STIs

Question 1

The 5 P’s to ask in a sexual history

Answer 1

1. Partners: M/F, how many in last 6 months
2. Practices: type of sex, use of condom in which type
3. Past STIs + treatment
4. Pregnancy plans, contraception
5. Protection from STDS: monogamy, self-perception of risk

Question 2

Risk factors for bacterial vaginosis

Answer 2

• New/ multiple sexual partners
• Vaginal douching
• Smoking
• Note: can occur in virgins

Question 3

Best investigation for BV

Answer 3

At least 20% “Clue cells” & mixed flora on vaginal wet film

Question 4

Which HPV strains cause genital warts

Answer 4

6 and 11

Question 5

Which HPV strains cause cervical cancer

Answer 5

16 and 18

Question 6

Clinical features of genital warts

Answer 6

• Pruritis, pain, tenderness, dysuria

* Bleeding, discharge

Question 7

How to diagnose genital warts

Answer 7

Clinical diagnosis: pink lesions

biopsy if in doubt

Question 8

Causes of urethritis (discharge, pain)

Answer 8

• Gonorrhoea
• Chlamydia
• Mycoplasma, ureaplasma (non-specific urethritis)
• HSV
• Trichomonas
• UTI

Question 9

Difference in discharge for BV, candida, trichomoniasis

Answer 9

• BV = watery white/ grey with fishy smell
• Candida = white curdy discharge with vulval rash
• Trichomoniasis = smelly green/yellow discharge

Question 10

Difference in discharge for BV, candida, trichomoniasis

Answer 10

• BV = watery white/ grey with fishy smell
• Candida = white curdy discharge with vulval rash
• Trichomoniasis = smelly green/yellow discharge

Question 11

Causes of genital ulcers

Answer 11

• HSV
• Syphilis
• Tropical STIs eg chancroid

Question 12

Causes of genital lumps

Answer 12

• Genital warts
• Secondary syphilis (condylomata lata)
• Molluscum contagiosum

Question 13

Causes of genital infestations

Answer 13

• Pubic lice

* Scabies

Question 14

Commonest STI in UK

Answer 14

Chlamydia

Question 15

Gold standard investigation for gonorrhoea and chlamydia

Answer 15

Nucleic acid amplification test

also do microscopy, swabs, culture

Question 16

Complications of passing gonorrhoea/ chlamydia on to neonate

Answer 16

• ophthalmia neonatorum
• mucous membrane infections
• pneumonitis

Question 17

Difference in symptoms of genital ulcers (HSV) in 1st vs recurrent episodes

Answer 17

1st episode: VERY SEVERE

• very very painful, burning vesicles
• flu-like symptoms: fever, cough, headache, sore throat, lymphadenopathy

Recurrent episodes: MILDER (due to formation of antibodies)

Question 18

How to detect HSV

Answer 18

• Viral culture
• Viral antigen detection tests
• PCR

Question 19

How to detect syphilis

Answer 19

• PCR
• dark ground microscopy
• serology

Question 20

Clinical features of primary syphilis

Answer 20

• PAINLESS ulcer

- regional lymphadenopathy

Question 21

Clinical features of secondary syphilis

Answer 21

• Maculopapular rash (trunk, limbs, palms, soles)

- Condylomata lata

Question 22

Condylomata vs acuminata

• what they look like
• what causes them

Answer 22

LATA

• secondary syphilis
• flat, smooth, moist

ACUMINATA

• HPV 6n11
• cauliflower-like, pearly, dry

Question 23

Clinical features of CVS syphilis

Answer 23

• aortic regurgitation

- ascending aortic aneurysm

Question 24

Clinical features of neuro syphilis

Answer 24

• Meningitis without fever
• Stroke
• Cervical myelopathy
• Hemiplegia

Question 25

Clinical features of gummatous syphilis

Answer 25

• lesions on skin, bones, organs, mucous membranes

- can cause local destruction eg saddle nose