STIs

Question 1

What are the different STIs that can present with discharge?

Answer 1

1. Gonorrhoea
2. Chlamydia
3. Trichomonas
   (Candida + BV)

Question 2

What are the different STIs that can present with ulcers?

Answer 2

1. Syphilis - painful
2. HSV - painless
3. (other more niece - LGV, Chancroid, Donovanosis)

Question 3

What are the different STIs that might present with genital Rashes/ Lumps

Answer 3

1. HPV - genital warts
2. Molluscum contagiosum
3. Scabies
4. Public lice

Question 4

What pathogen is Neisseria gonorrhoeae?

Answer 4

Obligate intracellular Gram -ve diplococcus

Question 5

What Are the main clincial signs and sympts of gonorrhoea in men?

Answer 5

Often asymptomatic (but less commonly asmyptomatic compared to women)

1. Urethitis - purulent urethral discharge
2. Dysuria, increased urinary frequency
3. Potentially: epidedimitis, prostatitis
4. Rectal procttitis (in MSM)

Question 6

How does gonococcal infection usually present in females?

Answer 6

Most commonly asymptomatic but can present with

1. Discharge + Cervicitis (malodorous, purulent discharge)
2. Cervical motion tenderness

Can also progress to PID
incl. Fitz-Hugh-Curtis syndrome (perihepatitis with RUQ pain)

Question 7

What is Disseminated gonococcal infection?

Answer 7

Disseminated gonorrhoea infection in patients with complement deficiencies. Can present as

1. Arthritis-dermatitis syndrome (polyarthritis –> migration, asymmetrial ) + purulent dermatitis
2. Or Purulent gonococcal arthritis:

• Abrupt inflammation in up to 4 joints (commonly knees, ankles, and wrists)
• No skin manifestations, rarely tenosynovitis

NOT reactive arthritis

Question 8

What is the management of Gonococcal infection?

Answer 8

Referral for all people to GUM

ABX

• Ceftriaxone 1 g intramuscular (IM) injection as a single dose (also safe in pregnancy)
• Abstain from sex for 7 days

Question 9

What pathogen is Chlamydia transmitted by?

Answer 9

Chlamydia trachomatis

obligate intracellular gram -ve pathpgen, cannot be cultured on agar

There are different serotypes that can cause different diseases

1. ABC: trachoma (infection of eyes that can cause blindness)
2. D-K: genital chlamydia

Question 10

What is the epidemiology of chlamydia?

Answer 10

common - in the UK
10% of all under 25 are infected

Question 11

How does chlamydia infection ususally present

Answer 11

Usually aymptomatic (50% of men, 80% of women)

Can cause urethritis
But one of the most common pathogens causind PID

Question 12

What are the main complications from a chlamydia infection?

Answer 12

1. PID (incl. tubular factor infertility, ectopica, chronic pelvic pain)
2. Epididymitis
3. Reactive arthritis (incl. conunctivitis)
4. Adjult conjunctivitis or ophtlamia neonatorum

Question 13

What is the treatment of chlamydia infections?

Answer 13

GUM referral

ABX
1st line: Doxycycline 100mg BD for 7 days
2nd line: Azithromycin 1g stat for one day, followed by 500 mg orally once daily for 2 days.

No sex for 7 days (if stat) or until treatment completet

Partner notification and treatment in last 60 days

Question 14

What pathogen causes syphillis infections?

Answer 14

Treponema pallidum - obligate gram-ve spirochaete

Question 15

Recap the 3 phases of a syphillis infection + the respective timings

Answer 15

1. Primary: single painful genital ulter 1-12 weeks after transmission + regional adenopathcy
2. Secondary: 1-6 months after infection witth rash on palmes and soles, malaise ad genital warts)
3. Tertiary: 2-30 years incl. Neurosyphillis, CVS and skin/bone/ mucosa granulomas

Question 16

How is syphilis tested for?

Answer 16

Many different test availalable but most commonly Serology with

1. Never had syphillis: Treponemal test (detects Antibodies against spicific antigens of t. pallidum)- but remains positive for years therefore
2. Had syphillis before: Non-Treponemal test (antibodies against non-specific antigens). If +ve followed-up with PCR

Question 17

How is a confirmed syphillis test treated?

Answer 17

Single dose IM Benzylpenicillin (or Doxy if allergic)

Commonly with Jarish-Herxenheim reaction (flue-like reaction to ABX up to until 24h after streatment)

Question 18

What is Trichomoniasis?

Answer 18

STI caused by T. vaginalis (causes 4-35% of all vulvovaginitis)

–> Flagellated protozoa

Question 19

What is the main clinical presentation of Trichomoniasis?

Answer 19

Usually asymptomatic in men
In females

• Foul-smelling, frothy, yellow-green, purulent discharge
• Vulvovaginal pruritus, burning sensation, dyspareunia, dysuria, strawberry cervix (erythematous mucosa with petechiae)

Question 20

How is Trichomoniasis usually diagnosed?

Answer 20

Referral to GUM
there

1. Wet prep microscopy (visualisation of flagellated organism)
2. PCR

Question 21

How is Trichomoniasis treated?

Answer 21

1. Oral Metranidazole 500mg BD for 5-7 days
2. Or 2g Metronidazole stat (single dose)

No alcohol!

Question 22

How is Bacterial Vaginosis usually diagnosed?

Answer 22

1. Microscopy and Gram Stain of vaginal wet mount preparatioon: reduced lactobacilli, clue cells (vaginal epithelial cells with a stippled appearance and fuzzy borders due to bacteria adhering to the cell surface)
2. pH = raised

Question 23

How is Bacterial Vaginosis usually treated?

Answer 23

Conservative

• advise vaginal douching and excessive genital washing should be avoided

Medical

• Oral metronidazole 400mg BD (5-7 days)
• Alternative: intravaginal metronidazole/ clindamycin gel

Question 24

How is vaginal candidiasis usually treated?

Answer 24

Most women:
o Local: clotrimazole pessary or cream (e.g. clotrimazole 500 mg PV stat)
o Oral: itraconazole 200 mg PO BD for 1 day or fluconazole 150 mg PO stat

In pregnancy only use local treatments