Sexually Transmitted Infections

Question 1

Risk factors for STIs

Answer 1

• Young age (<25, especially <20)
• Non in a monogamous relationship
• Multiple sexual partners or recent change of sexual partner
• Non use of barrier methods of contraception
• Ethnicity for some STIs (i.e. hepatitis B in Asians, gonorrhoea trichomonas in black Carribeans, HIV in black Africans)
• Sexual orientation (MSM)
• Residence in metropolitan areas

Question 2

Condoms

Answer 2

• Can be spermicidally lubricated (mmoxyl 9) or lubricated with non spermicide (sensitol)
• Can be latex frree
• Can reduce risk of some STIs

Question 3

Aetiology of Chlamydia

Answer 3

• Chlamydia trachomatis
• Obligate intracellular organism

Question 4

Presentation

Answer 4

• Women
  
  • Asymptomatic in 80%
  • Post coital or intramenstrual bleeding
  • Purulent discharge
  • Lower abdominal pain
  • Proctitis
  • Cervicitis
  • Cervical contact bleeding
  • Local complications (i.e. signs of pelvic infection)
• Men
  
  • Asymptomatic in 50%
  • Urethral discharge
  • Dysuria
  • Testicular/epididymal pain
  • Proctitis
  • Local complications (i.e. epididymitis)

Question 5

Diagnosis of Chlamydia

Answer 5

• PCR (NAAT) test
• Vulvovaginal swabs or first void urine in men
• Throat and rectal swabs as dictated by sexual history

Question 6

Treatment of Chlamydia

Answer 6

• Doxycycline 100mg for 7 days (not pregnant or breastfeeding)
• Erythromycin 500mg for 14 days (if pregnant or breastfeeding)
• No sexual contact until 1 week post treatment

Question 7

Complications of Chlamydia

Answer 7

• Pelvivc inflammatory disease (increasing risk of infertility, ectopic pregnancy, chronic pelvic pain)
• Epididymitis
• Reactive arethritis
• Fitz-Hugh Curtis syndrome
• Problems in pregnancy:
  
  • Neonatal conjunctivitis
  • Low birth weight
  • Post-partum endometritis

Question 8

Aetiology of Gonorrhoea

Answer 8

• Neisseria gonorrhoea infects mucosal surfaces of genital tract, rectum, oropharynx and eye
• Always sexually transmitted in adults
• Perinatal transmission causes eye infection in neonates

Question 9

Presentation of Gonorrhoea

Answer 9

• Rectal and pharyngeal infection often asymptomatic
• Cervical infection asymptomatic in 70%
• Vaginal discharge
• Low abdominal/pelvic pain
• 85% of men will develop urethral infection within 10 days
• Dysuria

Question 10

Diagnosis of Gonorrhoea

Answer 10

• PCR (NAAT) test alongside culture for sensitivities
• Vulvovaginal swab (can be self taken) or first void urine in men
• Throat and rectal swabs as dictated by sexual history

Question 11

Treatment of Gonorrhoea

Answer 11

• Depends on antibiotic resistance patterns, source of infection and anatomical site
• Positive test warrants referral to local sexual health service for treatment
• Ceftriaxone 1g stat (uncomplicated gonorrhoea)

Question 12

Complications of Gonorrhoea

Answer 12

• PID
• Bartholinitis
• Endometritis
• Epididymitis
• Infection of penile glands (Tyson’s glands)

Question 13

Aetiology of HSV

Answer 13

• HSV types 1 and 2
• Both can affect either mouth or anogenital skin
• Transmitted by close physical contact including oro-genital contact
• Asymptomatic shedding of the virus can occur at any time from an infected individual

Question 14

Presentation of HSV

Answer 14

• Variable
• 70-80% have no clinical symptoms
• Primary episodes may cause severe febrile illness lasting 5-7 days
• Dysuria
• Painful lymphadenopathy
• Neuropathic pain
• Genital blisters
• Ulcers and/or fissures

Question 15

Complications of HSV

Answer 15

• Urinary retention
• Constipation
• Rarely aseptic meningitis

Question 16

Diagnosis of HSV

Answer 16

• Can be detected by PCR from swab taken from lesions

Question 17

Treatment of HSV

Answer 17

• Primary episode
  
  • Acyclovir 400mg TDS for 5 days
  • Simple analgesia
  • Salt baths
• Recurrences
  
  • Acyclovir 800mg TDS for 2 days

Question 18

Aetiology of Syphilis

Answer 18

• Caused by Treponema pallidum
• Transmitted by skin to skin contact

Question 19

Presentation of Syphilis

Answer 19

• Anogenital ulcer - may occur in mouth
• Classically painless indurated ulcer (chancre) but may be multiple and painful

Question 20

Diagnosis of Syphilis

Answer 20

• Syphilis serology
• Swab of lesion for PCR
• Dark ground microscopy (of fluid from lesion)

Question 21

Treatment of Syphilis

Answer 21

• Benzathine penicillin 2.4mu IMI for early Syphilis
• Different regimens for late latent Syphilis

Question 22

Complications of Syphilis

Answer 22

• Neurosyphilis usually late complication but can occur earlier if immunocompromised
• CV syphilis is a late complication
• Gummata

Question 23

Aetiology of anogenital warts

Answer 23

• HPV (usually types 6 and 11)
• Transmission from skin to skin contact

Question 24

Presentation of anogenital warts

Answer 24

• Warts tend to appear round sites of maimal trauma (introitus in women, penis in men)
• Genital lumps
• Itch
• Bleeding

Question 25

Diagnosis of anogenital warts

Answer 25

• Clinical diagnosis
• Atypical warts should always be biopsied

Question 26

Treatment of anogenital warts

Answer 26

• Podophyllotoxin cream (not in pregnancy)
• Imiquimod
• Cryotherapy
• Prevention using HPV vaccine

Question 27

Causes of vaginal discharge

Answer 27