STIs

Question 1

What antibiotic is used to treat trichomonas?

Answer 1

Metronidazole or tinidazole

Question 2

What is the treatment for chlamydia?

Answer 2

1g Azithromycin single dose or if allergy, 7d 100mg BD doxycycline. Doxy can’t be used in pregnancy.

Longer course required if PID, epididymitis or reactive arthritis

Question 3

What is the most common bacterial STI?

Answer 3

Chlamydia trichomonas

Question 4

After diagnosing a patient with chlamydia and giving her antibiotics, what else should you do?

Answer 4

Contact trace for last 6 months and treat

POC not routinely performed, but can be done 2-3 months later since 20% become reinfected

Question 5

How does gonorrhoea gram stain?

Answer 5

Gram negative diplococcus

Question 6

How does gonorrhoea present in men and women? (genital sx)

Answer 6

Men - 75% have purulent discharge, dysuria
Women - 60% asx/minimal sx, rest have dysparenuia/mild PV bleeding/PV discharge. Less commonly may present with secondary Bartholin’s abscess

Question 7

How can gonorrhoea present in systems outside the genital system?

Answer 7

Can also present with PR bleeding/discharge, pharyngitis
Conjunctivitis (usually unilateral) - can also develop in neonates (ophthalmia neonatorum)
1-3% of anorectal becomes disseminated and pts very unwell - rash, fever, arthralgia, septic arthritis, endocarditis, meningitis
Fitz Hugh Curtis Syndrome - deranged LFTs, perihepatic inflammation/adhesions

Question 8

What treatment would you give a patient with suspected gonorrhea?

Answer 8

500mg IM ceftriaxone + local anaesthetic for comfort (used to use penicilin and ciprofloxacin - increasing resistance)
Rate of co-infection with chlamydia is also high so treat for chlamydia (azithromycin/doxycycline)

Question 9

In a woman with syphilis what are the chances of prematurity and perinatal death if she is untreated?

Answer 9

40%

Question 10

Stages of syphilis

Answer 10

Primary - painless rubbery ulcer (chancre)
Secondary - maculopapular rash on hands/soles, condylomata lata (perianal wart-like growths), painless oral ulcers
Latent syphilis - Asx
Tertiary syphilis - necrotic inflammatory lesions (gummas), CV and neurological damage

Question 11

True or false - syphilis serology (e.g. Treponemal IgG EIA, TPPA/TPHA) can be used as proof of cure

Answer 11

False - serology remains positive even after treatment

RPR titre can be used to monitor response to treatment

Question 12

What antibiotic is used to treat syphilis?

Answer 12

Penicillin

Allergy - doxycycline (NOT in pregnancy)

Question 13

Which HPV subtypes are important?

Answer 13

HPV subtypes 6 and 11 cause 90% of clinical warts in the genital area
Types 16 and 18 are responsible for approximately 70% of all cervical