STIs

Question 1

What organism causes Gonorrhoea?

Answer 1

Neisseria gonorrhoeae

Question 2

Gonorrhoea symptoms in Men and Women

Answer 2

Men

• Majority symptomatic (90%) - 10% have no symptoms but may still have clinical signs
• Thick, profuse yellow discharge
• Dysuria
• Rectal and pharyngeal infection is often asymptomatic

Women

• >50% have no symptoms
• Vaginal discharge
• Dysuria
• Intermenstrual/post-coital bleeding

Question 3

Complications of Gonorrhoea in Men and Women

Answer 3

• Men
  
  • Epididymitis
• Women
  
  • Pelvic inflammatory disease, Bartholin’s abscess
• Both (rare!)
  
  • Acute monoarthritis usually elbow or shoulder
  • Disseminated Gonococcal infection: skin lesions

Question 4

What is the incubation period of Gonnorrhoea?

Answer 4

• On average 5-6 days
• But can be from 2 days to 2 weeks.

Question 5

Epidemiology of Gonnorrhoea

Answer 5

• Much less common than chlamydia
• Most cases are in men and specically men who have sex with men

Question 6

How is Gonnorrhoea diagnosed?

Answer 6

• Nucleic Acid Amplification Test (NAAT) from urine sample or swab from an exposed site (vagina, rectum, throat)
• Gram stained smear from urethra/cervix/rectum in symptomatic people.
• Culture of swab-obtained specimen from an exposed site - should be done for all confirmed cases to assess antibiotic sensitivity.

Question 7

Treatment for Gonorrhoea

Answer 7

Blind treatment with ceftriaxone 1g im (injection)

Can also treat according to antibiotic sensitivities (once culture has been done)

Follow up = another swab/test at 2 weeks and again at 3 months

Question 8

What organism causes Chlamydia?

Answer 8

Chlamydia trachomatis serovars D to K

Question 9

Chlamydia symptoms in Men and Women?

Answer 9

Men

• >70% are asymptomatic
• Slight watery discharge
• Dysuria

Women

• >80% asymptomatic
• Vaginal discharge
• Dysuria
• Intermenstrual/post-coital bleeding

Both

• Conjunctivitis

Question 10

Complications of Chlamydia in Men and Women

Answer 10

Men

• Epididymitis

Women

• Pelvic inflammatory disease - ectopic pregnancy
• Pelvic pain
• Infertility

Both

• Reactive arthritis / Reiter’s syndrome - urethritis/cervicitis + conjunctivitis + arthritis

Question 11

How is Chlamydia diagnosed?

Answer 11

Females - swab from cervix or urethra or rectum - Nucleic Acid Amplification Test (commonly use PCR technique)

Males - First void urine in men or rectal swab - NAAT

Question 12

Treatment and follow up for Chlamydia

Answer 12

• Doxycycline 100mg twice a day
• Azithromycin if pregnant

Test for reinfection at 3-12 months

Question 13

What organisms cause Herpes?

Answer 13

Herpes simplex 1 + 2

Question 14

Symptoms of Herpes

Answer 14

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 15

Complications of herpes virus

Answer 15

• Autonomic neuropathy (urinary retention)
• Neonatal infection - TORCH
• Secondary infection

Question 16

What is the incubation period for herpes?

Answer 16

• About 5 days to months
• Some people never report symptoms

Question 17

Epidemiology of herpes

Answer 17

• Very common - 15 to 20% of the UK population has it
• Both strains equally common and roughly equal between sexes

Question 18

How is herpes diagnosed?

Answer 18

• Clinical impression
• Swab from lesion tested using PCR

Question 19

Treatment of herpes

Answer 19

• Primary outbreak
  
  • Aciclovir (5 days)
  • Lidocaine ointment
• Infrequent recurrences
  
  • Lidocaine ointment
  • Aciclovir - once daily until symptoms are gone (1-3 days)
• Frequent recurrences
  
  • Aciclovir - long term as suppression

Question 20

Trichomiasis:

• Causative organism
• Symptoms
• Epidemiology
• Complications
• Diagnosis
• Treatment

Answer 20

• Causative organism - Trichomonas vaginalis
• Symptoms:
  
  • Men
    
    • Usually asymptomatic
  • Women
    
    • 10-30% asymptomatic
    • Profuse thin vaginal discharge - greenish, frothy and foul smelling
    • Vulvitis
• Epidemiology
  
  • Uncommon, more common in middle aged women than other STIs
• Complications
  
  • Miscarriage and preterm labour
• Diagnosis
  
  • PCR on vaginal swab
  • No test for men as not validated on urine yet
• Treatment
  
  • Metronidazole for 5 days or single dose available

Question 21

What organism causes anogenital warts?

Answer 21

Human Papilloma virus types 6 and 11

Question 22

Epidemiology of genital warts

Answer 22

>90% of UK population have a genital HPV infection at some point in their life

Only about 20% of those infected with a wart-causing strain of human papilloma virus get warts.

Question 23

Treatment of anogenital warts

Answer 23

• Podophyllotoxin or imiquimod - both are home treatments.
• Others – cryotherapy (freezing)
• Bulky warts – diathermy, scissor removal.

Question 24

What organism causes syphillus?

Answer 24

Treponema pallidum

Question 25

Symptoms/stages of syphillis

Answer 25

Often entirely asymptomatic or mild symptoms which go unreported

• Primary - local ulcer
• Secondary - rash, mucosal ulceration
• Early latent - no symptoms
• Late latent
• Tertiary - neurological, CV or gummatous skin lesions

Question 26

Diagnosis of syphillis

Answer 26

• Clinical signs
• Serology for TP IgGEIA, TPPA and RPR tests
• PCR on sample from an ulcer

Question 27

Treatment of syphillis

Answer 27

Early (2 years) and no neurological involvement

• Benzathine penicillin im once
• Doxycycline 2x daily oral 2 weeks

Late >2 years and no neurological involvement

• Benzathine penicillin im weekly for 3 doses
• Doxycycline 2x daily oral 28 days