STIs

Question 1

Describe normal vaginal flora?

Answer 1

Lactobacillus species predominate and are protective e.g. L crispatus and L jensenii
acid pH is normal 4-4.5
other organisms that may be present include group B beta haemolytic strep (only important in pregnancy), candida (in small numbers), strep viridans group

Question 2

Describe the bacteria that causes gonorrhoea?

Answer 2

gram negative intracellular diplococcus which infects the urethra, endocervix, rectum and pharynx

Question 3

Tests for gonorrhoea?

Answer 3

NAATs (nucleic acid amplification tests) are test of choice as has better sensitivity that culture however as GC antimicrobial resistance is high culture on selective media should be performed prior to any treatment being given
in men FVU or urethral swabs and in women VVS or endocervical
MSM may need pharyngeal or recta

Question 4

Symptoms of gonorrhoea in men and women?

Answer 4

In women GC can cause increased vaginal discharge, dysuria, postcoital or intermenstrual bleeding and lower abdo pain
In men GC can cause anterior urethritis with mucopurulent or purulent urethral discharge and dysuria

Question 5

Treatment of gonorrhoea?

Answer 5

must refer to SRH to test for sensitivities as there are high rates of antibiotic resistance

first line is usually ceftriaxone and may give azithromycin on top of this but need to do selective culture due to high rates of resistance

Question 6

Gram staining of chlamydia?

Answer 6

it doesn’t gram stain

Question 7

Describe chlamydia serovars?

Answer 7

Serovars D-K cause genital infection, A-C eye infection and L1-L3 lymphogranuloma venereum

Question 8

Symptoms of chlamydia in women and men?

Answer 8

In women usually infects the endocervix but can infect the urethra. Symptoms include increased vaginal discharge, dysuria, post coital or intermenstrual bleeding and lower abdo pain. Exam of cervix may reveal mucopurulent cervicitis or contact bleeding

in men it can cause urethritis with milky discharge and dysuria

Question 9

Tests for chlamydia?

Answer 9

NAATs

get sample in men FVU or urethral swabs and women VVS or endocervical swabs

Question 10

Treatment of chlamydia?

Answer 10

doxycyline 100 mg bd for 7 days if intolerant azithromycin 1g od day 1 then 500 mg of for 2 days

Question 11

What organism causes syphilis?

Answer 11

infection with spirochete bacteria treponema pallidum

Question 12

Does syphilis gram stain?

Answer 12

no