HIV and Sexually Transmitted Infections

Question 1

Rectal Gonorrhoea
Transmission?
Symptoms?
Proctoscopy?
Treatment?
Complications?

Answer 1

Direct contact of mucosal surfaces
Low abdo pain, diarrhoea, rectal bleeding, anal discharge, tenesmus, urethral/vaginal discharge, dysuria, may be asymptomatic
Inflamed mucosae, purulent exudate
Ceftriaxone single dose + azothromycin 7/7
Abscess formation

Question 2

Rectal chlamydia
Transmission?
Symptoms?
Proctoscopy?
Treatment

Answer 2

Direct contact of mucosal surfaces
70% asymptomatic, anal discomfort/itch, discharge
Proctoscopy - less severe
Azothromycin single dose + doxycycline 7/7 course

Question 3

Syphilis

Primary vs secondary

Answer 3

Primary - solitary painful ulcer
Secondary
- Mucosal patches and ulcers
- Mouth, anogenital, rectal
- Systemic inflammation, hepatitis
"Any anogenital ulcer or sore is syphilis until proven otherwise"

Question 4

Syphilis
Symptoms
Treatment

Answer 4

Pain, ulcers, painful defaecation, bleeding, ulcers, viraemic symptoms
Benzathine penicillin

Question 5

Human Papillomavirus
Transmission?
Symptoms?

Answer 5

Ano-genital, ano-oral

Anal warts, can extend to rectum

Question 6

Lymphogranuloma Venereum
Epidemiology?
Associated with?
Clinical features?
Treatment

Answer 6

Common in MSM, especially those who are HIV+
Group sex, drug use, syphilis, Hep C
3-30 days - ulcer
3-6/12 - inguinal syndrome, ano-rectal syndrome
Then strictures, fistulae, genital elephantiasis
Doxycyclin 21/7