Common STI's

Question 1

What is the causative organism for gonorrhoea?

Answer 1

Neisseria gonorrhoeae

Question 2

What are the gonorrhoea symptoms seen in men?

Answer 2

10%- no symptoms
Thick profuse yellow discharge
Dysuria
rectal and pharyngeal infection

Question 3

What gonorrhoea symptoms can be seen in women?

Answer 3

Vaginal discharge
Dysuria
Intermenstrual or post-coital bleeding

Question 4

What is the epidemiology of gonorrhoea?

Answer 4

More common in men
Mostly MSM

incubation time 5-6 days
lasts 2 days-2 weeks if you get symptoms at all.

Question 5

What are the possible complications of gonorrhoea in men?

Answer 5

Epididymitis (inflammation of the epididymis)
Acute monarthritis - usually in elbow or shoulder
Gonococcal infection skin lesions, can be pustular (very rare)

Question 6

What are the possible complications of gonorrhoea in women?

Answer 6

Pelvic inflammation
Bartholin’s abcess
Gonococcal opthalmia neonatorum (pass on gonorrhoea infection to baby during delivery-baby gets infection in eyes)
Acute monarthritis - usually in elbow or shoulder
Gonococcal infection skin lesions, can be pustular (very rare)

Question 7

Which disease is diagnosed using a NAAT?

Answer 7

NAAT -nucleic acid ampilfication test, used to diagnose gonorrhoea, using urine sample or swab

grain stained smear from urethra, cervix or rectum in symptomatic patients
and
Culture
should also be done to confirm case and assess antibiotic sensitivity

Question 8

Treatment of gonorrhoea?

Answer 8

1g ceftriaxone intramuscular injection
Can also treat according to antibiotic sensitivities.
Test of cure at 2 weeks
Test for reinfection at 3 months

Question 9

Causative organism of chlamydia

Answer 9

Chlamydia tachomatis servors D-K

or Serovar L2b which is rare and gives severe proctitis

Question 10

What symptoms do men infected with chlamydia get?

Answer 10

> 70% asymptomatic
Slight watery discharge
Dysuria
Conjunctivitis

Question 11

What symptoms do women infected with chlamydia get?

Answer 11

>80% asymptomatic
Vaginal discharge
Dysuria
Intermenstrual/post coital bleeding
Conjunctivitis- inflammation of transparent membrane that lines eyelid and covers eyeball

Question 12

Complications of chlamydia in men

Answer 12

Epididymitis
reactive arthrits
Reiter’s syndrome- form of arthritis which commonly affects spine and sacroiliac joints +Urethritis/cervicitis + conjunctivits

Question 13

Complications of chlamydia in women

Answer 13

Pelvic inflammatory disease (infection in upper genital tract of woman)
ectopic pregnancy
pelvic pain
infertility (~1%)
reactive arthrits
Reiter’s syndrome- form of arthritis which commonly affects spine and sacroiliac joints +Urethritis/cervicitis + conjunctivits

Question 14

Epidemiology of chlamydia

Answer 14

most cases in <25 years

Especially sexually active teenage women.

Question 15

How is chlamydia diagnosed?

Answer 15

First void sample in men
Self-taken or clinican-taken swab from cervix, urethra or rectum in women
Both are then tested using NAAT- nucleic acid amplification test

Question 16

What is the treatment for chlamydia?

Answer 16

Doxycyline 100mg bd (twice a day)
or
Azithromycin 1g orally once if pregnant

Test for reinfection 3-12 months

An earlier test for cure not needed unless symptoms persist.

Question 17

What organisms can cause Herpes infection?

Answer 17

Herpes simplex virus 1 and 2

Question 18

What are the symptoms Herpes can present with?

Answer 18

80% asymptomatic
The rest have recurrent:
burning/itching->blistering->ulceration
Tender inguinal lymphadenopathy
flu-like symptoms
Dysuria
Neuralgic pain (severe, sudden stabbing pain) in back, pelvis and legs

Question 19

What are the possible complications of Herpes?

Answer 19

Urinary retention due to autonomic neuropathy
Neonatal infection
Secondary infection

Question 20

Epidemiology of Herpes

Answer 20

Very common (~15-20% UK population)
Equally common to affect both sexes
Incubation ~5 days to months

Question 21

How is herpes diagnosed?

Answer 21

PCR swab from lesion

Question 22

What is a PCR test?

Answer 22

PCR means polymerase chain reaction. It’s a test to detect genetic material from a specific organism, such as a virus.

Question 23

How is herpes treated?

Answer 23

Primary outbreak- aciclovir (antiviral) can be 400mgs (three times daily) for 5 days, Lidocaine treatment

Infrequent recurrences: Lidocaine ointment

Frequent recurrences: Aciclovir 400 (twice daily-bd) long-term

Question 24

Uncommon generally but more common in middle aged women than other STI’s and the causative organism is trichomonas vaginalis.
What STI is this?

Answer 24

Trichomoniasis

Question 25

What are the symptoms and possible complications of Trichomoniasis?

Answer 25

10-30% asymptomatic Profuse thin vaginal discharge-green, frothy and foul smelling Vulvitis Complications: Miscarriage Preterm labour

Question 26

How would you diagnose trichomoniasis?

Answer 26

Vaginal PCR swab | no test for men as no urine test avaliable yet

Question 27

Treatment for Trichomoniasis

Answer 27

Metronidazole 400mg orally twice/day for 5 days or 2g single dose

Question 28

What STI does Human Papilloma virus types 6 and 11 cause?

Answer 28

Anogential warts

Question 29

What are the symptoms of anogential warts? | What are the complications?

Answer 29

Lumps with surface texture of cauliflower (bumpy) Occasionally itchy or bleed Complications: Neonatal laryngeal papillomatosis (rare)-this can cause breathing difficulties

Question 30

How are anogenital warts diagnosed?

Answer 30

Appearance and sometimes biospy

Question 31

Podophyllotoxin or imiquimod are used to treat what STI? | What are the brand names?

Answer 31

Treats: anogenital warts Podophyllotoxin brands- warticon and condyline Imiquimod brand- Aldara Cryotherapy or diathermy can also be used as treatment

Question 32

What organism causes Syphilis?

Answer 32

Treponema pallidum

Question 33

Symptoms of syphilis

Answer 33

Asymptomatic Mild symptoms that go unreported or Primary- local ulcer Secondary- rash, mucosal ulceration, neuro symptoms (e.g. headache, stiff neck, nausea), patchy alopecia <2 years since caught (early latent) Late latent> 2 years since caught but no symptoms Tertiary- Neurological,cardiovascular or gummatous skin lesions (all very rare)

Question 34

What is gummatous syphilis?

Answer 34

Gumma, also known as gummy tumor, is more common in the late stages of syphilis and is highly destructive. In the early stage, it is a deep, subcutaneous nodule that gradually grows and adheres to the skin. The central site gradually softens, ulcerates, and releases viscous, gum-like pus

Question 35

What is the epidemiology and incubation of syphilis?

Answer 35

90% of cases in Scotland are MSM Rare ~20 cases/yr in Grampian 9-90 days incubation

Question 36

What are the possible complications of syphilis?

Answer 36

Cranial nerve palsies Cardiac or aortic involvement Congenital syphilis

Question 37

How is syphilis diagnosed?

Answer 37

Serology looking for TP, IgGEIA, TPPA and RPR PCR swab from ulcer

Question 38

How is syphilis treated?

Answer 38

Early <2 yrs and no neurological involvement- benzathine penicillin im injection once or Doxycyline 100mg twice/day orally for 2 weeks Late >2 years and no neurological involvement - Benzathine penicillin im injection weekly for 3 weeks or Doxycycline 100mg twice/day orally for 28 days