STIs

Question 1

What is a commensal micro-organism?

Answer 1

A micro organism that derives food or other benefits from another organism without hurting or helping it.

Question 2

What is pathogen?

Answer 2

A micro-organism that can cause disease.

Question 3

What is an infection?

Answer 3

The invasion of all or part of the body by a micro-organism.

Question 4

What is a sexually transmissible microbe?

Answer 4

A virus, bacteria or protozoan which can be spread by sexual contact.

Question 5

What is a sexually transmitted infection?

Answer 5

An infection by a pathogen which is sexually transmissible and which is unlikely to be transmitted by non-sexual means.

e.g Neisseria gonorrhoea, HPV type 6

Question 6

What is a sexually transmitted disease?

Answer 6

A disorder of structure or function caused by a sexually transmitted pathogen.

e.g pelvic inflammatory disease, genital warts

Question 7

What are some examples of Venereal diseases?

Answer 7

Syphilis (treponema pallidum pallidum)
Gonorrhoea (tessera gonorhoeae)
Chancroid (haemophilus ducreyi)

Question 8

What are some other sexually transmitted organisms in the UK?

Answer 8

Bacteria:

• Chlamydia trachomatis
• Klebsiella granulomatis
• Mycoplasma genitalium

Viruses:

• HSV
• HPV
• HIV

Parasites:

• Pthirus pubis
• Sacrcoptes scabei
• Trichomonas vaginalis

Question 9

What are some features of STIs?

Answer 9

Transmissible
Asymptomatic most of the time
All manageable but not all curable
Avoidable.

Question 10

What STIs are transmissible via genital contact only?

Answer 10

Pubic lice (pthirus pubis)
Scabies (sarcoptes scabeii)
Warts (human papilloma virus type 6&11)
Herpes (herpes simplex virus types 1&2)

Question 11

What are some systemic symptoms of STIs?

Answer 11

Fever
Rash
Lymphadenopathy
Malaise
infertility
Cancer
Adverse pregnancy outcomes

Question 12

What are the management aims of someone with a suspected STI?

Answer 12

Good history
Partner notification
HIV testing
Health promotion

Question 13

What are some genital symptoms?

Answer 13

Discharge from orifice
Pain from somewhere
Rashes
Lumps and swellings
Cuts
Sores
Ulcers
Itching
Change in appearance
Vague sense of things not being right.

Question 14

What are some possible causes of genital symptoms?

Answer 14

STD
Other microbial problem
Non-microbial

Question 15

What are some examples of microbial conditions not regarded as STDs?

Answer 15

Vulvovaginal candidosis
Bacterial vaginosis
Balanoposthitis 
Tinea cruris
Erythrasma
Impetigo
Cellulitis
Infected sebaceous glands

Question 16

What are some characteristics of vulvovaginal candidosis?

Answer 16

Usually acquired from bowel.
Often asymptomatic - changes in host environment can trigger pathogenicity.
If symptomatic then presents as ‘thrush’ - itch, thick cottage cheese discharge.

Question 17

What are some risk factors for vulvovaginal candidosis?

Answer 17

Diabetes
Oral steroids
Immune suppression 
Pregnancy
Reproductive age group

Question 18

What is the treatment for Vulvovaginal candidosis?

Answer 18

Azole antifungals:
-Clotrimazole 500mg PV once
-Fluconazole 150mg PO once.
Maintain skin - avoid irritants, treat dermatitis.

Question 19

What are the symptoms of bacterial vaginosis?

Answer 19

Asymptomatic in 50%
Watery grey/yellow ‘fishy’ discharge
May be worse after period/sex
Sometimes sore or itch from dampness.

Question 20

What are some problems with bacterial vaginosis that forms a biofilm?

Answer 20

Usually asymptomatic or very mild symptoms but associated with endometritis and premature labour.
Increases risk of HIV acquisition.

Question 21

What is the treatment for bacteria vaginalis?

Answer 21

Antibiotics - metronidazole (oral or gel), Clindamycin (vaginal)
Probiotics
Vaginal acidification

Question 22

What are the genital symptoms of non-microbial origin?

Answer 22

Perceived problem only - normal findings
Dermatoses
Structural abnormalities - congenital or acquired.

Question 23

What questions should you ask if there are no genital symptoms found on examination?

Answer 23

Regretted sexual encounter?
Problems in life?
Co-existing mental health issues?
When did they notice the problem?
When were things last normal? - fam/friend illness, media story etc.

Question 24

What is vulvodynia?

Answer 24

Persistent burning or aching of the vulva.