can be asymptomatic; rectal involvement if anal sex.

Question 11

Gonorrhoea Ix?

Answer 11

-M: urine PCR, urethral swab for Gram stain and culture
-F: urine PCR, endocervical swab for gram stain and culture, vaginal swab for wet mount (r/o trichomonas)
M/F: urine PCR

Question 12

Rx gonorrhoea?

Answer 12

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

Question 13

M complications gonorrhoea?

Answer 13

• Urethral strictures
• Epididymo-orchitis
• Infertility
• Disseminated disease (macular rash +/- necrotic pustules, septic arthritis)
• Increased risk HIV acquisition / transmission

Question 14

F complications gonorrhoea?

Answer 14

• PID (dyspareunia, intermenstrual bleeding, post coital bleeding)
• Infertility
• Perinatal infection
• Disseminated disease (macular rash +/- necrotic pustules, septic arthritis)
• Increased risk HIV acquisition / transmission

Question 15

Signs and symptoms of chlamydia?

Answer 15

70% asymptomatic

if symptoms, then similar to gonoccocal

Question 16

Ix of chlamydia?

Answer 16

-NAAT (FPU / self collected swab)

Question 17

Cause chlamydia?

Answer 17

Chlamydia trachomatis

Question 18

Treatment uncomplicated genital or pharyngeal chlamydia infection?

Answer 18

-Azithromycin 1g PO stat
OR
-Doxycycline 100mg, PO BD 7/7

Question 19

Non pharmacologic immediate management in treatment STI?

Answer 19

• 1. Advise no sexual contact for 7 days after treatment is administered.
• 2. Advise no sex with partners from the last 6 months until the partners have been tested and treated if necessary.
• 3. Contact tracing.
• 4. Provide patient with factsheet.
• 5. Notify the state/territory health department.

Question 20

Signs and symptoms of HPV?

Answer 20

Most are asymptomatic
M: cauliflower lesions (condylomata acuminata) on skin/mucosa of penile or anal area
F: cauliflower lesions and/or pre-neoplastic/neoplastic
lesions on cervix/vagina/vulva

Question 21

ix of HPV?

Answer 21

None needed if simple condylomata
Potential biopsy of suspicious lesions
F: screening for cervical dysplasia through regular Pap smears

Question 22

Treatment of HPV?

Answer 22

For condylomata: cryotherapy, electrocautery, laser excision, topical therapy (patient-applied or office-based)
For cervical dysplasia: colposcopy and possible excision, dependent on grade of lesion

Question 23

Complications HPV?

Answer 23

M and F: anal cancer MSM and F who have receptive anal sex: rectal cancer
F: cervical/vaginal/vulvar cancer

Question 24

Signs and symptoms of HSV I and II?

Answer 24

1° episode: painful vesicoulcerative genital lesions ± fever, tender lymphadenopathy, protracted course Recurrent episodes: less extensive lesions, shorter course, may have “trigger factors”

Question 25

Ix HSV I and II?

Answer 25

Swab of vesicular content for culture, type-specific serologic testing for HSV-1 vs. HSV-2 antibodies and to determine 1o vs. recurrent episode

Question 26

Rx HSV I and II?

Answer 26

1. 1° episode: - Acyclovir 200 mg PO 5x/d x 5-10 d - Famciclovir 250 mg PO tid x 5 d - Valacyclovir 1000 mg PO bid x 10 d 2. Recurrent Episode: - Acyclovir 200 mg PO 5x/d x 5d or 800 mg PO tid x 2d - Famciclovir 125 mg PO bid x 5 d - Valacyclovir 500 mg PO bid x 3 d or 1000 mg POODx3d

Question 27

Complications HSV I and II?

Answer 27

Genital pain, urethritis, cervicitis, aseptic meningitis, increased risk of acquiring and transmitting HIV

Question 28

Signs and symptoms of syphilis?

Answer 28

- 1°: chancre (painless sore), regional lymphadenopathy - 2°: rash and flu-like symptoms - Latent Phase: asymptomatic - 3°: neurologic, cardiovascular, and tissue complications

Question 29

Ix of syphilis?

Answer 29

- Specimen collection from 1° and 2° lesions - screen high risk individuals with serologic syphilis testing - universal screening of pregnant women

Question 30

Complications of syphilis?

Answer 30

- chronic neurologic and CV sequelae | - increased risk of acquiring and transmitting HIV

Question 31

Incubation period primary syphilis?

Answer 31

Incubation period 10-90 days (average 3 weeks).

Question 32

Signs and symptoms secondary syphilis?

Answer 32

The patient may present with - constitutional symptoms such as fever, malaise, headache and lymphadenopathy - The skin is involved in over 90% of cases - The rash is usually generalised involving the trunk but may just affect the palms and soles - The rash can be easily confused with drug eruptions, pityriasis rosea or guttate psoriasis

Question 33

Rx syphilis (1/2/latent)

Answer 33

-Benzathine penicillin 1.8g IMI, stat OR -Procaine penicillin 1.5g IMI, for 10 days

Question 34

Treatment of non infectious 3" syphilis?

Answer 34

Benzathine penicillin 1.8g IMI, weekly for 3 weeks

Question 35

What is procaine reaction?

Answer 35

Procaine reaction is a rare reaction to procaine penicillin. It is characterised by a sensation of impending doom with hallucinations. The reaction is self-limiting and lasts about 30 minutes. The patient needs to be reassured and given general supportive measures.

Question 36

What is Jarisch-Herxheimer reaction?

Answer 36

Jarisch-Herxheimer reaction is 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. Patients should be alerted to the possibility of this reaction and reassured accordingly.

Question 37

Non pharm immediate management of syphilis?

Answer 37

- Advise no sexual contact for 7 days after treatment is administered - Advise no sex with partners from the last 3 months (primary syphilis) and 6 months (secondary syphilis) until the partners have been tested and treated if necessary. - Contact tracing - Provide patient with factsheet - Notify the state/territory health department.

Question 38

What does syphilis of the aorta involve?

Answer 38

- Intima of coronary arteries and may narrow coronary ostia leading to myocardial ischaemia. - Destruction of medial muscle layers of aorta -> aortic dilation

Question 39

Why does myocardial ischaemia occur in AR (as in syphilis)?

Answer 39

- Oxygen requirements are elevated secondary to LV dilation and elevated LV systolic wall tension - Coronary blood flow normally during diastole when diastolic arterial pressure is subnormal > decreased coronary perfusion pressure