STIs

Question 1

High risk population for STIs [7]

Answer 1

Young, <20

Frequent partner change- concurrency

Men who have sex with men

Certain ethnicities

Non-barrier contraception

Inner city/ Deprived residents

History of previous STI

Question 2

Young people and STIs

Answer 2

Earlier coitarche = poor subsequent sexual health status

Display behaviour more vulnerable to STI

For females, physiologically more susceptible
- transforming cervix

Question 3

Behaviours of young people, making them more vulnerable to STI [5]

Answer 3

High number of sexual partners and concurrency

Yet to develop skills and confidence in using condoms

More risk taking behaviour and experimentation

Poor contraception awareness

Yet to develop skills in negotiating safe sex

Question 4

Vulnerabilities associated with early intercourse

Answer 4

Leaving home before 16

Leaving school at 16

Disruption in family

Main source of information on sex was not school/ parents

Question 5

Where do young people get information about sex?

Answer 5

Parents

School

Internet [porn]

• Free, unrestricted and uncensored.
• A lot of it is unintended

Books

Question 6

Negative aspects of porn

Answer 6

Unrealistic
- Raises unrealistic expectations

Sets performance anxiety

Lack of censorship
- Hardcore can become addictive

Ethical issues
- Exploitation

Consent blurred

Lack of condom use reduces risk perception

Question 7

Concurrent relationships

Answer 7

Having more than one sexual partner at the same time

• Increase opportunity for transmission
• Higher rates in younger people

Question 8

MSM

Answer 8

Men who have sex with men

- High incidence of Syphilis and gonorrhea

Question 9

Ethnic group and STI rates

Answer 9

Chlamydia particuarly higher in Black or Black British

Mixed ethnic groups second to highest.

Lowest
- Asian/ Asian british

Question 10

Core group

Answer 10

Sub-group of a population that is not static
- High turnover

Highly sexually active with a high prevalence of infection.

Creates reservoirs of infection
Have high frequency of transmission

Question 11

GMC guidance for genital examination

Answer 11

Offer a chaperone

Explain the examination

Give privacy to undress and dress

Obtain consent, allowing the patent to stop the examination if required

Question 12

Female genital exam

Answer 12

Inspect pubic area

• Majora
• Minora
• Perianal

Inspect and palpate inguinal region

Speculum
- Water as lubricant

Question 13

Male genital exam

Answer 13

Inspect pubic area + inguinal region

Inspect scrotum and perianal region
- Palpate scrotum

Inspect penis

• Circumcised?
• Inspect under foreskin if not

Note urethral discharge

Question 14

Examples of normal appearance in males

Answer 14

Pearly penile papules

Fordyce spots

Genital enlarged sebaceous glands

Question 15

Examples of normal appearance in females

Answer 15

Vulval papules/ papillomatosis

Question 16

Tinea cruris

Answer 16

Fungal infection in inguinal region

Question 17

Bacterial STI presentation

Answer 17

More florid symptoms

Presents earlier
- Rapidly diagnosed

Effective treatment usually available/ Curative

Reservoirs can be controlled

Question 18

Viral STI presentation

Answer 18

Many unaware on infection
- Delayed presentation

Diagnostic tests may be unreliable

Only treatments for symptoms
- Often life long

Reservoirs expanding

Question 19

Bacterial STI examples

Answer 19

Chlamydia

Gonorrhoea

Syphilis

Question 20

Protozoal STI examples

Answer 20

Trichomonas

Question 21

Viral STI examples

Answer 21

Herpes

HIV

Hepatitis

Warts [HPV]

Question 22

Common symptoms of gonorrhoea and syphilis

Answer 22

Dysuria

Discharge

Question 23

Bacterial appearance of gonorrhoea

Answer 23

Intracellular gram negative, diplococci bacteria

Question 24

Incubation period of gonorrhoea/ chlamydia

Answer 24

2-30

- On average 4-6.

Question 25

Primary syphilis

Answer 25

Occurs 1-3 (9-90 days) weeks after contract with infection
Presents with
- Ulcer that forms from red mark–> spot (chancre) Ulcer is not painful
- Enlarged lymph nodes in groin/ neck

Heals within 1-3 weeks

Question 26

Secondary syphilis

Answer 26

Occurs 2-6 weeks after primary stage
- Lasts for 2-4 weeks

Systemic dissemination

Flu-like illness

• Headache
• Lymphadenopathy

Mouth ulcers

Chondylomoata lata
- White/ grey lumps

Arthritis

Differentials

• Pityriasis rosea
• Psoriasis
• HIV

Question 27

Trichomonas vaginalis

• Organism description
• Symptoms
• Diagnosis

Answer 27

Single cell protozoan parasite
- Infects vagina and urethra

Symptoms

• Dysuria
• Frothy discharge
• Strawberry cervix

Diagnosis
- Microscopy–> Motile organisms seen

Question 28

Trichomonas vaginalis treatment

Answer 28

Metronidazole

Question 29

Molluscum contagiosum

Answer 29

Viral STI

- Small raised pink lesions

Question 30

Herpes simplex

- Symptoms

Answer 30

Painful ulcers

Dysuria

Vaginal discharge

Fever/ myalgia (systemic)

Question 31

Herpes simplex

- Signs

Answer 31

Blistering + ulceration in cervix/ rectum

Inguinal lymphadenopathy

Question 32

What proportion of people are aware they have genital herpes

Answer 32

20%

Question 33

Herpes simplex

Answer 33

Viral infection that can be sexually transmitted,

HSV-1 commonly cause cold sores
HSV-2 commonly causes genital infections

Question 34

Candida presentation and treatment

Answer 34

Itching, discharge, swelling

Papular rash in males

Treated with topical antifungals

Question 35

Bacterial Vaginosis

• Description
• Cause
• Treatment

Answer 35

Non-sexually transmitted

Fishy odour
- Imbalance of vaginal flora/ overgrowth of anaerobes

Cause
- Overwashing/ bubble baths

Treatment
- Metronidazole