Genitourinary

Question 1

ABx for cervicitis

Answer 1

Chlamydia
1- doxycycline 100mg BID 7 days
2- azithromycin 1g PO + 500mg PO OD 2 days

Neiserria
- ceftriaxone 1g IM single dose stat - TOC
Or
- cipro 500mg PO single dose

If genotypes anti microbial data suggests susceptibility to cipro - give cipro only , if unknown give ceftriaxone

Question 2

PID treatment
Outpatient
Inpatient

Answer 2

Out-
Oral Ofloxacin +oral metronidazole
Or
IM ceftriaxone + oral doxy + oral metronidazole

In- CDM
Ceftriaxone + doxy + metronidazole

Question 3

Yellow greenish, smelly vaginal discharge + itching
On exam - strawberry cervix
Vaginal pH >4.5
Dx + treatment ?

Answer 3

Trichomoniasis

Oral metronidazole

Question 4

Grey white fishy vaginal discharge
Positive whiff test
Vaginal pH>4.5
Dx + tx?

Answer 4

Bacterial vaginosis - Gardnerella vaginalis

Metronidazole +clindamycin

Question 5

Treatment of vulvovaginal candidiasis

Answer 5

Clotrimazole

Question 6

What is normal vaginal pH

Answer 6

3.8 -4.5

Question 7

Amsel’s criteria

Answer 7

Diagnosis of bacterial vaginosis 
3/4 of :
1. Homogenous grey - white discharge 
2. +ve whiff test (fishy smell w/ KOH)
3. Clue cells under microscopy 
4.vaginal ph> 4.5

Question 8

HPV 6 and 11 are responsible for

Answer 8

Genital warts

Question 9

HPV 16 & 18 are responsible for

Answer 9

Most cervical cancers in UK

Question 10

Prevention of genital warts

Answer 10

Gardasil

If vaccinated and warts still develop its of no help

Question 11

Treatment of genital warts

Answer 11

Ablation/ cryotherapy

Question 12

Multiple painful genital ulcers + dysuria

Dx +Treatment

Answer 12

HSV

Give acyclovir

Question 13

Single non painful genital ulcer

Dx?

Answer 13

Syphilis - treponema pallium

Chancre

Question 14

Single painful genital ulcer

Dx>

Answer 14

Haaemophilus Ducreyi (chancroid)

^ can be multiple and painful, like HSV - do PCR or viral culture to differentiate
PCR better **

Question 15

Motile flagellate on microscopy of vaginal discharge

Dx?

Answer 15

Trichomoniasis vaginalis

Question 16

Chlamydia presentation in males

Complications

Answer 16

Urethritis
Unilateral testicular pain

• untreated chlamydia - epididymis-orchitis or epididiymitis

Question 17

Major complication of untreated chlamydia in females

Answer 17

Saplingitis

Question 18

Most common STI in the UK

Answer 18

Chlamydia

Question 19

Complications of syphilis

Answer 19

Aortic aneurysm

Granulomatous lesions of skin and bone - 3ry stage syphilis

Question 20

Treatment of cervical ectropion

Answer 20

Resolves spontaneously

If tx required - cauterise with silver nitrate

Question 21

Anogenital warts are caused by

Answer 21

HPV 6 & 11

Question 22

Single best investigation in the case of a 20 YO with a new sexual partner and complaints of yellow green vaginal discharge that is increasing

Answer 22

Endocervical and high vaginal swab

Question 23

HVS, endocervical, and self collected vulvovaginal swabs uses

Answer 23

self collected - chlamydia, n.gonorrhoea screening
^ suspected case , asymptomatic

Signs and sx of chlamydia or gonorrhoea
- endocervical swab

Suspected trichomoniasis - HVS

To cover all @ once = endocervical + HVS

Question 24

Most sensitive screening test for chlamydia and gonorrhoea

Answer 24

Self collected vulvovaginal swab for NAAT

Question 25

HSV investigations

Answer 25

1st line - NAAT testing Others = viral culture + DNA PCR If negative and the ulcers are recurrent/atypical - Anti HSV antibody

Question 26

Treatment of HSV

Answer 26

Oral acyclovir

Question 27

Rashes on the palms and soles of feet occurs in (3)

Answer 27

1. HFMD - coxsackie 2. Rocky Mountain spotted fever - rickettsia 3. Secondary syphilis - treponema pallidum

Question 28

Primary stage of syphilis

Answer 28

Chancre - single painless ulcer

Question 29

2ry stage of syphilis - when does it occur Features (3)

Answer 29

6 weeks after chancre Fever lymphadenopathy malaise - systemic symptoms Rashes on soles palms and faced Condyloma lata

Question 30

3ry stage of syphilis | 3

Answer 30

Gumma - granulomatous lesion ; commonly affects skin & bones Cardiovascular - ascending aortic aneurysm , aortic regurgitation Neuro - dementia/ tabes dorsalis

Question 31

Management of syphilis

Answer 31

1st line - IM benzathine penicillin Alternatively , if allergic Doxycycline

Question 32

Investigations of syphilis

Answer 32

Ulcer still present + presents to GU clinic - dark microscopy Ulcer present + GP clinic - PCR Healed chancre (disappeared) - syphilis serology Healed chancre + oral ulcers present - mouth swab for PCR

Question 33

Investigation after anal intercourse (insertive & receptive )

Answer 33

Receptive = NAAT Rectal swab for screening of chlamydia and gonorrhoea - NAAT Insertive Urethral swab + first void sample urine *receptive much riskier for getting HIV Screen fro HIV Hep B chlamydia and gonorrhoea

Question 34

Treatment of pregnancy woman w/ UTI

Answer 34

Cefalexin

Question 35

Condyloma accuminatum vs Condyloma latum

Answer 35

Accumiantum - HPV = painless, skin coloured, cauliflower like Latum - 2ry syphilis = painless hypopigmented , firm moist , pink/reddish , papules containing spirochetes

Question 36

Chancre vs chancroid

Answer 36

Chancre - T.pallidum (syphilis) Painless, single , bilateral regional lymphadenopathy Exude serum Hard and indurated, sloping edges Chancroid = H.Ducreyi Painful, multiple, unilateral regional lymphadenopathy Purulent exudate Soft base, undermined edges