STIs

Question 1

What is the most common STI in England?

Answer 1

Chlamydia

Question 2

Why are older age groups also vulnerable to STIs?

Answer 2

May be less likely to see or engage with safer sex and sexual health messaging.

Question 3

Why are high levels of gonorrhoea concerning?

Answer 3

Emergence of resistance or decreased susceptibility to antimicrobials used for treatment.

Question 4

What type of infection is chlamydia?

Answer 4

Gram -ve bacteria

Question 5

What are the 3 main types of chlamydia?

Answer 5

1. Chlamydia trachomatis (most common)
2. Chlamydia pneumoniae
3. Chlamydia psittacci

C. pneumoniae and C. psittacci cause respiratory infections.

Question 6

How can chlamydia be diagnosed?

Answer 6

Genital swab

Question 7

Describe the life cycle of C. trachomatis

Answer 7

1. The elementary body (EB), a small infectious particle found in secretions, enters a cell, such as an endocervical or urethral cell, to replicate.
2. Within eight hours, the EB transforms into a reticulate body (RB), which begins to multiply within an isolated area called an inclusion.
3. Within 24 hours, some RBs reorganise back to EBs, and, as the cell wall bursts, the EBs are released to infect adjacent cells or to be transmitted to and infect another person.

Question 8

What are the symptoms of chlamydia in women?

Answer 8

• Asymptomatic in 80%
• Vaginal discharge
• Pelvic inflammatory disease (pain, infertility)
• Reactive arthritis

Question 9

What are the symptoms of chlamydia in males?

Answer 9

• Asymptomatic in 50%
• Penile discharge
• Reactive arthritis

Question 10

What are the symptoms of chlamydia in infants?

Answer 10

Prematurity, pneumonia, conjunctivitis (blindness)

Question 11

What is the treatment for chlamydia?

Answer 11

Antibiotics:

- Azithromycin (recommended)

Question 12

What type of infection is gonorrhoea?

Answer 12

Gram -ve bacteria

Neisseria Gonorrhoeae

Question 13

How is gonorrhoea diagnosed?

Answer 13

Genital swab

Question 14

What are the symptoms of gonorrhoea in men?

Answer 14

• Asymptomatic in 80% of men

- Urethral discharge

Question 15

What is pelvic inflammatory disease (PID)?

Answer 15

Infection of female upper genital tract

1 in 10 women can become infertile

Question 16

What are the symptoms of gonorrhoea in females?

Answer 16

• Asymptomatic in 50% of women
• Vaginal discharge
• PID, infertility

Question 17

What is the treatment for gonorrhoea?

Answer 17

Ceftriaxone (injection)

Usually given with treatment for Chlamydia

Question 18

How does HIV infect cells?

Answer 18

1. HIV enters macrophages and CD4-positive T cells (CD4 is a glycoprotein receptor found on cells) by the adsorption of glycoproteins on its surface to receptors on the target cell
2. Fusion of the viral envelope with the cell membrane
3. The release of the HIV capsid into the cell.

Question 19

What happens once HIV is released into cell?

Answer 19

1. Reverse transcriptase is activated and transcribes RNA into complementary DNA.
2. Viral DNA is integrated into the genome of the host cell.
3. DNA can be transcribed into mRNA which direct the synthesis of viral proteins (translation).

Question 20

What are the initial symptoms of HIV?

Answer 20

Flu like illness but often have a latency period that is asymptomatic

Question 21

When does HIV progress to AIDS?

Answer 21

Eventually, if untreated, immunodeficiency results and opportunistic infections.

Question 22

What is the treatment for HIV?

Answer 22

HAART (highly active antiretroviral therapy)

Question 23

What is HAART?

Answer 23

A treatment regimen typically comprised of a combination of three or more antiretroviral drugs.

Question 24

How are pregnant women with HIV treated? What care must be taken during childbirth?

Answer 24

• All women should be on HAART
• Can have a vaginal birth if viral load <50 HIV RNA at 36
  weeks. (LSCS if viral load >50)
• Should not breastfeed.

Question 25

What type of infection is syphilis?

Answer 25

Bacteria

Question 26

How does syphilis spread?

Answer 26

The disease starts as a painless sore — typically on your genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores.

Question 27

How is syphilis diagnosed?

Answer 27

Blood test

Question 28

What are the stages of syphilis?

Answer 28

Primary, secondary, latent, tertiary

Question 29

Describe the primary stage of syphilis

Answer 29

Presents with a single chancre (a firm, painless, non itchy skin ulceration)

Question 30

If untreated, 1ary develops to 2ary syphilis. What are the symptoms of 2ary syphilis?

Answer 30

A diffuse rash which frequently involves the palms of the hands and soles of the feet Sores in the mouth or vagina

Question 31

If untreated, 2ary can progress to latent syphilis. Describe this stage

Answer 31

Little to no symptoms (dormant) which can last for years

Question 32

What is tertiary syphilis?

Answer 32

Gummas (soft non-cancerous) growth will invade and damage organs, neurological and heart problems

Question 33

What is the treatment for syphilis?

Answer 33

Depends upon stage at diagnosis but can be cured completely Penicillin

Question 34

How can you reduce the risk of being infected with an STI?

Answer 34

Consistent and correct condom use Reducing the number of sexual partners Avoidance of overlapping sexual relationships Partner notification

Question 35

When should you be screened for STI?

Answer 35

- Change of sexual partner - Annually MSM: - HIV and STI screen annually, or every 3 months if having condom-less sex with new partners

Question 36

Which STI has the highest rate of new diagnosis in the UK?

Answer 36

Chlamydia

Question 37

Which age group is most at risk of acquiring an STI?

Answer 37

20-30

Question 38

Which organism causes Chlamydia?

Answer 38

C. trachomatis

Question 39

What treatment is advised following the detection of gonorrhoea?

Answer 39

Ceftriaxone and Azithromycin