STIs

Question 1

Most common STI

Answer 1

Chlamydia

Question 2

Profuse penile discharge, pain on passing urin

Answer 2

Gonorrhoea

Question 3

Chancre develops in which stage in syphily

Answer 3

primary

Question 4

the great imitator ?—resembles many other sti

Answer 4

Syphilis

—resembles Genital herpes, chancroid

Question 5

Which HSV type is viral shedding commonly seen in

Answer 5

HSV 2

—-more in the first year of infection

Question 6

What is chlamydia appear as under the microscope?

Answer 6

gram negative

olbigate intracellular bacterium

Question 7

What is the risk of PID from chlamydia ?

Answer 7

9%

Question 8

What does a single PID episode increase the risk of ?

Answer 8

• ectopic pregnancy by 10 fold

- carries a risk of TUBAL factor infertility of 15-20%

Question 9

How does Chlamydia present as?

Answer 9

• Post coital or intermenstrual bleeding
• Lower abdominal pain
• Dyspareunia
• Mucopurulent cervicitis

Question 10

Present. in Males for chlamydia?

Answer 10

• milky, clear discharge
• dysuria
• urethritis
• epididymo-orchitis
• proctitis (LGV)

Question 11

Complications of CT?

Answer 11

• PID (50%)
• REACTIVE arthtritis (can’t see,can’t pee, can’t bend my knee)
• ectopic pregnancy
• conjunctivitis
• transmission to neonate (conjunctivis and pneumonia)
• Fitz-hugh-curtis Syndrome (perihepatitis)

Question 12

What advise when testing for CT in women?

Answer 12

-STOP testing for CT in women >25y.o with vaginal discharge (false +)
- do test on women who have had CT in the past year
(1 in5 women can be re-infected within 10 months after initial rx)

Question 13

Where is L1-L3 serovars commonly diagnosed in? What are the symptoms?

Answer 13

• dx in MSM

- rectal pain, discharge and bleeding

Question 14

What risk does having LGV hold?

Answer 14

• 67% HIV

- HIGH risk of CONCURRENT STI

Question 15

How to dx chlamydia?

Answer 15

• NAAT (test for gonorrhoea too): vulvovaginal swab (no need speculum), first void urine
• MSM (do rectal swabs –if receptive ANAL intercourse)

Question 16

RX of Chlamydia

Answer 16

• doxycycline (100mg BD x 7 days)

- Axithromycin (1g stat FOLLOWED by 500mg DAILY for 2 days)

Question 17

What is mycoplasma genitalium a.w?

Answer 17

• non-gonococcal urethritis (15-25%)

- small a.w PID

Question 18

How to test for M.Genitalium?

Answer 18

• NAAT test (same sample as GC/CT)

Question 19

What is the incubation period of Gonorrhoea?

Answer 19

• urethral infect. in men is SHORT at 2-5 days
• 50-90% risk from INFECTED MAN to female partner
• —-20% risk from infected WOMan

Question 20

Primary site of INFECTION for Gonorrhoea

Answer 20

urethra, endocervix, rectum, and pharynx.

Question 21

Presentation of males for Gonorrhoea?

Answer 21

• <10 % is asymptomatic
• GREEN, YELLOW mucopurulent discharge from penis ( >80%)
• dysuria
• pharyngeal/ rectal infections (ASYMPTOMATIC; don’t forget to swab)

Question 22

How does gonorrhoea present in females?

Answer 22

• UP TO 50%: ASYMPTOMATIC …esp. with pharyngeal and rectal infection
• increased vaginal discharge (40%
• dysuria
• ## PELVIC pain <5%

Question 23

What is bartholinitis?

Answer 23

• SWOLLEN bartholin glands

Question 24

WHat does gonorrhoea appear as undee the microscope?

Answer 24

• gram -ve, intracellular DIPLOCOCCI

Question 25

What are the advantages of NAAT?

Answer 25

- non-invasive | - less trouble with storage, medium and transport

Question 26

How to treat gonorrhoea?

Answer 26

- 1st line: Ceftriaxone 500mg IM | - second line: cefixime 400 mg AND azithromycin 2g oral (only if IM is c/i)

Question 27

WHen should you ask the patient to come in?

Answer 27

- resampled AFTER 2 weeks

Question 28

How does genital herpes primary infection present as?

Answer 28

``` Blistering and ulceration of the external genitalia Pain External dysuria Vaginal or urethral discharge Local lymphadenopathy Fever and myalgia (prodrome) ```

Question 29

How long does genital herpes last?

Answer 29

14-21 days

Question 30

How do the recurrent episodes of HSV-2 infection present as?

Answer 30

- usually UNILATERAL - small blisters - ulcers - ---minimal systemic symptoms (resolves in 5-7 days)

Question 31

How to treat HSV?

Answer 31

- give ORAL antiviral (ACYCLOVIR) - consider LIDOCAINE if very painful - ---saline bathing - ----analgesia

Question 32

How to dx HSV

Answer 32

- swab ulcer base for HSV PCR

Question 33

Why is it important to know if a pregnant lady with HSV has had a previous herpetic episode ?

Answer 33

- -previous herpes episode means antibodies can be passed to the baby - ----they don't know if theyve had it ....do PCR of swab and serology tests for antibodies

Question 34

What genotypes are covered by HPV vaccines?

Answer 34

hpv 6 and 11 | HIGH risk types (this vaccine covers 90% of HPV cancers): HPV 16 and 18 and others

Question 35

What genotypes are covered by HPV vaccines?

Answer 35

hpv 6 and 11 HIGH risk types (this vaccine covers 90% of HPV cancers): HPV 16 and 18 and others - also available for MEN (esp. MSM)

Question 36

What is HPV 16 and 18 a.w?

Answer 36

16,18 responsible for the vast majority of cervical, anal, penile, vulval and oropharyngealW

Question 37

How long is the Incubation period of HPV?

Answer 37

- 3 weeks to 9 months

Question 38

How are you most l likely going to obtain HPV infection?

Answer 38

-----from asymptomative partner

Question 39

Where are genital warts usually found?

Answer 39

- occurs at site of friction | - ----ontriotikc entry to the vagina

Question 40

How to treat HPV ?

Answer 40

- Podophyllotoxin (Warticon) - Imiquimod (GOOD - its an immune modifier) ----used on anogenital warts - Cryotherapy - Electrocautery

Question 41

How is syphilis transmitted?

Answer 41

Sexual contact Trans-placental/during birth Blood transfusions Non-sexual contact – healthcare workers

Question 42

How does one contract syphilis?

Answer 42

- may be acquired from years ago - become symptomatically only recently - ---ps. RARE to develope to tertiary syphilis

Question 43

How long is the Incubation period of Primary syphilis?

Answer 43

9-90 days (non-tender LOCAL lymphadenopathy) | -mean of 21 days

Question 44

SYmptoms of SEcondary syphilis?

Answer 44

- rashes on hand, torso - lymphadenopathy - Lesions of mucous membranes - Generalized Lymphadenopathy - Patchy Alopecia - Condylomata Lata (VERY infectious ) ----THE GREAT IMITATOR

Question 45

What skin conditions develop with IIary syphilis?

Answer 45

- Macular/ follicular/ pustular

Question 46

What to expect in follow-up for syphilis?

Answer 46

- until RPR is negative - ---titres should decrease four fold by 3- 6months - ----serological relapse if titres increase by four fold

Question 47

What is a.w PID?

Answer 47

Chlamydia

Question 48

Disadvantages of NAAT?

Answer 48

- risk of FALSE positive | - ----NAAT usually confirms results

Question 49

What are the advantages and disadv. of culture?

Answer 49

- allows antibiotic sensitivity - monitoring Disadv.: invasive test/specific medium and incubation needed

Question 50

Advs of microscopy? Disadvs?

Answer 50

- near pt dx - timely rx (-)ves: invasive/ low sensitivity/ requires confirmation

Question 51

What is the incubation period of Genital Herpes?

Answer 51

3-6 days

Question 52

Is syphilis always infectious?

Answer 52

ONLY Primary, Secondary and Early Latent stages are

Question 53

What is the lesion of primary syphilis?

Answer 53

- primary chancre - painless - lesion at site of innoculation - ----90% sites are genital

Question 54

What serological tests specific to Treponema Pallidum?

Answer 54

- TPPA - ELISA/EIA - INNO-LIA - FTA abs