STDs

Question 1

🦠 Chlamydia (Chlamydia trachomatis)

Answer 1

Signs/Symptoms:

Males: Urethral discharge, urethrtis, dysuria, epididymo-orchitis, prostatitis

Females: Often asymptomatic; may experience abnormal vaginal discharge, cervicitis, Fits-Hugh Curtis (liver-capsule adhesions), intermenstrual bleeding, pelvic pain, PID

Neonates: Conjunctivitis, pneumonia​

Transmission: Unprotected vaginal, anal, or oral sex; vertical transmission during childbirth​

Treatment:
- First-line: Doxycycline 100 mg twice daily for 7 days
- Pregnancy: Azithromycin 1 g single dose ​

Notes: Test of cure not routinely required unless pregnant or symptoms persist.​

Question 2

🦠 Gonorrhoea (Neisseria gonorrhoeae)

Answer 2

Signs/Symptoms:

Males: Purulent urethral discharge, dysuria

Females: Often asymptomatic; may have vaginal discharge, pelvic pain

Neonates: Ophthalmia neonatorum (conjunctivitis)​
NICE

Transmission: Unprotected vaginal, anal, or oral sex; vertical transmission during childbirth​

Treatment: Refer to GUM clinic for management; Ceftriaxone

Notes: Antimicrobial resistance is a concern; culture and sensitivity testing recommended.

Question 3

🦠 Syphilis (Treponema pallidum)

Answer 3

Signs/Symptoms:

Primary: Painless ulcer (chancre) at infection site

Secondary: Rash, mucous membrane lesions

Tertiary: Neurological and cardiovascular complications

Neonates: Congenital syphilis—may present with rash, hepatosplenomegaly, bone deformities​ (Hutchinson teeth)

Transmission: Unprotected sexual contact; vertical transmission during pregnancy​

Treatment: Refer to GUM clinic; Penicillin, Doxycycline.

Notes: Early treatment is crucial to prevent progression; partner notification essential.

Question 4

🦠 Genital Herpes (Herpes Simplex Virus type 1 or 2)

HSV1= oral
HSV2= genital

Answer 4

Signs/Symptoms:

Males/Females: Painful genital ulcers, dysuria, systemic symptoms during primary episode

Neonates: Disseminated disease, encephalitis, high mortality if untreated​

Transmission: Skin-to-skin contact during sexual activity; vertical transmission during childbirth​

Treatment:

First episode: Aciclovir 400 mg three times daily for 5 days (or Famciclovir, Valaciclovir) or nucelotide/nucleoside analogs

Recurrent episodes: Consider episodic or suppressive antiviral therapy ​

Notes: Antiviral treatment reduces symptom duration; does not eradicate virus.​

Question 5

🦠 Genital Warts (Human Papillomavirus types 6 and 11)

Answer 5

Signs/Symptoms:

Males/Females: Flesh-colored, cauliflower-like lesions on genital or perianal areas

Neonates: Rare; may develop laryngeal papillomatosis​

Transmission: Skin-to-skin contact during sexual activity​

Treatment:

Topical agents: Topical Podophyllotoxin 0.5% solution, imiquimod 5% cream

Physical removal: Cryotherapy, surgical excision

Notes: HPV vaccination can prevent infection with high-risk strains.​

Question 6

🦠 Trichomoniasis (Trichomonas vaginalis)

Answer 6

Signs/Symptoms:

Males: Often asymptomatic; may have urethral discharge, dysuria

Females: Frothy yellow-green vaginal discharge, vulvar irritation

Neonates: Rare; may acquire infection during birth​

Transmission: Unprotected vaginal sex​

Treatment: Metronidazole 500 mg twice daily for 7 days ​

Notes: Avoid alcohol during treatment; treat sexual partners concurrently.

Question 7

🦠 HIV (Human Immunodeficiency Virus)

Answer 7

Signs/Symptoms:

Acute: Fever, sore throat, rash

Chronic: Opportunistic infections, weight loss, night sweats

Neonates: Failure to thrive, recurrent infections​

Transmission: Unprotected sex, blood exposure, vertical transmission during pregnancy, childbirth, or breastfeeding​

Treatment: Antiretroviral therapy (ART) to achieve viral suppression ​

Notes: Pre-exposure prophylaxis (PrEP) recommended for high-risk individuals.

Question 8

🦠 Hepatitis B (Hepatitis B virus – HBV)

Answer 8

Signs/Symptoms:

Males/Females: Often asymptomatic; may have fatigue, jaundice, RUQ pain, nausea

Chronic infection: Cirrhosis, hepatocellular carcinoma

Neonates: Often asymptomatic initially; high risk of chronic infection

Transmission: Blood, sexual contact, vertical transmission at birth

Treatment:

Acute: Supportive only

Chronic: Antivirals (e.g. tenofovir, entecavir) – refer to hepatology

Notes:
Neonates of HBsAg-positive mothers need HBV vaccine + HBIG within 24 hours

Routine antenatal screening in UK

Question 9

🦠 Hepatitis C (Hepatitis C virus – HCV)

Answer 9

Signs/Symptoms:

Males/Females: Often asymptomatic; fatigue, joint aches, liver dysfunction in chronic cases

Neonates: May be asymptomatic; risk of chronic liver disease later

Transmission: Blood (esp. IVDU), rarely sexual, vertical transmission

Treatment:

Direct-acting antivirals (DAAs) – refer to specialist care

Question 10

🦠 Bacterial Vaginosis (not strictly STI but often linked)

Answer 10

Signs/Symptoms:

Females only: Thin, grey-white vaginal discharge with fishy odor

Males: Usually asymptomatic

Neonates: No direct effect

Transmission: Associated with sexual activity but not considered STI

Treatment:
Metronidazole 400–500 mg twice daily for 5–7 days

Notes:
- Recurrence is common
- Avoid vaginal douching

Question 11

🦠 Candidiasis (Candida albicans – not strictly STI)

Answer 11

Signs/Symptoms:

Females: Itching, thick white vaginal discharge

Males: Balanitis – itching, redness, white patches

Neonates: Oral thrush or diaper rash

Transmission: Not an STI but may be related to sexual activity

Treatment:
Topical clotrimazole or oral fluconazole

n.b. Consider underlying diabetes/immunosuppression if recurrent

Question 12

Chlamydia serotypes; which is the most common, which causes blindness if untreated

Answer 12

D-K Serovars: The cause of most chlamydial infections!
D-K infect genital tract epithelial cells resulting in pelvic inflammatory disease, ectopic pregnancy, and sterility while L1-L3 infect epithelial cells and macrophages, causing an invasive infection

Serotypes L1, L2, and L3 serotypes cause lymphogranuloma venereum (LGV)

Chlamydia trachomatis serovars A-C infect conjunctival epithelial cells and untreated infection can lead to blindness.

Question 13

complications of Chlamydia

Answer 13

• reactive arthritis
• infertility
• PID

Question 14

What is the Fitz-Hugh Curtis sign?

Answer 14

🔍 Definition:
Right upper quadrant (RUQ) abdominal pain due to perihepatitis, typically seen in Fitz-Hugh–Curtis syndrome (a complication of pelvic inflammatory disease).

🦠 Causative Pathogens:
- Chlamydia trachomatis
- Neisseria gonorrhoeae

📋 Key Features:
- Sharp RUQ pain (may mimic gallbladder pathology)
- Often with lower abdominal pain, fever, and vaginal discharge
- “Violin string” adhesions between liver capsule and abdominal wall (seen on laparoscopy)

📈 Diagnosis:
- Clinical history + symptoms
- Imaging (US/CT): May show perihepatic inflammation
- Laparoscopy: Definitive diagnosis

💊 Treatment:
Empirical antibiotics:
Doxycycline + Ceftriaxone

📝 Notes:
- Occurs without liver parenchyma involvement
- Prompt treatment prevents complications