STIs

Question 1

what is the most likely differential for a male with purulent discharge and pain on urination

Answer 1

gonorrhoea

Question 2

what is the most likely differential for a male with mild watery discharge

Answer 2

chlamydia

Question 3

describe the normal vaginal flora

Answer 3

Normal vaginal flora – lactobacillus spp. Predominate in the healthy vagina produce:

• lactic acid – these suppress growth of other bacteria
• +/- hydrogen peroxide – of other bacteria

can also have small numbers of strep v, group b strep, candida

Question 4

Intensely itchy white vaginal discharge

Answer 4

candida

Question 5

what are the risk factors for candida

Answer 5

Recent antibiotic therapy; High oestrogen levels (pregnancy, certain types of contraceptives); Poorly controlled diabetes; Immunocompromised patients

Question 6

diagnose candida

Answer 6

high vaginal swab for culture

Question 7

treat oral candida

Answer 7

nystatin

Question 8

treat vaginal candida

Answer 8

topical clotrimazole pessary or cream

oral fluconazole

Question 9

Awful smelling discharge and may have dyspareunia

Answer 9

bacterial vaginosis

Question 10

what is the main cause of BV

Answer 10

gardnerella vaginalis

Question 11

what mainly has neutrophils on stain

Answer 11

gonorrhoea

Question 12

what type of cells indicate BV

Answer 12

clue cells

Question 13

diagnose BV

Answer 13

whiff test (add potassium hydroxide to elicit foul odor) 
wet mount

Question 14

treat BV

Answer 14

metronidazole 7 days

Question 15

describe chlamydia trachomatis

Answer 15

obligate intracellular bacteria with biphasic lifestyle

Question 16

does chlamydia stain with gram stain ?

Answer 16

no as no peptidoglycan in the cell wall

Question 17

what are the three serological groupings of chlamydia?

Answer 17

A-C - trachoma (eye infection)
D-K - genital infection
L1-L3 - lymphogranuloma venereum

Question 18

what are the main tests for chlamydia or gonorrhoea

Answer 18

NAAT or PCR

Question 19

how do you test for chlamydia and gonorrhoea

Answer 19

male - first pass urine

female - vulvovaginal swab

Question 20

how do you treat chlamydia

Answer 20

doxycycline (if contraindicated give azithromycin)

Question 21

what type of bacteria is Neisseria gonorrhoea?

Answer 21

gram neg intracellular diplococcus

Question 22

what is the incubation period of gonorrhoea

Answer 22

2-5 days

Question 23

what is the main symptom of gonorrhoea

Answer 23

purulent discharge

Question 24

treat gonorrhoea

Answer 24

IM ceftriaxone

Question 25

incubation of syphillus

Answer 25

9-90 days

Question 26

painful ulcer

Answer 26

herpes

Question 27

painless ulcer

Answer 27

syphillus chancre

Question 28

how do you test for syphilis

Answer 28

IgM or IgG elisa for screening | if positive PCR or dark chain microscopy for diagnosis (or VDRL/ TPPA)

Question 29

in syphilis what do you look for on dark chain microscopu

Answer 29

spirochaetes

Question 30

what bacetria causes syphillus

Answer 30

treponema pallidum

Question 31

types 6 and 11 HPV cause

Answer 31

warts

Question 32

types 16 and 18 cause

Answer 32

cervical cancer

Question 33

incubation of HPV

Answer 33

3 weeks to 9 months

Question 34

Painless cauliflower like warts on vagina or penis

Answer 34

HPV viral warts

Question 35

how do you treat viral warts

Answer 35

warticon (podophyllotoxin) imiquimoid cryotherapy

Question 36

what is the incubation of herpes?

Answer 36

3-6 days

Question 37

what is the duration of illness of herpes

Answer 37

14-21 days

Question 38

why can herpes come back

Answer 38

remains in sacral root ganglion

Question 39

how to test for herpes

Answer 39

viral swab pcr

Question 40

treat herpes

Answer 40

acyclovir and pain relief

Question 41

describe trichomonas vaginalis

Answer 41

Single celled protozoal parasite

Question 42

what STI divides by binary fission

Answer 42

trichomonas vaginalis

Question 43

diagnose trichomonas in females

Answer 43

high vaginal swab for PCR test

Question 44

treat trichomonas

Answer 44

oral metronidazole

Question 45

what is another name for phthirus pubis

Answer 45

crabs

Question 46

what is the main symptom of phthirus pubis

Answer 46

extreme itch

Question 47

how long do crabs live for

Answer 47

Males on average live for 22 days, female for 17 days

Question 48

how is the diagnosis of phthirus pubis made

Answer 48

clinically

Question 49

treat phthirus pubis

Answer 49

malathion lotion

Question 50

what are the causative organisms of prostatitis?

Answer 50

Same organisms as UTI (E. coli & other coliforms, Enterococcus sp., but check for STI in patients <35years (gonorrhoea, chlamydia)

Question 51

diagnosis of prostatitis

Answer 51

clinical signs and mid stream sample of urine for culture and sensitivity if under 35yo do first pass urine also for chlamydia / gonorrhoea)

Question 52

treat prostatitis

Answer 52

ciprofloxacin for 28 days | trimethoprim if high c diff risk