STI

Question 1

Gonorrhoea

Answer 1

• Gonorrhoea is most commonly diagnosed in men who have sex with men, young (heterosexual) Aboriginal and Torres Strait Islander people
• travellers returning from high prevalence areas overseas.
• Neisseria gonorrhoeae, (Gram-negative)

Question 2

Gonorrhoe - Clinical presentation

Answer 2

• often asymptomatic
• Penile urethral discharge
• Dysuria
• Vaginal discharge
• Dyspareunia with cervicitis
• Conjunctivitis: purulent, sight-threatening
• Anorectal symptoms: discharge, irritation, painful defecation, disturbed bowel function

Question 3

Gonorrhoe - Complication

Answer 3

1. Epididymo-orchitis:
   
   • Symptoms: Painful, red, swollen testicles.
   • Frequency: Uncommon.
2. Prostatitis:
   
   • Symptoms: Inflammation of the prostate.
   • Frequency: Very rare.
3. Pelvic Inflammatory Disease (PID):
   
   • Symptoms: Dyspareunia (painful intercourse), intermenstrual bleeding, post-coital bleeding, discharge.
4. Bartholin Gland Abscess:
   
   • Symptoms: Swelling and pain in the Bartholin glands.
5. Disseminated Disease:
   
   • Symptoms:
     
     • Skin: Macular rash, necrotic pustules.
     • Joints: Septic arthritis.
     • Other: Rarely, meningitis or endocarditis.

Gonorrhea can lead to several complications, including epididymo-orchitis, prostatitis, PID, Bartholin gland abscess, and disseminated disease, which may present with skin rashes, septic arthritis, and, rarely, meningitis or endocarditis.

• Epididymo-orchitis (uncommon): painful, red swollen testicle/s
• Prostatitis (very rarely)
• Pelvic inflammatory disease (PID): dyspareunia, intermenstrual bleeding, post-coital bleeding, discharge
• Bartholin gland abscess
• Disseminated disease (rarely):
  macular rash that may include necrotic pustules
  septic arthritis
• Meningitis or endocarditis (rarely)

Question 4

Gonorrhoe - Diagnostic

Answer 4

• First pass urine (FPU) - NAAT
• Penile urethral swab ( just if discharge)
• Clinician-collected endocervical swab -best
• Clinician-collected endocervical swab (men)
• Pharyngeal swab (men)

Question 5

Gonorrhoe - Treatment uncomplicated

Answer 5

• Ceftriaxone 500 mg IMI, stat. in 2 mL 1% lignocaine+ Azithromycin 1 g PO, stat.

same treatment in pregnancy

Question 6

Gonorrhoe - Treatment Conjunctivitis

Answer 6

• Ceftriaxone 1 g IMI, stat. in 2 mL 1% lignocaine+
  Azithromycin 1 g PO, stat.

Question 7

Gonorrhoe - other MX

Answer 7

• no sexual contact for 7 days
• Partner notification and testing ( 2 month back)
• Notify health department
• Testing for other STIs

Question 8

Chlamydia

Answer 8

• most commonly
• Those < 30 years are at greatest risk.
• Frequently asymptomatic.
• Simple to test and treat.

Chlamydia trachomatis

Question 9

Chlamydia - Symptoms

Answer 9

85%-90% have no symptoms

• Dysuria
• Penile urethral discharge
• Vaginal discharge
• Testicular pain
• Pelvic Pain
• Intermenstrual bleeding
• Postcoital bleeding
• Pain with sex - dyspareunia
• Anorectal symptoms

Question 10

Clamydia - complications

Answer 10

• Epididymo-orchitis
• Pelvic inflammatory disease (PID)
• Infertility
• Pregnancy - Ectopic pregnancy, Premature rupture of the membranes, preterm delivery, and low-birthweight infants
• Reactive arthritis: arthritis, sometimes with concurrent rash and gastrointestinal symptoms
• Cervicitis
• Conjunctivitis
• Perihepatitis

Question 11

Clamydia - Diagnostic

Answer 11

• First pass urin ( NAAT)
• Endocervical swab
• Anorectal swab
• Pharyngeal swab

NAAT highly sensitive

Question 12

Chlamydia - Treatment

Answer 12

For uncomlicated genital or pharyngial
* Doxycylin 100 mg for 7 days
* Alternative Azithromycin 1g, immed.

Anorectal asymptomatic
* Doxycylin 100 mg for 7 days
* Alternative Azithromycin 1g, immedi repeat in 12-24 hrs

Anorectal symptomatic
* Doxycylin 100 mg for 21 days
* Alternative Azithromycin 1g, stat repeat in 12-24 hrs

Question 13

Chlamydia - further MX

Answer 13

• No sexual contact for 7 days or until symptoms resolved
• Contact tracing and testing 6 month
• notify health department

Pregnancy : Azythromycin 1g immed

Retest in 3 month

Question 14

Syphillis

Answer 14

• high prevalence : homosexual, Abor/torres
• in pregnancy - congenital syphylis ( urgent specialist advice

Treponema Palidum

Question 15

Syphillis- Clinic

Answer 15

• 50% asymptomatic
• mimic many other conditions , consider testing in all pat with unexplained symptoms
• 3 stages

early infectious
late latent
tertiary or late symptomatic

Question 16

Syphylis - early

Answer 16

• primary and secondary and early latent infection

Question 17

Syphylis - Primary

Answer 17

• genital, anal, oral ulcer (chancre)
• enlarge LN, rubbery non tender
• mostly painless
• Incubation 10-90 days
• high infectious

Question 18

Syphylis - secondary

Answer 18

• more than 6 weeks after infection
• systemic signs and symptoms
• fever, malaise, headache and Lymphadenopathy
• rash( 90%) trunk, palms and soles
• Incubation averrage 6 Weeks
• highly infectious

Question 19

Syphylis - early latent

Answer 19

• <2 years
• positive syphilis serology with no clinical symptoms
• high infectious

Question 20

Syphylis - late

Answer 20

• > 2years
• absence of any symptoms
• no longer infectious to sexual partners but transmitted during pregnancy

Question 21

syphylis - Tertiary

Answer 21

• development of complication:
  Skin lessions ( gumma)
  Cardiovascular
  neurological (visual changes, tinnitus, deafness, cranial nerve palsies, meningitis), require intravenous treatment.)

Question 22

Syphylis - congenital

Answer 22

• severe multi-organ disease with very high mortality and morbidity in both in-utero and neonatal periods

Question 23

Syphylis - Diagnostic

Answer 23

• Blood Serolgy ( antibody)
• Swab of ulcer (NAAT/PCR)
• Test in pat with HIV
• In remote Australia include donovanosis Pcr

Question 24

Syphilis Treatment early stage

Answer 24

• Benzathine benzylpenicillin 2.4 MU (1.8 g) IMI, Stat, given as 2 injections containing 1.2 MU

Question 25

Syphilis Treatment Late/ unclear stage

Answer 25

* Benzathine benzylpenicillin 2.4 MU (1.8 g) IMI, given as 2 injections containing 1.2 MU (0.9 g) weekly for 3 weeks

Question 26

Syphilis - further Mx

Answer 26

* no sexual contact for 7 days or symptoms resolve * Contact tracing * Notify health department

Question 28

Discharge

Answer 28

**Bacterial vaginosis**: thin, grey-white, offensive and fishy odour **Candidiasis**: thick, white, non-offensive **Chlamydia and M. genitalium**: minimal discharge or purulent (cervicitis) **Gonorrhoea**: purulent (cervicitis) *** Trichomoniasis:** offensive green and yellow, scanty to profuse and frothy (vaginitis)

Question 30

Jarisch-Herxheimer reaction

Answer 30

* common reaction to treatment in patients with primary and secondary syphilis * 6-12 hours after commencing treatment * fever, headache, malaise, rigors and joint pains, and lasts for several hours * analgesics and rest * Patients should be alerted to the possibility of this reaction and reassured accordingly.