STIs

Question 1

How are infections transmitted during sex?

Answer 1

• Direct inoculation (HSV)
• Trauma (HCV)
• IVDU (HIV, HCV)
• Fomites (sex toys - gonorrhoea)
• Ingestion (shigella, Hep A)
• Sexual/genital secretions

Question 2

Risk factors for STIs

Answer 2

• <25 years old
• change sexual partner
• no condom use
• MSM
• Past history of STI
• Large Urban areas
• social deprivation
• Black ethnicity

Question 3

Where can STIs affect?

Answer 3

Anywhere along the GI tract

Question 4

Rectal Gonorrhoea

• transmission
• symptoms
• complications

Answer 4

Gram negative intracellular diplococci

Transmission - direct contact of mucosal surfaces

Symptoms

5-10 days incubation
Low abdo pain
diarrhoea
rectal bleeding
anal discharge
tenesmus
urethral/vaginal discharge

Complications

abscess formation
increased susceptibility of HIV
genital gonorrhoea (due to proximity)

Question 5

Rectal Chlamydia

Answer 5

Chlamydia trachomatis

Transmission - direct contact of mucosal surfaces

Symptoms -

milder than gonorrhoea
anal discomfort/itch
anal discharge

Question 6

Syphilis

• Primary
• Secondary
• Ulcer

Answer 6

Can mimic many other diseases. MULTI SYSTEM DISEASE

Transmission

spread through close contact with an infected sore.
- IV drug users

Primary Syphilis -

solitary painless ulcer

Secondary Syphilis

• mucosal patches and ulcers (mouth, anogenital, rectal)
• condylomata lata (warts)
• Hepatitis
• Systemic inflammation
• Ulcers are quite firm, feels like there is a button underneath

Question 7

Herpes Simplex Virus

Answer 7

Transmission - ano-genital or oro-anal

Usually HSV2

Usually peri-anal mucosa but may extend into rectum

Symptoms

• pain
• ulcers
• painful defecation
• bleeding
• mucous
• viraemic

Question 8

HPV

Answer 8

Transmission - ano-genital/ oro-anal

Anal Warts
can extend to rectum

anal cancers in homosexual men and HIV positives

Question 9

Lymphogranuloma Venereum (LGV)

Answer 9

Primary - ulcer

Perianal abscesses
Friable rectal mucosa, large ulcers, contact bleeding

Bloody diarrhoea
severe anorectal pain

Secondary (3 to 6 months) - inguinal syndrome; and-rectal syndrome

Tertiary

• strictures
• fistulae
• genital elephantiasis

anyone diagnosed with LGV should be tested for HIV, Hep C, syphilis

associated with group sex; drug use; syphilis, Hep C

Question 10

GALT (Gut-associated Lymphoid Tissue)

Answer 10

• Largest immune compartment in the body
• mucosal lymphocytes in rectum, foreskin, cervico-vagina
  -Dense clustering of lymphocytes
• easy cell to cell transmission
  HIGH SUSCEPTIBILITY TO HIV INFECTION

Question 11

Investigations in STIs

Answer 11

• Proctoscopy (rectal)
• Gram staining from discharge/swab (x3)
• Gonorrhoea NAAT
• Culture
• Rectal biopsy

Question 12

Management of rectal gonorrhoea

Answer 12

Ceftriaxone 500mg
Doxycycline
Public health interventions

Question 13

Management of Rectal Chlamydia

Answer 13

Azithromycin
Doxycycline
STI testing
Public health interventions

Question 14

Syphilis management

Answer 14

Benzathene penicillin
Public health interventions
Follow up serology

Question 15

LGV management

Answer 15

Doxycycline 100mg for 3 weeks

Question 16

What do inflammatory cells attract?

Answer 16

HIV

More inflammation = more likely to contract HIV