STIs

Question 1

How is regular sex good for you?

Answer 1

Fitter
Lower rates of depressive symptoms
Better cardiovascular health

Question 2

When is sex bad for you?

Answer 2

Non-consensual sex 
Exploitative sex
Sexual dysfunction (physically or mentally)
Unwanted conception 
Infections

Question 3

What type of sex do people in the UK have?

Answer 3

Vaginal sex

Increase in oral and anal sex over the past few years

Question 4

Is there an increase in same-sex experiences in the population?

Answer 4

Women -yes (from 2% to 8%)

Men - yes (from 4% to 5%)

Question 5

How has there been changes in sexual lives over time?

Answer 5

Average age of first sexual intercourse has decreased
Average age of first live-in relationship has increased
Average age of first child has increased
Increase in same-sex relationship
Increase in multiple partners
Increase in casual sex
Increase in sexual activity with strangers

Question 6

Give some reasons as to why younger people have higher STI diagnoses than older people.

Answer 6

Older people are more likely to have a long term partner
Younger people are more likely to have multiple partners, casual sex and sex with strangers. They are also more likely to be less educated

Question 7

Which gender are more commonly affected by STIs?

Answer 7

Women

Question 8

Which gender is more likely to be affected by gonorrhoea?

Answer 8

Men - spread easily though men who have sex with men than any other population

Question 9

Geographically, where are there most likely to be higher STI rates?

Answer 9

In large cities (especially London)

Question 10

Which personal factors increases the risk of an STI?

Answer 10

Partner choice
Multiple partners - sexual partners can form a network and an STI can easily pass from person to person
No condom use

Question 11

Why should a patient be diagnosed and given treatment on the day they arrive at the clinic?

Answer 11

Otherwise they might leave diagnosed and go and have sex with someone and pass on the infection.

Question 12

What are the basic principles of STI managment?

Answer 12

Diagnosis before treatment 
Screen for accompanying STIs
Simple treatment regimens
Follow-up after treatment 
Partner notification
Non-judgemental patient support, counselling and education

Question 13

Why are simple treatment regimens important?

Answer 13

Some people don’t think they need treatment, so if the regimen is complication

Question 14

Why is a follow up after treatment needed?

Answer 14

To check that the treatment has been effective and the infection has been cleared properly so there is no more spread.

Question 15

What is the most likely causative organism of urethral discharge?

Answer 15

Gonorrhoea (perhaps Chlamydia)

- but gonorrhoea has a thicker dischrage

Question 16

When someone comes in with an STI, what do you need to know?

Answer 16

Last time they has any kind of sex
Who it was with - gender, long-term/casual partner and location
Types of sex - oral, condom use, sex toys, receptive anal sex

Question 17

What would you expect to see on a microscope slide from a Gonorrhoea swab?

Answer 17

Gram negative
Intracellular
Diplococci
Presence of may neutrophils

Question 18

How would the cell sample for Gonorrhoea be obtained?

Answer 18

Urethral gram film

- take a sample of urethral discharge

Question 19

What is the name of the test for Gonorrhoea?

Answer 19

NAAT test - nucleic acid amplification test (uses PCR methods)

Question 20

How would a sample for a NAAT test be collected?

Answer 20

Male urine - highly sensitive

Female vulvovaginal swab (Self taken is fine as sensitivity remains the same whether taken high or low in the vagina)

Question 21

What more unusual places can be swabbed for an NAAT test?

Answer 21

Rectal swab (depending on the sexual history) 
Throat swabs - only men as women would also have it in the vagina if they have it in the throat

Question 22

What is disseminated gonorrhoea?

Answer 22

Gonorrhoea outside the genitals, throat and rectum
Very rare
Form little nodules on the skin (hard to see on dark skin)
Affects bony joints and tendons

Question 23

Why is examining the proportion of each ST found in each gender important?

Answer 23

This suggests which STIs are likely to be heterosexually or homosexually acquired

Question 24

What is the standard management of male urethral discharge?

Answer 24

Ceftriaxone 500mg IM
Azithromycin 1g stat
Partner notification

Question 25

What are the symptoms of Chlamydia trachomatis?

Answer 25

Asymptomatic
Infection can lead to tubal damage, and cause PID in 16% of women
- pain during sex
- vaginal discharge after sex

Question 26

How is chlamydia currently treated?

Answer 26

A single dose of azithromycin (1g oral stat) cures in 90% of cases
- no check up for infection as it is normally effective

Question 27

What are treatment options other than Azithromycin?

Answer 27

Doxycyline 100mg BD for one week

• not used as much due to compliance issues
• given for 3 weeks in LGV infections

Question 28

What is Lymohogranuloma venereum?

Answer 28

LGV - subtype of Chlamydia 
- lymphotropic chlamydia 
This is a type of bacteria that attacks the lymph nodes
Most commonly infects the rectum
Can infects all mucosal sites

Question 29

What are the symptoms of LGV in the rectum?

Answer 29

Severe proctitis causing constipation, rectal bleeding and tensemus
Inguinal bulbos come to the surface and look like fissures

Question 30

How does Syphilis present?

Answer 30

In very unusual ways - any strangely presenting patient is probably syphilis
Chancre
Rash

Question 31

What is the natural history of Syphilis?

Answer 31

Exposure
Primary lesion (chancre - 3 weeks)
Secondary lesion (rash - 8-16 weeks)
Latent syphilis (Positive serology but no symptoms)
Tertiary syphilis (10-40 years) 
- Gumma
- Cardiovascular
- Neurological

Question 32

What is a Chancre?

Answer 32

Little organisms entering through an abrasion in the skin
Can present anywhere
- commonly on the penis

Question 33

Which community is Syphilis passed most easily through?

Answer 33

Men who have sex with men

Easily transmitted through oral sex, but can travel through vaginal and anal

Question 34

Why does a rash occur in secondary syphilis?

Answer 34

Triponines pass through the skin and are spreading though the body.
Rash is hard to see dark skin

Question 35

Describe the secondary syphilis stage.

Answer 35

High infectious, with strongly positive blood test serology
Not all patients have a secondary stage
Rash
Can easily be confused with other medical condtions

Question 36

What are some of the non-gential related problems that arise in late syphilis?

Answer 36

Can get into the bone - bone pain
Ophthalmic complications - can pop small blood vessels in the eye
Hearing loss

Question 37

What is the treatment for Syphilis?

Answer 37

Penicillin

• Two IM injections
• not very good evidence that it works

Question 38

Name the viral STIs.

Answer 38

HIV
Hepatitis B and C
HPV - warts

Question 39

What is the treatment for genital warts?

Answer 39

Warts are usually benign

- topical solutions (imiquimod)

Question 40

Which population does anogenital warts affect most?

Answer 40

Young women

Question 41

Which type of herpes simplex virus is associated with the genitals?

Answer 41

Both Types 1 and 2

- increase in type 1 in the genitals due to increased oral sex (mouth to genital transmission)

Question 42

Describe the treatment for herpes simplex.

Answer 42

New episode
- Aciclovir 400mg 3 times a day for 5 days
Recurrence episode
- Aciclovir 400mg 3 times a day for 2 days

Question 43

Name some of the less common STIs.

Answer 43

Trichomonas vaginalis
Mycoplasma genitalium
Donovanosis
Chancroid