STIs / PID

Question 1

What is a contraindication to Azithromycin?

Answer 1

Long QT syndrome

Or taking QT prolonging drugs

Question 2

After treating Chlamydia, how long should you wait before test of cure?

Answer 2

At least 5 weeks

Because diagnostic tests can detect traces of dead organisms

Question 3

What are possible sequelae of Chlamydia infection?

Answer 3

PID - infertility, pelvic pain, ectopic pregnancy
Fitz-Hugh-Curtis (peri-hepatitis)
Sexually acquired reactive arthritis or conjunctivitis

Males: epididymo-orchitis

Question 4

What is the therapy for Gonorrhoea, in patients allergic to Ceftriaxone?

Answer 4

Gentamicin 240mg IM stat

Question 5

What are the possible sequelae of Gonorrhoea infection?

Answer 5

PID - infertility, pelvic pain, ectopic pregnancy
Fitz-Hugh-Curtis (peri-hepatitis)
Disseminated infection
- arthritis, skin lesions, endocarditis, meningitis
Adverse pregnancy outcomes: Chorio-amnio it is, PPROM, neonatal conjunctivitis
Adult gonococcal conjunctivitis

Males: epididymo-orchitis

Question 6

What type or organism is Trichomonas?

Answer 6

Protozoan

Trichomonas vaginalis

Question 7

What are the examination findings with a Trichomonas infection?

Answer 7

Vulvitis, vaginitis
- scalded skin or napkin distribution dermatitis

“Classic” profuse yellow frothy discharge occurs in 10-30%

Question 8

What are the pregnancy implications of trichomonas infection?

Answer 8

LBW
PPROM and PTL
Post-party infection

Unclear whether treatment of asymptomatic infection in pregnancy reduces these outcomes

Question 9

What are two implications of trichomonas on other STIs / PID

Answer 9

Increases the risk of HIV acquisition and transmission

Increases the risk of PID in women with HIV

Question 10

What is the treatment for RECURRENT HSV infection?

Answer 10

Valciclovir - 500mg bd 3/6

Aciclovir - 800mg tds 2/7

Question 11

If concerned about contracting gonorrhoea from a specific episode of USPI, when should the person be tested?

Answer 11

At least 2/52 after exposure

Question 12

What are the effects of chlamydia on pregnancy?

Answer 12

Increases

• LBW
• PPROM

Neonatal

• conjunctivitis
• pneumonia

Question 13

What are the effects of gonorrhoea on pregnancy?

Answer 13

Increases

• Chorio-amnionitis
• PPROM

Neonatal

• conjunctivitis
• disseminated infection causing sepsis and arthritis
• scalp abscess following FSE

Question 14

Why is the vaginal pH < 4.5?

Answer 14

The presence of oestrogen leads to a glycogen-rich environment
Glycogen is broken down to lactic acid
Causing the pH to be <4/5

Question 15

What bacteria are commonly present in the vagina (commensal)?

Answer 15

Acid-tolerant organisms and lactobacilli
Anaerobic cocci
Diptheroids
CONS
Alpha-haemolytic streptococci
Possible pathogens can also be colonising organisms - GBS, actinomyces

Question 16

What is the commonest cause of abnormal discharge in women of reproductive age?

Answer 16

Bacterial Vaginosis

Question 17

What type of organisms are overgrown in BV?

Answer 17

Predominantly ANAEROBIC organisms
Which replace the lactobacilli
Increasing the pH up to 7.0

Gardnerella vaginalis
Prevotella species
Mycoplasma hominis

Question 18

What is Amsel’s Criteria?

Answer 18

Diagnostic criteria for BV, need to have at least 3 of 4:

Characteristic discharge
Clue cells on wet slide microscopy
pH > 4.5
Fishy odour on adding alkali to slide

Question 19

What is the treatment for recurrent BV?

Answer 19

Metronidazole at the beginning and end of each period

Aci-Jel at menstruation

Question 20

What are the effects of BV on pregnancy?

Answer 20

Late miscarriage
PPROM and PT
Endometritis

Symptomatic women should be treated with metronidazole (but there is no clear evidence that this improves outcomes)