STIs

Question 1

Bacterial STIs?

Answer 1

Chlamydia
Gonorrhoea
Syphilis

Question 2

Viral STIs?

Answer 2

Genital warts (HPV)
Genital herpes
Hepatitis and HIV

Question 3

Parasitic STIs?

Answer 3

Trichomonas vaginalis
Pubic lice
Scabies

Question 4

Predisposing factors for candida infection?

Answer 4

Recent antibiotic therapy
High oestrogen levels
Poorly controlled diabetes
Immunocompromised patients

Question 5

Presentation of candida infections?

Answer 5

Itchy

White vaginal discharge

Question 6

Diagnosis of candida infection?

Answer 6

Clinical

HVS for culture

Question 7

Treatment of candida infection?

Answer 7

Topical clotrimazol pessary or cream

Oral fluconazole

Question 8

What is prostatitis?

Answer 8

Rare complication of UTI in men

Question 9

Symptoms of prostatitis?

Answer 9

Symptoms of UTI +/- lower abdo/ back/ perineal/ penile pain

Tender prostate

Question 10

Diagnosis of prostatitis?

Answer 10

Clinical signs

MSSU for c and s

Question 11

Treatment of prostatitis ?

Answer 11

Ciprofloxacin for 28 days

Trimethoprim for 28 days of high c diff risk

Question 12

What does lactobacillus produce?

Answer 12

Lactic acid

Hydrogen peroxide

Question 13

What are normal vaginal flora?

Answer 13

Lactobacillus spp.
Strep viridans
Group B beta haemolytic streptococcus
Candida in small numbers

Question 14

What is the normal pH of vagina?

Answer 14

pH4-4.5

Question 15

What happens in bacterial vaginosis?

Answer 15

Replacement of normal vaginal flora with gardnerella vaginalis and species of anaerobic bacteria

Question 16

What is vaginal discharge like in bacterial vaginosis?

Answer 16

Homogenous

May contain bubbles

Question 17

What is the whiff test??

Answer 17

Adding 10% potassium hydroxide to discharge. +ve test elicits fishy odour

Question 18

Does bacterial vaginosis have a positive or negative whiff test?

Answer 18

Positive

Question 19

Treatment of bacterial vaginosis?

Answer 19

Metronidazole for 7 days

No point treating male partners

Question 20

What is the commonest bacterial STI in UK?

Answer 20

Chlamydia

Question 21

What organism is chlamydia caused by?

Answer 21

Chlamydia trachomatis

Question 22

Does chlamydia stain with gram stain?

Answer 22

No - doesn’t have peptidoglycan in cell wall

Question 23

Diagnosis of chlamydia?

Answer 23

14 days after exposure 
NAATs or PCR on:
Males - first pass urine sample 
Females - HVS or vulvo-vaginal swab 
Rectal or throat swabs 
Eye swabs

Question 24

Treatment of chlamydia?

Answer 24

Azithromycin if uncomplicated

Doxycycline

Question 25

What organism is gonorrhoea caused by?

Answer 25

Neisseria gonorrhoea

Question 26

What type of bacteria is neisseria gonorrhoea?

Answer 26

Gram negative diplococcus- looks like 2 kidney beans.

Question 27

Diagnosis of gonorrhoea?

Answer 27

NAATs or PCR Microscopy of urethral/ endocervical swabs Culture on selective agar plates

Question 28

Treatment of gonorrhoea?

Answer 28

IM ceftriaxone | Oral azithromycin

Question 29

Advantages of NAATs / PCR over culture

Answer 29

Less invasive specimens required More sensitive Positive even if organisms dead Takes hours instead of days

Question 30

Disadvantages of NAATs/PCR over culture

Answer 30

Will detect dead organisms | Cannot test antibiotic sensitivities without culture so difficult to track antibiotic resistance

Question 31

What organism causes syphilis?

Answer 31

Treponema pallidum - a spirochaete

Question 32

Does treponema pallidum stain with gram stain?

Answer 32

No

Question 33

How many stages are in the syphilis illness?

Answer 33

4

Question 34

What are the stages of the syphilis illness?

Answer 34

Primary lesion - chancre - organism multiplies at inoculation site and gets into bloodstream Secondary stage - large numbers bacteria circulating in blood with manifestations in different sites Latent stage - low level multiplication of spirochaete in intima of small blood vessels Late stage - CVS or neuro complications many years later

Question 35

Diagnosis of syphilis?

Answer 35

Dark ground microscopy Swab for PCR Serology tests for antibodies

Question 36

Treatment for syphilis?

Answer 36

Penicillin

Question 37

What causes genital herpes?

Answer 37

Herpes simplex virus type 1 and type 2

Question 38

How is genital herpes spread?

Answer 38

Genital/ genital contact or oropharyngeal/ genital contact

Question 39

Diagnosis of genital herpes?

Answer 39

Swab deroofed blister for PCR

Question 40

Treatment of genital herpes?

Answer 40

Aciclovir | Pain relief

Question 41

What does trichomonas vaginalis cause?

Answer 41

Vaginal discharge and irritation

Question 42

Diagnosis of trichomonas vaginalis?

Answer 42

HVS for microscopy | PCR

Question 43

Treatment for trichomonas vaginalis?

Answer 43

Oral metronidazole

Question 44

How long does a make louse live for?

Answer 44

22 days

Question 45

How long does a female louse live for?

Answer 45

17 days

Question 46

Treatment of pubic lice?

Answer 46

Malathion lotion

Question 47

Presentation of chlamydia in females?

Answer 47

Post coital or intermenstrual bleeding Lower abdo pain Dysparaneuria Mucopurulent cervilitis

Question 48

Presentation of chlamydia in males?

Answer 48

``` Urethral discharge Dysuria Urethritis Epididymo-orchitis Proctitis ```

Question 49

Complications of chlamydia?

Answer 49

PID Tubal damage - can lead to infertility and ectopic pregnancy Chronic pelvic pain Transmission to neonate Adult conjunctivitis Sexually acquired reactive arthritis (SARA) / reiters syndrome Fitz Hugh Curtis syndrome

Question 50

Incubation period of gonorrhoea in men - (urethral infection )

Answer 50

About 2-5 days

Question 51

What is the risk of transmission of gonorrhoea from female to male?

Answer 51

20%

Question 52

What is the risk of transmission of gonorrhoea from male to female?

Answer 52

50-90%

Question 53

Presentation of gonorrhoea in males?

Answer 53

<10% asymptomatic Urethral discharge Dysuria Pharyngeal/rectal infection

Question 54

Prevention of gonorrhoea in females?

Answer 54

``` <50% asymptomatic Increased/ altered vaginal discharge Dysuria Pelvic pain Pharyngeal / rectal infection ```

Question 55

Lower genital tract complications of gonorrhoea?

Answer 55

``` Bartholinitis Tysonitis Periurethral abscess Rectal abscess Epididymitis Urethral stricture ```

Question 56

Upper genital tract complication of gonorrhoea?

Answer 56

``` Endometritis PID Hydrosalpinx Infertility Ectopic pregnancy Prostatitis ```

Question 57

Classification of genital herpes ?

Answer 57

Primary infection Non-primary first episode Recurrent infection

Question 58

Presentation of genital herpes primary infection ?

Answer 58

``` Blistering and ulceration of external genitalia Pain External dysuria Vaginal or urethral discharge Local lymphadenopathy Fever and myalgia ```

Question 59

Incubation period of syphilis primary infection

Answer 59

3-6 days

Question 60

Duration of syphilis primary infection?

Answer 60

14-21 days

Question 61

What is the most common viral STI in UK?

Answer 61

HVP

Question 62

How many of the 170 HVP infect anogenital epithelium?

Answer 62

40

Question 63

List some low risk HPV types?

Answer 63

``` 6 11 42 43 44 ```

Question 64

List some high risk HPV types?

Answer 64

``` 16 18 31 33 35 45 51 52 66 ```

Question 65

What is the HPV incubation period ?

Answer 65

3 weeks - 9 months

Question 66

Treatment of HPV?

Answer 66

``` Podophyllotoxin Imiquimod Cryotherapy Electrocautery HPV vaccination ```

Question 67

Incubation period of primary syphilis?

Answer 67

9-90 days - mean 21 days

Question 68

Incubation period of secondary syphilis?

Answer 68

6 weeks - 6 months

Question 69

Presentation of secondary syphilis?

Answer 69

``` Skin - macular, follicular or pustular rash on palms and soles Lesions of mucous membranes Generalised lymphadenopathy Patchy alopecia Condylomata lata ```

Question 70

What is condylomata lata?

Answer 70

Highly infectious lesion in syphilis | Exudes a serum teeming with treponemes