STIs

Question 1

What is urethritis?

Answer 1

Inflammation of the urethra - can present with redness, soreness, discharge etc.

Question 2

What is pelvic inflammatory disease?

Answer 2

Infection of the female upper genital tract (incl. womb, fallopian tubes and ovaries) - can present with pain around pelvis or lower abdomen, discomfort during sex, pain when urinating, bleeding (between periods, after sex, heavy periods etc.)

Question 3

What is epididymo-orchitis?

Answer 3

Inflammation of the epididymis and testes - can present with pain/tenderness and swelling

Can be caused by UTI, STI (Gonorrhoea, chlamydia), mumps

Question 4

What bacteria causes gonorrhea?

Answer 4

Intracellular gram-negative diplococci - Neisseria Gonorrhoeae

Question 5

What do NICE class as infertility?

Answer 5

1-2 years of attempting pregnancy

Question 6

What bacteria causes syphilis?

Answer 6

Treponema pallidum

Question 7

What are the major systemic viral diseases transmitted by sexual intercourse?

Answer 7

Hepatitis B + C

HIV

Question 8

What are the principles of antimicrobial therapy?

Answer 8

Right drug (guidelines; check for allergy, contraindications and interactions) 
Right dose 
Right time (asap) 
Right duration (single dose if possible as increases concordance and minimises side effects)

Question 9

What are the principles of identifying a microbial diagnosis?

Answer 9

See it, grow it, kill it

Detect pathogen and response to pathogen

Question 10

What tests are done to aid a Gonorrhoea diagnosis?

Answer 10

Nucleic acid amplification test (NAAT)
M, C and S
Non-culture methods

Question 11

What are the advantages and disadvantages of using an MCS to aid Gonorrhoea diagnosis?

Answer 11

Advantages: rapid (can give result in clinic); gives antimicrobial susceptibility; useful for individual patient treatment and for epidemiological surveillance; used when patient is asymptomatic

Disadvantages: less sensitive than NAAT; requires skilled microscopist

Question 12

What are the advantages and disadvantages of using non-culture methods to aid Gonorrhoea diagnosis?

Answer 12

Advantages: high sensitivity and specificity

Disadvantages: 24-48hr result; no antimicrobial susceptibility; not suitable for normal swabs (as requires a non-inhibitory specimen)

Question 13

How is chlamydia diagnosed?

Answer 13

Nucleic acid amplification test

Obligate intracellular bacterium - will not grow on agar plate

Question 14

How is syphilis diagnosed?

Answer 14

Antibody detection (PCR) 
Serum IgM indicates recent infection

Question 15

How can STIs be transmitted?

Answer 15

Sexual contact: oral, anal, vaginal, sharing of sex toys, skin to skin contact etc.

Non-sexual contact: in utero (e.g. syphilis); peripartum; blood-borne virus exposure (e.g. occupational, recreational drug use etc.)

Question 16

What are the principles for controlling STI transmission?

Answer 16

Remove source
Treat other infections/ sources of inflammation
Interrupt transmission
Increase host resistance

Question 17

What are the primary and secondary prevention strategies for controlling transmission of STIs?

Answer 17

Primary = safe sexual behaviour; barrier contraceptive methods; immunisation (e.g. HPV); PrEP

Secondary = detection (screening, access to services, targeted information); prompt effective treatment; partner notification/ contact tracing

Question 18

What is the clinical term for inflammation of the rectum?

Answer 18

Proctitis

Question 19

What is the clinical term for inflammation of the testes?

Answer 19

Orchitis

Question 20

What is the clinical term for inflammation of the head of the penis?

Answer 20

Balanitis

Question 21

What would the differential diagnoses be for someone presenting with urethritis?

Answer 21

Chlamydia trachomatis
Neisseria gonorrhoeae (or both!)
Mycoplasma genitalium

Question 22

What would the differential diagnoses be for someone presenting with vaginal discharge?

Answer 22

STI (Gonorrhoea, chlamydia, trichomonas)

Non-STI (candidiasis, bacterial vaginosis)

Question 23

What is Candidiasis?

Answer 23

Thrush

Question 24

What would the differential diagnoses be for someone presenting with painful genital ulceration?

Answer 24

STI (Herpes Simplex Virus, Syphilis)

Non-STI (e.g. Crohn’s, allergy, trauma, drug-induced etc.)

Question 25

What would the clinical presentation be like for someone with Herpes?

Answer 25

Painful genital ulcers
Headache
Myalgia
Painful dysuria

Question 26

What would the clinical presentation be like for someone with Syphilis?

Answer 26

(Usually) painless swelling with ulceration

Question 27

What infestations could a patient present with?

Answer 27

Scabies (skin rash, itching)

Pubic lice

Question 28

Which STIs can also present systemically?

Answer 28

With genital manifestations (secondary syphilis; gonorrhoeal arthritis; sexually acquired reactive arthritis; herpes meningitis or encephalitis)

Without genital manifestations (HIV, Hepatitis A/B/C)