Final SH II

Question 2

Tx for:

• uncomplicated urogenital chlamydia? [2]
• rectal infections [1]

Answer 2

A seven day course of doxycycline
OR
Aziothromycin due to potentially poor compliance with a 7 day course of doxycycline

Question 3

Describe the clinical stages of LGV infection [3]

Answer 3

Typically infection comprises of three stages:
* stage 1: small painless pustule which later forms an ulcer
* stage 2: painful inguinal lymphadenopathy
* stage 3: proctocolitis - leading to anal pain; tenesmus and discharge

Question 4

Which patient populations do you offer a repeat Chlaymdia test in and why? [1]

Answer 4

Patients < 25 years old who are diagnosed with chlamydia should be offered a repeat chlamydia test in 3-6 months.

This is because there is a higher risk of reinfection (2-6x higher), which also increases the risk of PID and infertility.

Question 5

Describe the diagnostic criteria that needs to be met for BV dx

Answer 5

Amsel’s criteria for diagnosis of BV - 3 of the following 4 points should be present:
* thin, white homogenous discharge
* clue cells on microscopy: stippled vaginal epithelial cells
* vaginal pH > 4.5
* positive whiff test (addition of potassium hydroxide results in fishy odour)

Question 6

How do you treat BV in:

• asymptomatic women [1]
• symptomatic [1]
• pregnant [2]

Answer 6

asymptomatic women:
- treatment not required (unless undergoing pregnancy termination)

symptomatic:
- oral metronidazole for 5-7 days
- a single oral dose of metronidazole 2g may be used if adherence may be an issue

pregnant
- oral metronidazole is used throughout pregnancy if symptomatic
- If asymptomatic: may be considered for treatment, but should discuss with obstetrician.

Question 7

Describe the clinical presntation of chancroid [4]

Answer 7

Painful papules:
- early lesion that deteriorates into pustule then ulcer. May be one or more lesions

Multiple, deep ulcers

Lymphadenopathy:
- usually inguinal region

Buboe:
- infected, painful lymphadenitis that ulcerates and becomes suppurative. Can cause chronic draining sinuses.

NB: note it is rarely seen in the UK

Question 8

Which tests should you perform if you suspect chancroid to rule out DDx? [4]

Answer 8

Herpes culture
Syphilis serology
HIV test
LGV

Question 9

State three management options for chancroid [3]

Answer 9

A single IM dose (250 mg) of ceftriaxone
or
a single IM dose (1gram) of azithromycin

or an oral (500 mg) of erythromycin four times a day for seven days.

Question 10

Treatment for recurrent thrush? [2]

> 4 episodes a year

Answer 10

induction:
- oral fluconazole every 3 days for 3 doses

maintenance:
- oral fluconazole weekly for 6 months

Question 11

Investigations for trichomoniasis?

Answer 11

Swabs taken from lateral walls of vagina: pH > 4.5
and high vaginal swab: staining, microscopy and culture.

microscopy of a wet mount shows motile trophozoites

NAAT testing - gold standard

Question 12

A 15-year-old presents with a mouth ulceration and fever. On examination he has severe gingivostomatitis is a stereotypical history for infection by:

Answer 12

HSV - primary infection