T3 L8 Sexually transmitted infections

Question 1

Who gets STIs?

Answer 1

Young age
Frequent partner change, high number, concurrency (simultaneous partners) 
Sexual orientation
Ethnicity for some STIs
Use of non-barrier contraception 
Residence in inner city / deprivation
History of previous STI

Question 2

What factors are associated with early intercourse?

Answer 2

Leaving home / not living with parents before 16 years
Leaving school early
Family disruption & disadvantages
Lack of nurturing relationships
Those whose main source of information on sex wasn’t school / parents

Question 3

What are the negative aspects of porn?

Answer 3

Unrealistic nature & expectations
Self-image / performance anxiety
Lack of censorship / boundaries 
Hardcore material becomes addictive / normalised
Ethical issues eg exploitation of women
Sexual consent becomes blurred
Lack of condom use
Reduced risk perception or perceived need to practice safe sex

Question 4

What are the main messages to get across to young people?

Answer 4

Don't rush into it - avoid peer pressure
Use condoms with all new partners
Sort out contraception
Avoid overlapping sexual relationships
Get screened for chlamydia / gonorrhoea with new partner

Question 5

What is the GMC guidance for genital examinations?

Answer 5

Offer chaperone
Explain why examination is necessary and what it involves
Give patient privacy to undress and dress
Obtain permission before examination and discontinue if patient asks you to
Keep discussion relevant

Question 6

Describe the female genital examination

Answer 6

Inspect pubic area, labia major, minor and perianal area
Inspect and palpate inguinal ring
Leg rests for better visualisation
Speculum examination
Bimanual examination if indicated

Question 7

Describe the male genital examination

Answer 7

Inspect pubic area, inguinal region
Inspect scrotum and perianal area
Palpate scrotal contents
Inspect penis
Particular attention to coronal sulcus, frenulum and meatus
Note presence of urethral discharge

Question 8

What are pearly penile papule?

Answer 8

Coronal papillae

Secrete oil that moistens glans of penis

Question 9

What are fordyce spots?

Answer 9

Visible sebaceous glands present in most individuals

Question 10

What other conditions can present with genital signs?

Answer 10

Malignant melanoma
Psoriasis
Tinea cruris
Scabies

Question 11

Describe the appearance of scabies

Answer 11

Pruritic papules on genitals
Lesions and burrows in finger webs and wrists
Often find a rash down side of body

Question 12

Give examples of bacterial STIs

Answer 12

Chlamydia
Gonorrhoea
Syphilis

Question 13

Give example of protozoal STI

Answer 13

Trichomonas

Question 14

Describe bacterial STIs

Answer 14

More often florid symptoms
Rapid diagnosis
Effective treatment available
Curative
Reservoirs can be controlled

Question 15

Give examples of viral STIs

Answer 15

Herpes, warts, HIV, hepatitis, molluscum contagiosum

Question 16

Describe viral STIs

Answer 16

Many are unaware of infection
Delayed presentation
Diagnostic tests may be unreliable
Symptomatic treatment only
Often life-long
Expanding reservoirs

Question 17

What are the common symptoms of gonorrhoea and chlamydia?

Answer 17

Dysuria

Discharge

Question 18

What is the incubation period of gonorrhoea and chlamydia?

Answer 18

2 to 30 days

Most symptoms occur 4-6 days after being infected

Question 19

Describe primary syphilis

Answer 19

1-3 weeks after contact
Red mark leading to raised spot leading to ulcer at site of contact
Enlarged lymph nodes in groin / neck which heal within 1-3 weeks
Lesions don’t tend to be painful

Question 20

Describe secondary syphilis

Answer 20

2-6 weeks after primary stage
Lasts for 2-4 weeks
Systemic dissemination - millions of spirochetes spread throughout body
Flu-like illness (headache, lymphadenopathy)
Mouth ulcers
Condylomata lata
Arthritis
Rapid resolution with effective treatment (penicillin)
Particularly suspect if rash involves palms & soles

Question 21

Describe trichomonas vaginalis

Answer 21

Single cell protozoan parasite
Infects vagina and urethra
Dysuria, discharge
Strawberry cervix
Diagnosed by seeing motile organisms on microscopy

Question 22

What is used to treat trichomonas vaginalis?

Answer 22

Metronidazole

Question 23

What are the most common types of genital warts?

Answer 23

6 and 11

Question 24

What types of HPV cause cervical cancer?

Answer 24

16
18
31
33

Question 25

What are the signs and symptoms of herpes simplex?

Answer 25

Painful ulceration, dysuria, vaginal discharge
Systemic symptoms - fever, myalgia
Signs - blistering, ulceration, inguinal lymphadenopathy

Question 26

Describe candida / thrush

Answer 26

Fungal
Itching, discharge, swelling
Popular rush in males
Topical antifungals

Question 27

Describe bacterial vaginosis

Answer 27

Discharge, fishy odour
Imbalance of vaginal flora
Overgrowth of anaerobes
Often due to over-washing
Responds to metronidazole

Question 28

What are the complications of chlamydia / gonorrhoea?

Answer 28

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

Question 29

What are the complications of HPV / warts?

Answer 29

Cervical cancer
AIN
VIN
PIN

Question 30

What are the complications of bacterial vaginosis?

Answer 30

Miscarriage
Early labour
Low birth weight

Question 31

What are the complications of trichomonas vaginalis?

Answer 31

Miscarriage
Early labour
Low birth weight

Question 32

What are the complications of syphilis?

Answer 32

Dementia

Cardiac abnormalities

Question 33

what are the complications of hep B/C?

Answer 33

Cirrhosis

Liver cancer

Question 34

What are the complications of HIV?

Answer 34

Long-term morbidity and mortality
Opportunistic infections
Tumours
Non-AIDs malignancies