Urethritis, Vaginal Discharges, PID, Prostatitis, Inguinal and Scrotal Swellings 2

Question 1

What are the types of prostatitis?

Answer 1

Acute

Chronic bacterial

Chronic non-bacterial/prostatodynia

Question 2

What causes acute bacterial prostatitis?

Answer 2

Same organisms that cause UTIs

Question 3

Where does bacteria that cause prostatitis come from?

Answer 3

Organisms ascend from urethra and urinary bladder.

Rarely caused by haematogenous spread.

Question 4

How is prostatitis treated?

Answer 4

Depends on organism if found

Long term therapy is 6 - 8 weeks

Anti-inflammatory action of macrolides

Often persisting symptoms

May need alpha blockers or neurogenic pain relief

Question 5

What is the typical presentation of LGV serovar of trachomatis?

Answer 5

Proctitis

Question 6

How is LGV trachoma treated?

Answer 6

3 weeks of doxycycline

Question 7

Which conditions are more common in WA these past few years?

Answer 7

Syphillis and chlamydia

Question 8

What group most commonly is affected by syphillis?

Answer 8

Men who have sex with other men

Question 9

What pathogen causes syphillis?

Answer 9

Tryponema Pallidum which is a spirochete

Question 10

What are the symptoms of syphillis?

Answer 10

Primary: chancre with incubation period of 2 - 12 weeks that lasts 6 - 12 weeks

Secondary: rash, ulcers, condyloma lata, alopecia, lymphadenopathy 6 weeks later

Latent and tertiary: Gummas, CVS, Neuro 6 years +

Question 11

How is syphillis diagnosed?

Answer 11

DGI, SEROLOGY, TPHA or Enzyme ImmunoAssay as screen

RPR if positive ask for syphilis serology

PCR can give diagnosis

Question 12

How is syphilis treated?

Answer 12

Benzathine penicillin (makes it last for 10 days due to long term effect of syphillis), ceftriaxone, doxycycline

Question 13

What is TPHA/TPPA?

Answer 13

T.pallidum haemagglutination assay/ T.pallidum particle agglutination

These are important serology tests done for syphillis

Question 14

What are the specific antibody tests done for syphillis serology?

Answer 14

EIA - Enzyme ImmunoAssay

TPHA/TPPA - T.pallidum haemagglutination assay / T.pallidum particle agglutination

FTA-Abs - Fluorescent Treponemal antibody absorption

Question 15

What is RPR/VDRL?

Answer 15

Venereal Diseases Research Laboratories / Rapid Plasma Reagin (nontreponemal tests which measure titres of specific antibodies directed towards cardiolipin, lecithin and cholesterol

Question 16

What is the accuracy like in RPR/VDRL?

Answer 16

It is non-specific and tends to fall over time and become negative in 2 years.

Question 17

How is RPR/VDRL used?

Answer 17

To test effectiveness of treatment rather than diagnosis.

This allows for testing of reinfection (only test)

VDRL is used in neurosyphilis IgM mainly

Question 18

When does RPR give false positives?

Answer 18

Acute in febrile illnesses such as hepatitis EBV infection and Malaria, can give false positive from pregnancies and immunizations.

Chronic IDUs, autoimmune diseases, chronic diseases such as leprosy, and malignancy

Question 19

When are all test sensitivities highest?

Answer 19

During secondary syphillis and higher.

During primary syphillis test sensitivities range from 70 - 90% (EIA and FTA-abs highest)

Question 20

Which viruses cause herpes?

Answer 20

HSV 1 and 2

Question 21

How is herpes treated?

Answer 21

No cure

Question 22

How is Herpes tested for?

Answer 22

PCR swab of lesions

Serology is no useful for acute disease diagnosis.

Question 23

How is HSV treated?

Answer 23

Prodrug antivirals:

Famciclovir (77%)

Valaciclovir (54%)

Normal antivirals:

Aciclovir

Question 24

What effect do the prodrugs have?

Answer 24

They are very safe because they are only effective when virus is present.

They suppress viral action and prevent episode recurrence

Question 25

How is donovanosis caused by klebsiella granulomatis treated?

Answer 25

Azithromycin 1g

Question 26

What is the treatment for chancroid caused by haemophilus ducreyi and where is it seen most often?

Answer 26

Azithromycin, ceftriaxone, ciprofloxacin, and erythromycin

Seen in South East Asia and Africa

Question 27

How is chancroid prevented and diagnosed?

Answer 27

Prevented from male circumcision and can be diagnosed via gram stain, culture and nucleic acid tests