STIs Flashcards
35 year old male with dysuria and purulent urethral discharge.
What’s the likeliest diagnosis?
Gonorrhoea
35 year old male with dysuria and purulent urethral discharge.
How would you diagnose?
Urethral swab
NAAT (FCU)
35 year old male with dysuria and purulent urethral discharge.
How would you treat? What if there is known ABX resistance?
IM Ceftriaxone 250mg IM
Azithromycin 1g PO
Then
Ciprofloxacin 500mg PO
–> Quinolone
Chlamydia is normally asymptomatic in males and females – true or false?
true
Chlamydia is associated with endometriosis – true or false?
false
Chlamydia can lead to infertility – true or false?
true
How would you test for chlamydia?
NAAT – urine sample (men); vaginal swab (female)
Chlamydia is treated by?
Azithromycin or doxycycline
Name an STI that can cause septic Arthritis.
Gonnorhoea
Which STI can commonly cause a green, frothy vaginal discharge?
trichomoniasis
How would you treat Trichomoniasis?
Metronidazole or tinidazole
What are crabs in relation to STIs?
Pubic lice
Name 3 symptoms of endometriosis.
- Dysmenorrhoea/Oligomenorrhoea*
- Chronic pelvic pain*
- Deep dyspareunia*
- Chronic fatigue*
- Sub-fertility*
Can endometriosis cause ovarian cysts – true or false? How may this be shown or not shown.
True (ovarian endometrioma) shown by homogenous, low-level echoes on TV-US
Can endometriosis be rules out by examination alone?
No, TV-US required
Which is the most certain way to diagnose endometriosis?
A. Clinical examination
B. TV-US
C. Hysterosalpingography (HSG)
D. Diagnostic laparoscopy
D. Diagnostic laparoscopy
Name 3 possible treatments for Endometriosis.
Fertility desired
• Clomifene: 50-200mg PO OD 5/7
–> Ovulatory stimulant: increase GnRH ≈ increase FSH and LH
Fertility undesired
• COCP: Drospierenone/Ethinylestradiol: 30mg/3mcg
+
• NSAIDs: Mefenamic acid
OR
• Laparoscopic diathermy/excision
OR
• Hysterectomy
1) Clomifene
2) COCP + Mefenamic Acid
3) Laparoscopic Diathermy
4) Hysterectomy
Is endometriosis as common as diabetes?
A. Less common
B. Equal
C. More common
D. Data not available
B. Equal
PID usually causes cyclical pelvic pain –true or false?
False
Name 2 ways weight management can be relevant to infertility (be as precise as possible)
Weight gain if BMI < 19
Weight loss (6.5kg) if BMI > 29
≈ stimulate ovulation
Name 3 presenting clinical features of PCOS.
Hirsutism
Acne
Oligomenorrhea
Obesity/ Metabolic Syndrome
Infertility
Name 3 treatments for PCOS that may increase the chances of conception.
Weight loss / gain
Clomifene
Metformin
Name 2 examination findings that may suggest a cause for male infertility
Varicocele
Hypogonadism
Klinefelter’s Syndrome (Gynecomastia)
Cryptorchidism
Which disease does a chancre suggest?
Syphilis
What is the treatment for Genital Herpes?
Give the pathogen which causes this disease.
Aciclovir
HSV-2
What pathogen causes anogenital warts?
What is the Latin term for Anal warts?
Condyloma acuminatum
HPV
What is an STI?
Group of infections transmitted through sexual intercourse (venereal) involving range of clinical syndromes.
List 5 risk factors in general for STIs.
- Young age < 25 years
- No contraception
- Non-regular sexual relationships
- IVDU/PWID
- Sex workers
- Social deprivation
- Poor access to advice and Rx of STIs
- African Origin
What is the reason for using a charcoal swab when testing for STIs?
A. Stop reduction
B. Stop oxidation
C. Stop hydrolysis
D. Stop damage of the sample
B. Stop oxidation
List 3 investigations used for diagnosing STIs.
NAAT (VVS/ECS/FCU)
Culture and Microscopy
Serology
What type of intracellular particle facilitates the active spread of chlamydia?
Elementary Bodies
Concept: Elementary as ‘new’
What type of intracellular particle facilitates the latency of chlamydia?
Reticulate Bodies
What type of bacteria is chalmydia?
A. Spirochete
B. Bacillus
C. Diplococcus
D. Sarcina
B. Bacillus
What type of bacteria is Gonorrhoea?
A. Spirochete
B. Bacillus
C. Diplococcus
D. Sarcina
C. Diplococcus
What type of bacteria is Syphilis?
A. Spirochete
B. Bacillus
C. Diplococcus
D. Sarcina
A. Spirochete
What type of gram bacteria is Syphilis?
A. Gram positive
B. Gram negative
C. No cell wall
B. Gram negative
What type of gram bacteria is Chlamydia?
A. Gram positive
B. Gram negative
C. No cell wall
B. Gram negative
What type of gram bacteria is Gonorrhoea?
A. Gram positive
B. Gram negative
C. No cell wall
B. Gram negative
How may chlamydia usually present? List 3 features for males and 3 for females.
Usually asymptomatic
F • Vaginal/Anal discharge • Post-coital bleeding • Abdnominal/Pelvic Tenderness • Reiter’s Syndrome (arthritis; cervicitis; urethritis and conjunctivitis) • Proctitis • Pharyngitis • Perihepatitis
M • Vaginal/Anal discharge • Epididymal tenderness • Prostatitis • Reiter’s Syndrome (arthritis; cervicitis; urethritis and conjunctivitis) • Pharyngitis • Perihepatitis
What are the features of Reiter’s Syndrome?
Conjunctivitis
Arthritis
Cervicitis (Female)
Urethritis
Which of the following is not a feature of Reiter’s Syndrome in males?
A. Arthritis
B. Cervicitis
C. Conjunctivitis
D. Urethritis
B. Cervicitis
Give two features which may present in a neonatal with a Chlamydia trachomatis infection.
Conjunctivitis (5-12 days)
Pneumonia (1-3 years)
Ellie, a 22 year old Geography student presents with vaginal discharge, joint pain and pain when urinating (dysuria). In her history she says she recently went clubbing in America where she had two one night stands to get over her ex-Boyfriend. She recounts having an UPSI with a random person she met on one of the nights out.
What investigations would you want to run?
- NAAT: VVS/ECS/FCU
- Direct immunofluorescence
- Microscopy?
Ellie, a 22 year old Geography student presents with vaginal discharge, joint pain and pain when urinating (dysuria). In her history she says she recently went clubbing in America where she had two one night stands to get over her ex-Boyfriend. She recounts having an UPSI with a random person she met on one of the nights out.
The investigation comes back to show an infection with Chlamydia.
What pathogen causes this?
Chlamydia trachomatis
Ellie, a 22 year old Geography student presents with vaginal discharge, joint pain and pain when urinating (dysuria). In her history she says she recently went clubbing in America where she had two one night stands to get over her ex-Boyfriend. She recounts having an UPSI with a random person she met on one of the nights out.
The investigation comes back to show an infection with Chlamydia.
How would you treat this?
• Doxycycline: 100mg PO BD 7/7
OR
• Erythromycin: 500mg QDS 7/7
+
• Supportive: Notify partner/avoid sexual contact
List 3 potential complications of Chlamydia.
- Trachoma
- Genital infection
- Lymphogranuloma (serovars L1-L3)
- PID
- Sexually-acquired arthritis (ankles + feet)
- Epididymo-orchitis
- Peri-hepatitis
- Cancer
Which serovars of Chlamydia trachomatis can cause lymphogranuloma?
A. A
B. B
C. C
D. L1-3
D. L1-3
Outline the pathophysiology behind the most distinctive symptom/clinical feature of Gonorrhoea.
adherence to urogenital epithelium –> phagocytosed by macrophages and neutrophils –> neutrophil-rich (purulent) exudate –> transmission across epithelial membrane
List 3 clinical features of Gonorrhoea in Males and 3 in Females
F • Dysuria • Mucopurulent discharge ** • Post-coital bleeding** • Septic arthritis** (single joint) • Lower abdominal pain • Rectal infection • Salpingitis • PID • Pharyngeal infection
M • Mucopurulent discharge ** • Epididymal tenderness • Septic arthritis** (single joint) • Pharyngeal infection
Which of the following is the most distinctive symptom of Gonorrhoea?
A. Dysuria
B. Lower abdominal pain
C. Septic arthritis
D. Mucopurulent discharge
D. Mucopurulent discharge
Which condition may be present in neonates who have Gonorrhoea?
• Ophthalmia neonatorum
Ellie, a 22 year old Geography graduate presents with abdominal pain, dysuria and post-coital bleeding. She says she only has one partner currently but 6 months ago, after her ex-boyfriend broke up with her, she tried to replace him with multiple one-night stands to no avail. She has a gravidity of 0 and parity of 0 (nulliparous). She has been diagnosed with an anankastic personality disorder to which she is receiving CBT.
You get a chaperone for her physical examination. O/E you notice mucopurulent discharge which is sampled with a VVS. Additionally, when performing a general MSK exam, you notice unilateral knee joint pain (septic arthritis)?).
What is the likely diagnosis? Which pathogen causes this disease?
Gonorrhoea
Neisseria gonorrhoea
Ellie, a 22 year old Geography graduate presents with abdominal pain, dysuria and post-coital bleeding. She says she only has one partner currently but 6 months ago, after her ex-boyfriend broke up with her, she tried to replace him with multiple one-night stands to no avail. She has a gravidity of 0 and parity of 0 (nulliparous). She has been diagnosed with an anankastic personality disorder to which she is receiving CBT.
You get a chaperone for her physical examination. O/E you notice mucopurulent discharge which is sampled with a VVS. Additionally, when performing a general MSK exam, you notice unilateral knee joint pain (septic arthritis)?).
What investigations would you wish to confirm the suspicion of Gonorrhoea?
- NAAT: FCU/ECS/VVS/PS
- Culture + Light microscopy: Negative gram stain diplocci
- Urinalysis: Proteinuria/Haematuria/Leukocytes
Ellie, a 22 year old Geography graduate presents with abdominal pain, dysuria and post-coital bleeding. She says she only has one partner currently but 6 months ago, after her ex-boyfriend broke up with her, she tried to replace him with multiple one-night stands to no avail. She has a gravidity of 0 and parity of 0 (nulliparous). She has been diagnosed with an anankastic personality disorder to which she is receiving CBT.
You get a chaperone for her physical examination. O/E you notice mucopurulent discharge which is sampled with a VVS. Additionally, when performing a general MSK exam, you notice unilateral knee joint pain (septic arthritis)?).
The investigations show a positive find for a gram negative pathogen, with the light microscopy showing a diplococci (Neisseria gonorrhoea).
How would you manage this condition?
Ceftriaxone (250mg IM)
+
Azithromycin (1mg PO)
+
Notify partner
+
NAAT (test of cure)
Ellie, a 22 year old Geography graduate presents with abdominal pain, dysuria and post-coital bleeding. She says she only has one partner currently but 6 months ago, after her ex-boyfriend broke up with her, she tried to replace him with multiple one-night stands to no avail. She has a gravidity of 0 and parity of 0 (nulliparous). She has been diagnosed with an anankastic personality disorder to which she is receiving CBT.
You get a chaperone for her physical examination. O/E you notice mucopurulent discharge which is sampled with a VVS. Additionally, when performing a general MSK exam, you notice unilateral knee joint pain (septic arthritis)?).
The investigations show a positive find for a gram negative pathogen, with the light microscopy showing a diplococci (Neisseria gonorrhoea). Upon further testing, the pathogen is known to bear some Antibiotic Resistance.
How would you manage this condition?
• Ciprofloxacin: 500mg PO \+ Notify partner \+ NAAT (test of cure)
List the complications of Gonorrhoea.
- PID
- Ectopic Pregnancy
- Infertility
- Blindness (Ophthalmia neonatorum)
- Fitz-Hugh-Curtis Syndrome (PID –> perihepatitis ≈ cholecystitis Sx)
What eponymous syndrome is a complication of Gonorrhoea and may resemble Cholecystitis.
Fitz-Hugh-Curtis Syndrome due to peri-hepatitis
List 2 pathogens which may trigger (Bacterial) Vaginosis.
Trichomonas vaginalis
Candida albicans
Outline the pathophysiology of Bacterial Vaginosis
• Dysbiosis (impaired vaginal flora) + Trigger –> Inflammation
List 3 features of Bacterial Vaginosis.
- Vaginal discharge (thick, white and cottage-cheese = Candida vs Malodorous and white = Bacterial Vaginosis vs Yellow and odorous = Trichomoniasis)
- Dysuria
- Discharge adherent to vaginal walls
- Pruritus
- Vulvodynia
- Erythema
- Shiny/pale epithelium
Eleanor, a 22 year old Fashion student, presents with dysuria and vaginal discharge. She describes it as malodorous and white. She explains that she has been having affairs with other men from Tinder whilst still being in a relationship with her boyfriend of 3 years. She is nulliparous and occasionally smokes cannabis, takes magic mushrooms but does not drink alcohol as it is too unhealthy for her.
You get a Chaperone for her physical examination. O/E you identify the malodorous, cottage-cheese like vaginal discharge. It is adherent to the vaginal wall and you identify vulvodynia, erythema and a pale epithelium.
What is your most likely diagnosis?
Bacterial Vaginosis
Eleanor, a 22 year old Fashion student, presents with dysuria and vaginal discharge. She describes it as malodorous and white. She explains that she has been having affairs with other men from Tinder whilst still being in a relationship with her boyfriend of 3 years. She is nulliparous and occasionally smokes cannabis, takes magic mushrooms but does not drink alcohol as it is too unhealthy for her.
You get a Chaperone for her physical examination. O/E you identify the malodorous, cottage-cheese like vaginal discharge. It is adherent to the vaginal wall and you identify vulvodynia, erythema and a pale epithelium.
What investigation would you wish to conduct?
And what process would you use to make the diagnosis?
Vaginal pH (elevated) > 4.5
Amine whiff test: Volatile mines
Microscopy: Clue cells
Diagnosis requires 2/3 Amsel Criteria
1) Discharge
2) Amine whiff test
3) Microscopy
4) pH
What diagnostic criteria can be used to diagnose Bacterial Vaginosis?
Amsel criteria (2/3)
1) Discharge
2) Amine whiff test
3) Microscopy
4) pH
Eleanor, a 22 year old Fashion student, presents with dysuria and vaginal discharge. She describes it as malodorous and white. She explains that she has been having affairs with other men from Tinder whilst still being in a relationship with her boyfriend of 3 years. She is nulliparous and occasionally smokes cannabis, takes magic mushrooms but does not drink alcohol as it is too unhealthy for her.
You get a Chaperone for her physical examination. O/E you identify the malodorous, cottage-cheese like vaginal discharge. It is adherent to the vaginal wall and you identify vulvodynia, erythema and a pale epithelium.
What management or treatment would you give for this Bacterial Vaginosis?
• Metronidazole
OR
• Clotrimazole
Eleanor, a 23 year old Marketing student, presents with dysuria and vaginal discharge. She describes it as viscous and white. She explains that she has been having affairs with other men from Tinder whilst still being in a relationship with her boyfriend of 3 years. She is nulliparous and occasionally smokes cannabis, takes magic mushrooms but does not drink alcohol as it is too unhealthy for her.
What is your differential? Which pathogen might cause this?
Thrush
Candida albicans
Eleanor, a 23 year old Marketing student, presents with dysuria and vaginal discharge. She describes it as viscous and white. She explains that she has been having affairs with other men from Tinder whilst still being in a relationship with her boyfriend of 3 years. She is nulliparous and occasionally smokes cannabis, takes magic mushrooms but does not drink alcohol as it is too unhealthy for her.
What investigation might you consider?
• Clinical DDx
or
• Microscopy: Hyphae and budding yeast
Eleanor, a 23 year old Marketing student, presents with dysuria and vaginal discharge. She describes it as viscous and white. She explains that she has been having affairs with other men from Tinder whilst still being in a relationship with her boyfriend of 3 years. She is nulliparous and occasionally smokes cannabis, takes magic mushrooms but does not drink alcohol as it is too unhealthy for her.
What treatment would you advise?
• Clotrimazole
What pathogen causes Syphilis?
Treponema pallidum
Outline the pathophysiology of Syphilis.
• Sexual intercourse or inherited in utero –> T. pallidum enters via skin or mucosal membrane –> disseminated systemically via lymphatic system to regional lymph nodes ± invasion of CNS
Outline the 3 stages of Syphilis
- Chancre @ 3 weeks
- Red maculopapular rash (likely urogenital region and mouth)
- CNS degeneration, aneurysms and granulomatous lesions in liver, skin and bone in 40% of pt
List 3 clinical features of Syphilis
- Chancre (anogenital)
- Lymphadenopathy
- Diffuse maculopapular rash (condyloma lata)
- Constitutional symptoms
- Rhinitis
- Hepatosplenomegaly
What is condyloma acuminatum? What pathogen causes this.
Genital Warts
HPV
What is condyloma lata? What pathogen causes this.
Syphilis
Treponema pallidum
Joanne, a 54 year old Care Worker presents with fever and rhinitis. She says she has had this for a week or two and despite trying everything, it won’t resolve. She also mentions she has had a rash on her palms and soles. She is worried it may be an infectious parasite she caught when she went holidaying in the Bahamas last month.
She is recently divorced, has an IUD so doesn’t use barrier contraception. She says recently she has had sex with three men and a woman, all unprotected - two of which were on multiple occasions. She is a smoker with 20 pack years, drinks 14 units of alcohol a week, has a BMI of 28 and is has had all her vaccines when required.
You ask for a Chaperone for her physical examination. O/E you notice diffuse lymphadenopathy. Additionally a diffuse maculopapular rash (condyloma lata) is identified on her both volar aspects bilaterally. On her vulva, you identify a painless chancre.
What is your differential?
Syphilis
Joanne, a 54 year old Care Worker presents with fever and rhinitis. She says she has had this for a week or two and despite trying everything, it won’t resolve. She also mentions she has had a rash on her palms and soles. She is worried it may be an infectious parasite she caught when she went holidaying in the Bahamas last month.
She is recently divorced, has an IUD so doesn’t use barrier contraception. She says recently she has had sex with three men and a woman, all unprotected - two of which were on multiple occasions. She is a smoker with 20 pack years, drinks 14 units of alcohol a week, has a BMI of 28 and is has had all her vaccines when required.
You ask for a Chaperone for her physical examination. O/E you notice diffuse lymphadenopathy. Additionally a diffuse maculopapular rash (condyloma lata) is identified on her both volar aspects bilaterally. On her vulva, you identify a painless chancre.
What investigations would you wish to conduct to confirm your diagnosis of Syphilis?
- Microscopy (dark field): Coiled spirochete
- NAAT: Swab/FPU
- Serology: EIA positive Treponema enzyme
Joanne, a 54 year old Care Worker presents with fever and rhinitis. She says she has had this for a week or two and despite trying everything, it won’t resolve. She also mentions she has had a rash on her palms and soles. She is worried it may be an infectious parasite she caught when she went holidaying in the Bahamas last month.
She is recently divorced, has an IUD so doesn’t use barrier contraception. She says recently she has had sex with three men and a woman, all unprotected - two of which were on multiple occasions. She is a smoker with 20 pack years, drinks 14 units of alcohol a week, has a BMI of 28 and is has had all her vaccines when required.
You ask for a Chaperone for her physical examination. O/E you notice diffuse lymphadenopathy. Additionally a diffuse maculopapular rash (condyloma lata) is identified on her both volar aspects bilaterally. On her vulva, you identify a painless chancre.
What is your management of Joanne?
• Benzathine Benzylpenicillin G: 2.4 MU IM for 3 weeks (3 doses)
What is the treatment for Syphilis detected early?
A. Benzathine Benzylpenicillin G: 2.4 MU IM single dose
B. Benzathine Benzylpenicillin G: 2.4 MU IM for 3 weeks (3 doses)
C. Benzylpenicillin: 10.8-14.4g as 1.8-2.4g IV every 4 hours for 14
A. Benzathine Benzylpenicillin G: 2.4 MU IM single dose
What is the treatment for Syphilis detected late?
A. Benzathine Benzylpenicillin G: 2.4 MU IM single dose
B. Benzathine Benzylpenicillin G: 2.4 MU IM for 3 weeks (3 doses)
C. Benzylpenicillin: 10.8-14.4g as 1.8-2.4g IV every 4 hours for 14
B. Benzathine Benzylpenicillin G: 2.4 MU IM for 3 weeks (3 doses)
What is the treatment for Syphilis detected late?
A. Benzathine Benzylpenicillin G: 2.4 MU IM single dose
B. Benzathine Benzylpenicillin G: 2.4 MU IM for 3 weeks (3 doses)
C. Benzathine Benzylpenicillin: 10.8-14.4g as 1.8-2.4g IV every 4 hours for 14
C. Benzylpenicillin: 10.8-14.4g as 1.8-2.4g IV every 4 hours for 14
What is the characteristic clinical feature of Genital HPV infection?
Genital Warts (condyloma acuminatum)
Outline the pathophysiology of HPV causing Cervical Cancer.
• Sexual contact -> taken up L1-receptor -> viral replication -> Infected cell leaves SC compartment to become more active (E6 + E7 oncogenes + viral replication + inhibition of p53 and pRB) ≈ immortalise keratinocyte -> oncogene activation causes transition from CIN to ICC ≈ cancer risk; Viral-laden cells ready for desquamation
Which HPV serotypes are most oncogenic?
HPV-16 and HPV-18
Which HPV serotypes are most likely to cause a condyloma acuminatum?
HPV-6 and HPV-11
Ellie, a 23 year old Law student, presents with an anogenital pruritus and vaginal bleeding. She has recently engaged in UPSI with 3 partners, all unprotected. She discloses that she takes LARCs in the form of Drospirenone/Ethinylestradiol (30mg/3mcg) so does not require barrier contraception.
You get a chaperone for her examination. O/E you identify numerous condyloma acuminatum in the anogenital region.
What is your differential?
Genital Warts
HPV
Ellie, a 23 year old Law student, presents with an anogenital pruritus and vaginal bleeding. She has recently engaged in UPSI with 3 partners, all unprotected. She discloses that she takes LARCs in the form of Drospirenone/Ethinylestradiol (30mg/3mcg) so does not require barrier contraception.
You get a chaperone for her examination. O/E you identify numerous condyloma acuminatum in the anogenital region.
What investigation might you consider?
Clinical diagnosis
OR
cancer risk? Serotype of HPV…
Ellie, a 23 year old Law student, presents with an anogenital pruritus and vaginal bleeding. She has recently engaged in UPSI with 3 partners, all unprotected. She discloses that she takes LARCs in the form of Drospirenone/Ethinylestradiol (30mg/3mcg) so does not require barrier contraception.
You get a chaperone for her examination. O/E you identify numerous condyloma acuminatum in the anogenital region.
What is your management?
• Vaccination: VLPL1 capsid proteins
+
• Podophyllotoxin topical: 0.5% BD for 3 days
Which pathogen causes Genital Herpes?
HSV-2
Where are HSV-1 viral particles likely to establish themselves?
Trigeminal ganglia
Where are HSV-2 viral particles likely to establish themselves?
Lumbosacral ganglia
List 3 features of Genital Herpes.
- Genital ulcer (vesicular)
- Oral ulcer
- Tingling neuropathic pain
- Lymphadenopathy
Initial: Latent following initial reactivation with episodes shorter than 10 days • Febrile flu-like prodrome • Neuropathic tingling pain • Dysuria • Bilateral crops of painful blisters • Lymphadenopathy • Local oedema • Discharge
A 24 year old male Architecture student, Johnknee, presents with a complaint about pain in his right middle finger and sore neck. He says he has had this pain for about 3 months and Ibuprofen fails to alleviate it fully.
He also mentions prior to the pain, he had a fever which he worries could have caused these symptoms. He is a non-smoker who drinks 8 units a week, exercises for 3 hours a week and lives with his girlfriend of 3 years. He travels a lot with his internship and admits having sex with other people. Towards the end, he brings up a separate matter of a genital ulcer.
O/E you notice an oral ulcer, the diffuse lymphadenopathy present in the inguinal region and femoral regions. The neuropathic pain is localised to the dermatomes T1 and L4. You identify vesicular lesions on his penis.
What is your differential? Which putative pathogen causes this?
Genital Warts
Herpes Simplex Virus-2
A 24 year old male Architecture student, Johnknee, presents with a complaint about pain in his right middle finger and sore neck. He says he has had this pain for about 3 months and Ibuprofen fails to alleviate it fully.
He also mentions prior to the pain, he had a fever which he worries could have caused these symptoms. He is a non-smoker who drinks 8 units a week, exercises for 3 hours a week and lives with his girlfriend of 3 years. He travels a lot with his internship and admits having sex with other people. Towards the end, he brings up a separate matter of a genital ulcer.
O/E you notice an oral ulcer, the diffuse lymphadenopathy present in the inguinal region and femoral regions. The neuropathic pain is localised to the dermatomes T1 and L4. You identify vesicular lesions on his penis.
What investigations might you want to conduct to confirm your differential of Herpes Simplex-2 Genital Herpes?
- Viral culture
- HSV PCR
- Serology: Glycoprotein G with Ab to HSV-1/HSV-2
A 24 year old male Architecture student, Johnknee, presents with a complaint about pain in his right middle finger and sore neck. He says he has had this pain for about 3 months and Ibuprofen fails to alleviate it fully.
He also mentions prior to the pain, he had a fever which he worries could have caused these symptoms. He is a non-smoker who drinks 8 units a week, exercises for 3 hours a week and lives with his girlfriend of 3 years. He travels a lot with his internship and admits having sex with other people. Towards the end, he brings up a separate matter of a genital ulcer.
O/E you notice an oral ulcer, the diffuse lymphadenopathy present in the inguinal region and femoral regions. The neuropathic pain is localised to the dermatomes T1 and L4. You identify vesicular lesions on his penis.
What is your management for this?
• Aciclovir: 400mg PO TDS 7-10 days
