6: STIs

Question 1

What is the most common STI in the UK?

Answer 1

Chlamydia

Question 2

How does Chlamydia appear on a Gram stain?

Answer 2

Gram negative

But it’s very difficult to stain

Question 3

What is a rare consequence of chlamydia infection?

Answer 3

Pelvic inflammatory disease (PID)

Question 4

What type of bleeding occurs in chlamydia infection?

Answer 4

Post-coital and intermenstrual bleeding

Question 5

How does chlamydia present in females?

Answer 5

Post-coital / intermenstrual bleeding

Mucopurulent discharge

Abdominal pain

Dyspareunia

Question 6

How does chlamydia present in males?

Answer 6

Urethral discharge

Dysuria

Question 7

Apart from PID, what are other complications of chlamydia infection?

Answer 7

Tubal damage –> infertility

Neonatal transmission (look out for conjunctivitis)

Reiter’s syndrome

Question 8

What rheumatological condition can people get following chlamydia infection?

Answer 8

Reactive arthritis

i.e Reiter’s disease

Question 9

Chlamydia is more common in (men / women).

Answer 9

women

Question 10

Which variant of chlamydia is more severe than average and presents primarily in MSM?

Answer 10

Lymphogranuloma venereum (LGV)

Question 11

LGV is primarily found in MSM.

What are the symptoms?

Answer 11

Rectal pain / discharge / bleeding

often misdiagnosed as GI problem

Question 12

Chlamydia is likely to ___ with other STIs.

Answer 12

coexist

Question 13

When is chlamydia tested for?

Answer 13

14 days following exposure

Question 14

What are the NAAT tests used to detect chlamydia, 14 days after exposure, in

a) men
b) women?

Answer 14

a) First pass urine sample +/- rectal swab

b) Vulvovaginal swab

Question 15

How is chlamydia treated?

Answer 15

Doxycycline 100mg BD 1/52

Question 16

Which antibiotic is used second-line for chlamydia infection?

Answer 16

Azithromycin

Question 17

How does Neisseria gonorrhoeae appear on a Gram stain?

Answer 17

Gram negative intracellular diplococci

Question 18

What is the incubation time of gonorrhoea?

Answer 18

2 - 5 days

Question 19

Gonorrhoea is more common in (men / women).

Answer 19

men

as opposed to chlamydia

Question 20

How does gonorrhoea present in men?

Answer 20

Purulent urethral discharge

Dysuria

Question 21

WHERE must you swab in men with suspected gonorrhoea infection?

Answer 21

Urethra

Rectum

Pharynx…

all the sites

Question 22

What percentage of women have gonorrhoea and are asymptomatic?

How do they present otherwise?

Answer 22

50%

Vaginal discharge, pelvic pain

Question 23

How is gonorrhoea screened for?

Answer 23

NAAT testing

First pass urine in men, VV swab in women

Concurrently tests for chlamydia

Question 24

How is gonorrhoea investigated in patients who are symptomatic?

Answer 24

Culture

Question 25

How is **gonorrhoea** treated?

Answer 25

**Ceftriaxone 500mg IM**

Question 26

How is **gonorrhoea** treated if an IM injection of ceftriaxone is rejected by the patient?

Answer 26

**Cefixime 400mg PO**

Question 27

What must be done **two weeks** after antibiotic treatment in all patients with **gonorrhoea**?

Answer 27

**Test of cure**

Question 28

What is the **presentation** of a **primary infection** of **genital herpes**?

Answer 28

**Extreme pain** **Blistering and ulceration of genitalia** **Dysuria** **Discharge (urethral / vaginal)** **Enlarged inguinal lymph nodes** **Viral prodrome (fever and myalgia)**

Question 29

Which subtype of **HSV** causes **recurrent genital herpes?**

Answer 29

**HSV-2**

Question 30

How often does genital herpes recur when the causal agent is a) HSV-1 b) HSV-2?

Answer 30

**a) Every 1-2 years** **b) Every 2-3 months**

Question 31

**Genital herpes** tends to recur **(more / less)** often over time.

Answer 31

**less often** disease burns itself out

Question 32

How is **genital herpes** investigated?

Answer 32

**Swab of deroofed lesions for viral PCR**

Question 33

What drugs are used in the treatment of **genital herpes**?

Answer 33

**To treat: Aciclovir 400mg TDS 5/7** **PO** For pain: topical lidocaine

Question 34

Which subtype of **HSV** sheds more often and causes more **recurrent** genital herpes?

Answer 34

**HSV-2**

Question 35

What drugs can be given for **highly recurrent HSV-2** to prevent recurrence and transmission?

Answer 35

**Aciclovir 400mg BD** **for a year** Check this

Question 36

Why is **genital herpes** in the **3rd trimester** of pregnancy concerning?

Answer 36

**Chance of neonatal herpes**

Question 37

What is the most common **viral STI** in the UK?

Answer 37

**HPV** 80% of people will have it

Question 38

**HPV** has a ton of subtypes. Which cause a) low risk disease (e.g genital warts) b) high risk disease (e.g cancer)?

Answer 38

**a) 6 & 11** **b) 16 & 18**

Question 39

Which presentations of HPV are caused by ## Footnote **a) HPV 6 & 11** **b) HPV 16 & 18?**

Answer 39

**a) Anogenital warts** **b) Cancers**

Question 40

Which **drugs** are used to kill off **genital warts** topically?

Answer 40

**Podophyllin** first-line **Imiquimod** second-line

Question 41

Apart from **podophyllin** and **imiquimod**, what treatment options exist for **genital warts**?

Answer 41

**Cryotherapy** **Electrocautery**

Question 42

Who is **vaccinated** against HPV?

Answer 42

**11 - 13 year old girls** **MSM** (School-age boys are going to be included soon)

Question 43

Which bug causes **syphilis**?

Answer 43

**Treponema pallidum**

Question 44

What does **treponema pallidum** look like on microscopy?

Answer 44

**Spirochaete**

Question 45

Which **stages** of syphilis are a) infectious b) non-infectious?

Answer 45

**a) Primary, secondary and early latent** **b) Late latent and tertiary**

Question 46

How long does **syphilis** incubate for before a **chancre** appears?

Answer 46

**21 days on average**

Question 47

What is a **chancre?**

Answer 47

**Painless ulcer** of primary syphilis

Question 48

What is the presentation of **secondary syphilis?**

Answer 48

**Rashes** **Snail-track ulcers** **Lymphadenopathy** **Alopecia**

Question 49

What is **condylomata lata**?

Answer 49

**V infectious skin lesion of secondary syphilis**

Question 50

Why is **syphilis** referred to as the **great imitator**?

Answer 50

**Mimics many other diseases** (skin, pharynx, rectum, mucous membranes...)

Question 51

What are **two investigations** used for **syphilis?**

Answer 51

**Viral swab --\> PCR** **Serology**

Question 52

Which **drug** is used to treat **syphilis?**

Answer 52

**Benzathine penicillin IM**

Question 53

What is **Reiter's syndrome?**

Answer 53

**Triad of arthritis, conjunctivitis and urethritis** Commonly seen after GU and GI infections e.g chlamydia and gonorrhoea