STIs

Question 1

Which organism causes gonorrhoea?

Answer 1

Neisseria gonorrhoeae

Question 2

What are the symptoms of gonorrhoea?

Answer 2

Men
- 10 % of males have no symptoms though might have clinical signs if examined
- thick, profuse, yellow discharge, dysuria
- rectal and pharyngeal infection often asymptomatic
Women
- >50% have no symptoms
- vaginal discharge, dysuria or intermenstrual/postcoital bleeding

Question 3

What are the complications of gonorrhoea?

Answer 3

Male
- epididymitis
Female
- pelvic inflammatory disease
- bartholin's abscess
- gonococcal ophthalmia neonatorum
Both
- acute monoarthritis usually elbow or shoulder
- disseminated gonococcal infection: skin lesions - pustular ith halo

Question 4

How is gonorrhoea diagnosed?

Answer 4

Nucleic Acid Amplification Test on urine or swab from an exposed site - vagina, rectum, throat. Could be self obtained or clinician obtained.
Gram stained smear from urethra/cervix/rectum in symptomatic people.

Question 5

How is gonorrhoea treated?

Answer 5

Blind treatment with ceftriaxone 1g IM
Can also treat according to antibiotic sensitivities
Test of cure at 2 weeks and test of reinfection at 3 months

Question 6

What are the symptoms of the rare Chlamydia trachomatis Serovar L2b?

Answer 6

Severe proctitis

Causes lymphogranuloma venereum

Question 7

What are the symptoms of chlamydia?

Answer 7

Men
- >70% asymptomatic
- slight watery discharge, dysuria
Women
- >80% asymptomatic
- vaginal discharge, dysuria, intermenstrual/postcoital bleeding
Both
- conjunctivitis

Question 8

What are the complications of chlamydia?

Answer 8

Men
- epididymitis
Women
- PID and hence ectopic pregnancy, pelvic pain and infertility (probably only 1% of women who get chlamydia will develop a problem with their fertility)
Both
- reactive arthritis/reiter’s syndrome - urethritis/cervicitis + conjunctivitis + arthritis

Question 9

How is chlamydia diagnosed?

Answer 9

First void urine in men
Self-taken or clinician-taken swab from cervix, urethra, rectum as appropriate
All specimens tested using a NAAT

Question 10

How is chlamydia treated?

Answer 10

Doxycycline 100mg bd 1 week
Azithromycin 1g once if pregnant
Test for reinfection at 3-12 months
Earlier test of cure not needed unless symptoms persist

Question 11

What is the causative organism of chlamydia?

Answer 11

Chlamydia trachomatis serovars D to K

Question 12

What is the causative organism of herpes?

Answer 12

Herpes Simplex Virus types 1 and 2

Question 13

What are the symptoms of herpes?

Answer 13

80% have no symptoms
The rest have recurring symptoms - monthly, annually
Burning/itching then blistering then tender ulceration
Tender inguinal lymphadenopathy
Flu like symptoms
Dysuria, neuralgic pain in back, pelvis and legs

Question 14

What are the complications of herpes?

Answer 14

Autonomic neuropathy (urinary retention)
Neonatal infection
Secondary infection

Question 15

How is herpes diagnosed?

Answer 15

Clinical impression

Swab from lesion tested using PCR

Question 16

How is herpes treated?

Answer 16

Primary outbreak
- aciclovir: various regimens e.g. 400mg tds for 5 days
- lidocaine ointment
Infrequent recurrences
-