Trends + presentations of STIs

Question 1

What is typically tested in an STI screen?

Answer 1

HIV
syphilis
chlamydia
gonorrhoea

Question 2

What age is most likely to be diagnosed with an STI?

Answer 2

15-24

Question 3

Commonest STI in UK

Answer 3

Chlamydia trachomatis

Question 4

Female presentation chlamydia trachomatis

Answer 4

asymptomatic
discharge
deep dyspareunia
dysuria
lower abdominal pain
inter-menstrual bleeding
post-coital bleeding

Question 5

Male presentation chlamydia trachomatis

Answer 5

urethral discharge
dysuria
testicular pain and swelling

Question 6

Signs on examination of female with chlamydia trachomatis

Answer 6

cervicitis
pelvic tenderness

Question 7

Signs on examination of male with chlamydia trachomatis

Answer 7

urethral discharge
testicular tenderness and swelling

Question 8

Female complications of chlamydia trachomatis

Answer 8

pelvic inflammatory disease
endometritis
salpingitis
tubal infertility
ectopic pregnancy
sexually acquired reactive arthritis (SARA)
perihepatitis

Question 9

Male complications of chlamydia trachomatis

Answer 9

sexually acquired reactive arthritis
epididymo-orchitis

Question 10

How is chlamydia trachomatis diagnosed?

Answer 10

NAAT (nucleic acid amplification test)

Question 11

Chlamydia trachomatis management

Answer 11

doxycycline 100mg BD for 1 week
no sexual intercourse during treatment
contact tracing

Question 12

Neisseria gonorrhoea clinical presentation

Answer 12

penile urethral infection - discharge/dysuria, mucopurulent

female urethral infection - dysuria without urinary frequency

endocervical infection - increased or altered vaginal discharge, lower abdominal pain

rectal infection - anal discharge, perianal/anal pain or discomfort

pharyngeal infection - sore throat

complicated infection - epididymo-orchitis, prostatitis, PID

Question 13

How does disseminated gonococcal infection occur and how does it present?

Answer 13

haematogenous dissemination from infected mucous membranes to cause skin lesions, arthralgia, arthritis and tenosynovitis

Question 14

Microscopy findings gonorrhoea

Answer 14

gram negative diplococci

Question 15

Neisseria gonorrhoea treatment

Answer 15

in uncomplicated ano-genital and pharyngeal infection in adults:

• when antimicrobial sensitivity not known - ceftriaxone 1g IM single dose
• when antimicrobial sensitivity known and is sensitive - ciprofloxacin 500mg orally single dose

Question 16

What type of organism is trichomonas vaginalis?

Answer 16

flagellated protozoa
(single-celled organism)

Question 17

Where is trichomonas vaginalis found in cis women if infected?

Answer 17

vagina
urethra
paraurethral glands

Question 18

Clinical features of trichomonas vaginalis in women

Answer 18

symptoms:
asymptomatic
vaginal discharge
vulval itching
dysuria
offensive odour
lower abdominal pain

signs:
vaginal discharge - classical = yellow frothy
vulvitis
vaginitis
strawberry cervix

Question 19

Clinical features of trichomonas vaginalis in men

Answer 19

symptoms:
asymptomatic (usually present as sexual partner of infected woman)
urethral discharge
dysuria
urethral irritation
urinary frequency

signs:
urethral discharge
rarely - balanoposthitis

Question 20

Trichomonas vaginalis treatment

Answer 20

metronidazole 400-500mg BD 7 days
no sex during treatment

Question 21

What type of bacteria causes syphilis?

Answer 21

treponema pallidum - spirochaete

Question 22

Describe primary syphilis

Answer 22

incubation usually 21 days
chancre (develops from single papule)
anogenital, single, painless and indurated with clean base, non-purulent
can be multiple, painful and purulent
resolve over 3-8 weeks

Question 23

Describe secondary syphilis

Answer 23

if primary syphilis is untreated - some can develop secondary syphilis
4-10 weeks after initial chancre
multi-system (rash, neurological)

Question 24

Describe the rash of secondary syphilis

Answer 24

widespread, mucocutaneous
may be itchy
palms and soles
mucous patches (buccal, lingual and genital)
condylomata lata

Question 25

Neurological complications of secondary syphilis

Answer 25

acute meningitis cranial nerve palsies uveitis optic neuropathy interstitial keratitis and retinal involvement

Question 26

Describe latent syphilis

Answer 26

secondary syphilis will resolve spontaneously in 3-12 weeks and disease enters asymptomatic latent stage can get recurrence of secondary disease in early latent stage

Question 27

What is late syphilis

Answer 27

after 2 years from initial infection generally 20-40 years after initial infection gummatous, cardiovascular and neurological complications

Question 28

Signs of congenital syphilis (early - within 2 years of birth)

Answer 28

rash haemorrhagic rhinitis generalised lymphadenopathy hepatosplenomegaly skeletal abnormalities condylomata lata vesiculobullous lesions osteochondritis periostitis pseudoparalysis

Question 29

Signs of congenital syphilis (late - after 2 years)

Answer 29

interstitial keratitis Clutton's joints Hutchinson's incisors mulberry molars high palatal arch rhagades sensorineural deafness frontal bossing short protuberance of mandible saddle nose

Question 30

Syphilis treatment

Answer 30

benzathine penicillin 2.4MU gluteal injection mixed with lidocaine (first line for primary, secondary and early latent syphilis)

Question 31

What causes genital herpes?

Answer 31

herpes simplex virus

Question 32

What are the 2 types of HSV associated with genital herpes?

Answer 32

HSV-1 = orolabial herpes, now most common cause of genital herpes in UK HSV-2 = used to be most common cause of genital herpes in UK, virus that is more likely to cause anogenital symptoms

Question 33

Clinical features of genital herpes

Answer 33

asymptomatic local - painful ulceration, dysuria, vaginal or urethral discharge systemic = more common in primary disease = fever, myalgia signs: blistering or ulceration of external genitalia or perianal region tender inguinal lymphadenitis recurrent outbreaks limited to affected dermatome

Question 34

Aetiology of genital warts

Answer 34

human papillomavirus (HPV) subtypes 6 or 11 most infections resolve spontaneously within a year

Question 35

Clinical features genital warts

Answer 35

symptoms: asymptomatic single or multiple lumps irritation/itching or discomfort bleeding signs: soft, cauliflower-like growths flat, plaque-like or pigmented

Question 36

Genital warts treatment

Answer 36

cosmetic home treatment: podophyllotoxin or imiquimod cream clinic: cryotherapy

Question 37

General risk factors for STIs

Answer 37

young age GBMSM (gay and bisexual men who have sex with men) geography - more likely in cities more than one partner in preceding 3 months

Question 38

Questions to ask in a history to screen for HIV risk factors

Answer 38

ever had sexual contact with a man or transwoman? for women: ever had sex with bisexual man? contact with anyone born outside UK? which country? patient's country of origin ever injected drugs or had a partner who injected drugs? ever paid for sex or been paid for sex?

Question 39

Mycoplasma genitalium treatment

Answer 39

uncomplicated = doxycycline 100mg BD 7 days followed by azithromycin 1 gram day 8, 500mg days 9 and 10 PID/epididymoorchitis = moxifloxacin 400mg OD for 14 days

Question 40

What are the guidelines for test for cure for STIs?

Answer 40

gonorrhoea re-test 2 weeks post-treatment, no sex for those 2 weeks chlamydia no sex during treatment and until partner treated, test for cure at 6 weeks for 25y and under mycoplasma genitalium test for cure 5 weeks after starting treatment