STIs and vaginal discharge

Question 1

White clumped discharge like cottage cheese, associated with vaginal itch

Answer 1

Candidiasis (thrush)

Question 2

Whitish-grey discharge with unpleasant fishy smell

Answer 2

Bacterial vaginosis

Question 3

Frothy green/yellow discharge with strawberry cervix on examination

Answer 3

Trichomonas

Question 4

Colourless discharge with a consistency that varies with menstrual cycle

Answer 4

Physiological vaginal discharge

Question 5

General STI screening guidelines

Answer 5

All sexually active young people age 15-29 who are asymptomatic and high risk populations (ATSI, IVDU, sex workers, MSM) should be tested annually for chlamydia with a first pass urine or genital swab (Dr/ self collected) PCR

Question 6

STI screening guidelines for MSM

Answer 6

MSM should be screened for gonorrhoea, chlamydia, syphilis, HIV, Hep A and Hep B annually

Question 7

STI screening guidelines for pregnant women

Answer 7

All pregnant women should be screened for Hep B, C, HIV and syphilis

Question 8

Male presents with urethritis with dysuria and clear urethral discharge after unprotected sex a few weeks ago

Answer 8

Chlamydia trachomatis

Question 9

Management for Chlamydia trachomatis

Answer 9

Azithromycin 1g as a single dose stat or Doxycycline 100mg BD for 7 days
No sex for 7 days including oral sex, not even with condoms
Screen for other STIs
Contact trace partners
Notify Victorian Health Department
Safe sex education (condoms, no sex with partners from last 6/12 until they are tested and treated)
Retest in 3/12
HEEADSSS
Ongoing annual STI screening
Immunisations for hepatitis if not already immunised

Question 10

Returned male traveller presents with thick, purulent discharge with dysuria

Answer 10

Neisseria gonorrhoea

Question 11

What is the gram stain for Neisseria gonorrhoea?

Answer 11

Gram negative diplococci

Question 12

Management for Neisseria gonorrhoea

Answer 12

Ceftriaxone 500 mg in 2 ml of 1% lignocaine as a single IM injection + Azithromycin 1g as a single dose
MCS for sensitivity
No sex for 7 days including oral sex, not even with condoms
Screen for other STIs
Contact trace partners
Notify Victorian Health Department
Safe sex education (condoms, no sex with partners from last 2/12 until they are tested and treated)
Retest in 3/52 for cure, 6/12 for reinfection
HEEADSSS
Ongoing annual STI screening
Immunisations for hepatitis if not already immunised

Question 13

Which STI is usually asymptomatic?

Answer 13

Chlamydia trachomatis

Question 14

What is the treatment for Treponema Pallidum (syphilis)?

Answer 14

Penicillin

Question 15

What is the treatment for Trichomonas?

Answer 15

Metranidazole

Question 16

What is the treatment for bacterial vaginosis?

Answer 16

Metranidazole