T2 L8 Sexually Transmitted Diseases

Question 1

What group of people get STIs?

Answer 1

Young age (<20 years) - low age at 1st intercourse - coitarche

Frequent partner change, high no. lifetime partners, concurrency (simultaneous partners)

Sexual orientation (e.g. MSM)

Specific ethnic for some STIs

Use of non barrier contraception

Residence in inner city/ deprivation

History of previous STI

Question 2

Why are younger people at an increased risk of getting STIs?

Answer 2

They are behaviourally more vulnerable to STI acquisition.

• Higher numbers of sexual partners / partners change
• Greater numbers of concurrent partners
• Yet to develop skills and confidence to use condoms, negotiate safe sex,
• More risk-taking behaviour/ experimentation
• Poor contraception awareness

Question 3

Why are young women more vulnerable to a HPV infection?

Answer 3

There is a larger SA of columnar epithelium in younger female which is what viruses like HPV likes to infect.

Question 4

What is happening to the age of first intercourse in the UK?

Answer 4

The age of first intercourse is declining

Question 5

Which sex has a higher % of STIs between the ages of 16-24?

Answer 5

Females

Question 6

What % of men and women expressed regret regret for not waiting longer to have sexual intercourse?

Answer 6

Men = 20%
Women = 42%

Question 7

What vulnerabilities are associated with early intercourse?

Answer 7

• Leaving home / not living with parents before 16 years
• Leaving school early
• Family disruption & disadvantage
• Lack of nurturing relationships
• Those whose main source of information on sex was not school / parents

Question 8

Where do young people get their information on sex from?

Answer 8

School

Peers

Internet

Parents

Books

Question 9

What % of teenagers view porn regularly?

Answer 9

58%

NOTE: 1:10 watch it every day

Question 10

What is the average age of first seeing porn in boys and girls?

Answer 10

Boys: 10 years
Girls: 14 years

Question 11

What the main reasons boys start to watch porn?

Answer 11

Learn about sex / how to give pleasure

Gain status in peer group

Question 12

What are the effects of consuming a lot of porn on males?

Answer 12

More likely to have earlier sex

Certain sexual activities,

Less condom use

Question 13

How many times are men more likely than women to access porn?

Answer 13

6 times more likely

Question 14

What are female attitudes towards porn?

Answer 14

More likely to see as degrading

Many afraid to show concerns

Have mixed feelings about their partners using it

Question 15

What are the negative aspects of porn usage?

Answer 15

-Unrealistic nature & expectations
-Self-image / performance anxiety
-Lack of censorship / boundaries – hardcore material becomes addictive / normalised
-Ethical issues e.g. exploitation of women
-Sexual consent blurred
-Lack of condom use = reduced risk perception /
perceived need to practice safe sex

Question 16

What are the main messages that should be gotten across to young people about sex?

Answer 16

• Don’t rush into it – avoid peer pressure
• Use a condom with all new partners - continue until both screened
• Sort out contraception
• Avoid overlapping sexual relationships
• Get screened for chlamydia/gonorrhoea when you have a new partner
• MSM should have regular sexual health screens, including HIV, get vaccinated for hepatitis A/B and HPV & consider PrEP for HIV prevention

Question 17

What % of men and women had concurrent partnerships within the last 5 years?

Answer 17

Men = 14.6 %
Women = 9%

NOTE: Higher rates concurrence in the younger age range

Question 18

What % of gonorrhoea diagnoses in men were among MSM?

Answer 18

Over 70%

Question 19

What % of syphillis diagnoses were among MSM?

Answer 19

84%

Question 20

How did the rate of syphillis compare to other STIs? How does its rate differ between men and women?

Answer 20

Rates of syphilis diagnoses were much lower than for other STI infections

Rates were ten times higher among men compared to women

Question 21

Which ethnic group had the highest rate of STIs and which had the lowest rate?

Answer 21

The highest rates of STI diagnoses were reported in ‘Black or Black British’ & ‘Mixed’ ethnic groups.

The lowest rates were among those of ‘Asian or Asian British’ ethnic group.

Question 22

Define “core group”

Answer 22

• sub-group of the population – high turnover
• not a static entity
• highly sexually active individuals
• high prevalence of infection
• reservoirs of infection
• high frequency of transmission

Question 23

What is the effective control at the population level based on?

Answer 23

Targeting core groups

Question 24

In terms of area, where was the rate of STIs the highest?

Answer 24

Highest among those living in the most deprived areas of England

NOTE: STI rates increased with increasing IMD (Index of Multiple Deprivation) quintile

Question 25

What group of people have the highest rate of repeat gonorrhoea infections?

Answer 25

MSM

Question 26

What is the GMC guidance on carrying out a genital examination?

Answer 26

Offer a chaperone (this does not mean that you have to have a chaperone with you at all times) Explain to patient why examination is necessary & what it will involve Give patient privacy to undress & dress Obtain patient’s permission before the examination - discontinue if patient asks you to Keep discussion relevant - avoid unnecessary comments

Question 27

In what % of examinations are chaperones used?

Answer 27

>5%

Question 28

What should be done when carrying out a female genital examination?

Answer 28

- Inspect pubic area, labia majora & minora & perianal area - Inspect & palpate inguinal region - Leg rests - allow better visualisation - Speculum examination (use water as lubricant - gels can interfere with tests) - Bimanual examination (if indicated

Question 29

What should be done when carrying out a male genital examination?

Answer 29

- Inspect pubic area, inguinal region - Inspect scrotum & perianal area - Palpate scrotal contents – note presence of testes, any lumps/ tenderness - Inspect penis - record whether circumcised - if not inspect under foreskin - Particular attention to coronal sulcus, frenulum & meatus - Note presence of urethral discharge

Question 30

If you see this on the male/female genitalia is it normal or abnormal? - Pearly penile papules/ vulva papules (a.k.a papillomatosis) - Fordyce spots - Genital enlarged sebaceous glands - Malignant melanoma - Tinea cruris - Pruritic papules

Answer 30

- Pearly penile papules/ vulva papules (a.k.a papillomatosis) = NORMAL - Fordyce spots = NORMAL - Genital enlarged sebaceous glands = NORMAL - Malignant melanoma = ABNORMAL - Tinea cruris = ABNORMAL - indicates a dermatophyte (fungal) infection - Pruritic papules = ABNORMAL - indicates scabies

Question 31

Is scabies always sexually transmitted?

Answer 31

NO

Question 32

What are the characteristics of bacterial/protozoa STIs?

Answer 32

Chlamydia, gonorrhoea, syphilis, trichomonas - more often florid symptoms - early presentation - rapid diagnosis - effective treatment available - curative - reservoirs can be controlled

Question 33

What are the characteristics of viral STIs?

Answer 33

Herpes, warts, HIV, hepatitis - many unaware of infection - delayed presentation - diagnostic tests may be unreliable - symptomatic treatment only - often life-long - expanding reservoirs

Question 34

What symptoms does gonorrhoea & chlamydia commonly cause?

Answer 34

- dysuria | - discharge

Question 35

What is the incubation period for gonorrhoea/chlamydia? When do most symptoms occur?

Answer 35

The incubation period = 2 to 30 days Symptoms occur between 4–6 days (after being infected)

Question 36

When does primary syphilis occur?

Answer 36

1-3 weeks after contact (9-90 days)

Question 37

What are the physical characteristics of syphilis?

Answer 37

red mark => raised spot => ulcer at the site of contact Enlarged lymph nodes in the groin/neck Heals within 1-3 weeks (with or without treatment)

Question 38

TRUE OR FALSE | Lesions of primary syphilis lesions are very painful

Answer 38

FALSE

Question 39

When does secondary syphilis occur? How long does it last for?

Answer 39

2-6 weeks after 10 stage Lasts for 2-4 weeks

Question 40

What are the signs/symptoms of secondary syphilis?

Answer 40

Systemic dissemination - millions spirochaetes spread through-out the body Flu-like illness, headache, lymphadenopathy Mouth ulcers - “snail track” painless Condylomata lata - white/grey lumps in moist areas Arthritis NOTE: Particularly suspect if rash involves palms & soles

Question 41

How is syphilis treated?

Answer 41

Penicillin Rapid resolution with effective treatment

Question 42

What is Trichomonas vaginalis?

Answer 42

Single cell protozoan parasite Infects vagina & urethra Causes trichomonas vaginalis

Question 43

What are the symptoms caused by Trichomonas vaginalis?

Answer 43

Dysuria Discharge (causes frothy discharge, “strawberry cervix”)

Question 44

How is Trichomonas vaginalis diagnosed?

Answer 44

Diagnosed by seeing motile organisms on microscopy

Question 45

How is Trichomonas vaginalis treated?

Answer 45

Responds well to metronidazole

Question 46

What is the common cause of genital warts?

Answer 46

Extremely common, human papilloma virus (HPV) Type 6 & 11 in 90% Vs types 16 & 18, 31, 33 etc. (cervical cancer)

Question 47

TRUE OR FALSE | Increased cervical smears are recommended in patients with genital warts

Answer 47

FALSE

Question 48

What has happened to the number of diagnoses of anogenital warts since 2009? What could be the reason behind this?

Answer 48

It has declined The decline can partly be attributed to the moderately protective effect of HPV 16/18 vaccination against anogenital warts in young women.

Question 49

What is Molluscum contagiosum?

Answer 49

A viral infection that affects the skin

Question 50

How can Molluscum contagiosum be treated?

Answer 50

- Liquids, gels or creams that are applied directly to the skin - Minor procedures such as cryotherapy (where the spots are removed by freezing them)

Question 51

What are the symptoms for Herpes simplex?

Answer 51

painful ulceration, dysuria, vaginal discharge systemic symptoms e.g. fever and myalgia (more common in primary stage)

Question 52

What are the signs for Herpes simplex?

Answer 52

blistering & ulceration (+/- cervix/rectum) inguinal lymphadenopathy

Question 53

What proportion of people are aware they have genital herpes?

Answer 53

20%

Question 54

TRUE OR FALSE | Genital herpes is always type 2, cold sores are always type 1

Answer 54

FALSE

Question 55

Name the non-sexually transmitted infections and their characteristics

Answer 55

Candida / thrush - fungal - itching, discharge, swelling - papular rash in males - topical antifungals Bacterial vaginosis - discharge / “fishy” odour - imbalance of vaginal flora - overgrowth of anaerobes - often result of over-washing / bubble baths etc. - responds to metronidazole

Question 56

What are the complications of chlamydia / gonorrhoea?

Answer 56

- PID - Epididymitis - Infertility - Chronic pain - Reiter’s syndrome (urethritis, arthritis, conjunctivitis)

Question 57

What are the complications of HPV / warts?

Answer 57

- Cervical cancer - AIN (acute interstitial nephritis) - VIN (vulvar intraepithelial neoplasia) - PIN (prostatic intraepithelial neoplasia)

Question 58

What are the complications of bacterial vaginosis?

Answer 58

- Miscarriage - Early labour - Low-birth weight

Question 59

What are the complications of Trichomonas vaginalis?

Answer 59

- Miscarriage - Early labour - Low-birth weight

Question 60

What are the complications of syphilis?

Answer 60

Dementia Cardiac abnormalities

Question 61

What are the complications of hepatitis B, hepatitis C?

Answer 61

Cirrhosis Liver cancer

Question 62

What are the complications of HIV?

Answer 62

- Long term morbidity & mortality opportunistic infections - Tumours - Non-AIDS malignancies