STIs

Question 1

what is trichomonas vaginalis caused by?

what is elicited in the history?

Answer 1

• anaerobic protozoan
• asymptomatic (especially in men)
• profuse, offensive greenish/grey, frothy discharge
• vaginal and vulval irritation
• superficial dyspareunia
• dysuria

Question 2

what would you see on examination of trichomonas?

Answer 2

• erythematous punctuate appearance cervix (strawberry cervix)
• vaginal discharge and vulval erythema

Question 3

what are the diagnostic investigations for trichomonas? (3)

Answer 3

• vaginal pH >5.0
• HVS for direct microscopy and culture in a trichomonas medium
• trichomonads are seen on saline wet-mount (pathognomonic)

Question 4

what STIs can be detected in a high vaginal swab?

endocervical swab?

blood tests?

Answer 4

• BV, candida albicans
• chlamydia and gonorrhoea
• blood tests for HIV, syphilis and hepatitis B (abundance of leukocytes)

Question 5

what is the treatment for trichomonas?

what complications are there?

Answer 5

• metronidazole (200mg PO)
• PID
• premature delivery, PROM etc
• SEs of Tx (flushing, headache, nausea, etc)

Question 6

what is the most common adverse side effect of chlamydia?

what percentage of people are asymptomatic ?

Answer 6

• PID (accounts for 50% of cases of PID)

- 60-80%

Question 7

what are symptoms in males and females of chlamydia?

Answer 7

• vulval irritation
• superficial/ deep dyspareunia
• dysuria and frequency
• vaginal discharge
• PCB, IMB
• abdo pain, fever

male:

• urethritis
• unilateral testicular pain
• dysuria

Question 8

what may be seen on examination in chlamydia?

Answer 8

• copious mucous vaginal discharge
• pain
• induration
• speculum shows cervicitis, friable contact bleeding.
• PID, adnexal tenderness, cervical motion tenderness, abdo tenderness

Question 9

what investigations would you do for chlamydia in males, then females?

Answer 9

males:
- first void urine (NAATs)
- swab urethra from discharge (CT and GN)
- MSU if UTI

females:
- endocervical swab (NAATs)
- VVS (NAATs, red)
- HVS (TV, BS, candida, gonorrhoea)
- urine dip and MSU

Question 10

what is the management of chlamydia?

Answer 10

• azithromycin stat
• doxycycline
• erythromycin
• avoid intercourse for 7 days after completion treatment, contact tracing.

Question 11

what are the complications of chlamydia?

neonatal complications?

Answer 11

• PID
• seronegative arthritis
• Reiters syndrome
• fitz- hugh- curtis syndrome
• pregnancy problems
• neonatal pneumonia
• ophthalmitis, pneumonia

Question 12

what can PID cause?

Answer 12

• tubal infertility, Acute PID results in tubal blockage in 15% of cases following 1st episode, 40% following 2nd

Question 13

what percentage of men and women are symptomatic following gonorrhoea infection?

what is the incubation period?

Answer 13

• 50% of women, 90% of men

- 2-10 days

Question 14

what are the symptoms of gonorrhoea in women?

men?

Answer 14

• purulent, offensive vaginal discharge
• deep dyspareunia
• IMB, PCB, menorrhagia

men:
- urethral dysfunction (discharge, dysuria)
- epididymal tenderness/ swelling
- balanitis

Question 15

what are the complications of gonorrhoea?

Answer 15

• local spread: bartolinitis, skenitis
• ascending spread:
  salpingitis, fever, malaise, rash
• septicaemia, infection of rectum, fits Hugh-curtis syndrome

Question 16

what can be found on pelvic exam?

Answer 16

• white/ yellow purulent discharge
• abscess (urethral or bartholins)
• uterine tenderness, adnexal tenderness, cervical excitation

Question 17

what would gonorrhoea look like under microscope?

what investigations would you do?

Answer 17

• gram -ve diplococci
• EC swab (NAATs)
• VVS (NAATs)
• urethral, rectal and pharyngeal swabs
• microscopy and culture of swab will identify n.gonorrhoea and antibiotic sensitivity

Question 18

what is the management of gonorrhoea?

Answer 18

• ceftriaxone 500mg and azithromycin 1g

Question 19

what are the neonatal complications of gonorrhoea?

Answer 19

• neonatal ophthalmia (presents 2-7 days after birth with severe bilateral conjunctivitis, chemosis and lid oedema

Question 20

what is more common HSV1 or 2?

what would you obtain from a history

Answer 20

• equally as common
• extensive sore genital ulceration
• can be systemic “flu-like”
• dysuria
• discharge
• neuropathic pain in buttocks/ genitals

Question 21

what do the lesions look like in hsv?

Answer 21

• vesicles that burst leaving superficial tender ulceration with erythematous halo and grey/white exudate

Question 22

how do recurrent infections compare with initial infections in HSV?

what might be a trigger for reactivation?

Answer 22

• shorter and less severe, last 3-5 days, cause unilateral lesions
• trauma, stress, menstruation

Question 23

what is the difference in reactivation between HSV 1 and 2?

Answer 23

• HSV 2 has 4-6 outbreaks a year

- HSV 1 limited to once per annum

Question 24

when are you most infectious in HSV?

what prodromal symptom may alert you of it coming on?

Answer 24

• during viral shedding and symptoms

- neuralgia pain down legs and buttocks

Question 25

what investigations would you perform?

Answer 25

- swab ulcer vesicular fluid for PCR (HSV and syphilis) | - STI screen (NAAT's urine, bloods HIV and Hep B, syphilis)

Question 26

what is the management of HSV?

Answer 26

- primary episodes 400mg TDS for 5 days - topical/ oral analgesia - recurrent episodes are self limiting, use saline baths and analgesia

Question 27

what do you do if a mother gets herpes in 1st/2nd trimester? what do you do in 3rd trimester acquisition?

Answer 27

- daily suppressive acyclovir from 36 weeks - 1st episode associated with first trimester miscarriage - takes 6 weeks for pregnant women to develop Ab's in response to HSV and protect neonate - offer C section if present delivery or within 6 weeks of birth - Give IV acyclovir