STIs

Question 1

Which patients should you offer performing a sexual screen for?

Answer 1

Anyone presenting with:
- vaginitis (change in discharge, dysuria, change in menstrual bleeding)
- urethritis (penile discharge, dysuria, meatal discomfort)
- epididymo-orchitis (swollen, painful testicle)
- PID (pelvic pain, fever, change in discharge, dyspareunia)
- proctitis (rectal discharge/pain/bleeding)
- possible syphilis (esp rash on hands/feet)
- possible HIV seroconversion

Question 2

What is included in a standard sexual health screen?

Answer 2

• chlamydia + gonorrhoea (naat test)
• syphilis + HIV (blood test - big edta bottle)

Question 3

What groups are more at risk of gonorrhoea?

Answer 3

• MSM
• Afro-Carribean
• urban areas with deprivation
• women <25

Question 4

Describe the features of gonorrhoea

Answer 4

• bacterial
• caused by gram negative diplococcus N. Gonorrhoeae
• infects mucous membranes of urethra, endocervix, rectum, pharynx + conjunctiva
• inoculations are through secretions from one mucous membrane to another

Question 5

Describe the signs and symptoms of gonorrhoea

Answer 5

• penile urethra (90% symptomatic soon after inf.): urethral discharge (yellow) + dysuria
• vaginal: change in discharge, abdo/pelvic pain, dysuria, altered bleeding (rare)
• pharynx: asymptomatic
• rectum: asymptomatic, anal discharge, pain, discomfort

Question 6

Who is given treatment for gonorrhoea and what is given?

Answer 6

• people with a positive test result
• under clinical suspicion (really severe symptoms)
• recent/ongoing sexual contact with someone with gonorrhoea

Ceftriaxone 1g IM (or ciprofloxacin)
* test repeated after 2 weeks to ensure cure

Question 7

What are the possible complications of gonorrhoea?

Answer 7

• epidimyo-orchitis: testicular pain/swelling/tenderness
• prostatitis
• PID
• disseminated gonoccoccal infection (rare - affects skin + joints)
• resistance to antibiotics

Question 8

What are the risk factors of chlamydia?

Answer 8

• <25 years old
• new sexual partner or >1 partner in a year
• inconsistent condom use

Question 9

Describe the signs and symptoms of chlamydia

Answer 9

• penile urethra: asymptomatic, discharge (clear/white), meatal discomfort
• vaginal: intermenstrual/PC bleeding, cervicitis, change in discharge, pelvic pain
• pharynx: asymptomatic
• rectum: asymptomatic, proctitis, PR discharge, bleeding, tenesmus, constipation, LGV

Question 10

What is the treatment for chlamydia?

Answer 10

Doxycycline 100mg twice a day for a week

Question 11

Describe the possible complications associated with chlamydia

Answer 11

• PID: fever, pain, pelvic pain, dyspareunia/ tubal infertility/ ectopics/ Fitz-Hugh-Curtis syndrome
• epididymo-orchitis: male infertility

Question 12

Describe the features of mycoplasma genitalium

Answer 12

• bacterial infection
• some people get symptoms of urethritis/PID
• treatment only administered if symptoms/partner has symptoms (highly resistant to antibiotics)
• detected through naat testing

Question 13

Describe the signs and symptoms of trichomonas vaginalis

Answer 13

• often asymptomatic
• vaginal: frothy yellow discharge + intense itch (marker), strawberry cervix
• penile: urethritis

Question 14

How is trichomonas vaginalis detected and treated?

Answer 14

• detection is through microscopy/culture
• treatment = metronidazole

Question 15

Describe the features of syphilis

Answer 15

• treponema pallidum
• gram negative spirochete
• transmitted sexually (can vertically too)
• more common MSM
• asymptomatic positive test = latent syphilis

Question 16

What is the clinical presentation of primary syphilis?

Answer 16

• chancre (single, painless ulcer that leaks clear fluid) at the site of inoculation
• 9-90 days after infection

Question 17

Describe the clinical presentation of secondary syphilis

Answer 17

• generalised rash on palms and soles
• muco-cutaneous lesion, condylomata lata/lymphadenopathy and fever
• patchy alopecia, anterior uveitis, meningitis, cranial nerve palsies, hearing loss, hepatitis, arthritis, glomerulonephritis (all less common)
• 3 months-2 years

Question 18

Describe the clinical presentation of tertiary syphilis

Answer 18

• neurosyphilis (variation of neurological symptoms including cognitive)
• cardiovascular syphilis (aortic valve disease, aortic aneurysm, aortitis)
• gummatous syphilis

Question 19

Describe the diagnosis and treatment of syphilis

Answer 19

• dark ground microscopy + viral PCR (chancre swab)
• bloods for antibody testing (3 month period - stays positive after treatment completion)
• rapid plasma reagin (quantitative marker)
• treatment = benzathine penicillin

Question 20

Describe the features of ano-genital warts

Answer 20

• caused by HPV
• more common types cause warts = 6 + 11
• quadrivalent vaccine (6, 11, 16 + 18)
• asymptomatic transmission possible
• itch + aesthetic problems

Question 21

Describe the diagnosis and management of ano-genital warts

Answer 21

• reassure high prevalence and benign
• no require for partner notif (but advise condoms reduce transmission)
• many people clear virus
• smoking + hair removal increase risk

Treatment = cryotherapy, topical treatments (podophyllotoxin/imiquimod), surgical excision

Question 22

Describe features of HSV

Answer 22

• 2 types
• often symptomatic with first presentation (further episodes show reduction in severity)
• detected with viral PCR swab
• complications: CNS infection, balantitis, proctitis, urinary retention, risk of neonatal infection if pregnant

Question 23

Describe the advice and management for HSV

Answer 23

• high prevalence
• possible future recurrence
• condoms reduce transmission

Treatment: aciclovir (can be given long term if frequent recurrences)

Question 24

Describe the features of scabies

Answer 24

• itches (particularly at night)
• caused by mite excrement which triggers a hypersensitivity reaction
• burrows in web-spaces, wrist, elbows + nipples
• diagnosis made on clinical appearance

Question 25

Describe the treatment of scabies

Answer 25

- permethrin 5% or malathion 0.5% - wash off after 24hrs - wash contaminated clothes at 50 degrees

Question 26

Describe the features of phthirus pubis

Answer 26

- transmitted by close bodily contact - live on coarse body hair (differs from head lice) - incidence decreasing (hair removal?)

Question 27

What is the treatment for phthirus pubis?

Answer 27

Malathion 0.5% or permethrin 1% cream