HIV and STI's

Question 1

List the major bacterial STI’s

Answer 1

• Gonorrhoea
• Chlamydia
• Syphilis

Question 2

List the major viral STI’s

Answer 2

• HIV
• Herpes
• HPV
• HBV

Question 3

List the major STIs in terms of prevalence in descending order

Answer 3

• Trichomoniasis: 143 million
• Chlamydia: 131 million
• Gonorrhoea: 76 million
• HIV: 36 million people
• Syphilis: 6 million

Question 4

List the clinical aspects of common STIs

Answer 4

• Urethral discharge: males
• Vaginal discharge: females
• Genital ulcers
• Lumps, rashes, scrotal swelling, lower abdominal pain

Question 5

What are the common infective causes for urethral discharge?

Answer 5

• Gonorrhoea
• Chlamydia
• Mycoplasma genitalium
• Ureaplasma urealyctium

Question 6

What are the common infective causes for vaginal discharge?

Answer 6

• Candidiasis
• Bacterial Vaginosis
• Trichomoniasis

Question 7

What are the common infective causes for genital ulceration?

Answer 7

• Herpes simplex 1 and 2
• Syphilis
• Tropical STDs

Question 8

State the cause, sites involved, clinical features, complications, diagnostic methods and treatment options for chlamydia.

Answer 8

Chlamydia
Causes
• Chlamydia trachomatis
• Bacteria

Sites of infection
• Male urethra
• Cervix
• Anal canal
• Throat

Clinical features
• Discharge

Complications
• Pelvic inflammatory disease
• Epididymitis (inflammation of the epididymis)
• Reactive arthritis

Diagnostic methods
• PCR
• Culture

Treatment
• Azithromycin 1g single dose
OR
• Doxycycline 100mg for 7-10 days

Question 9

State the cause, sites involved, clinical features, complications, diagnostic methods and treatment options for gonorrhoea.

Answer 9

Gonorrhoea
Causes:
• Neisseria gonorrhoeae
• Bacteria

Sites of infection
• Male urethra
• Cervix
• Anal canal
• Throat

Clinical features
• Discharge
• Sore throat

Complications
• Pelvic inflammatory disease
• Epididymo - orchitis (inflammation of the epididymis and testes)
• Disseminated infection

Diagnostic methods
• PCR
• Gram stain and culture

Treatment
• Combination of 2 antibiotics
• Ceftriaxone 500mg + Azithromycin 1g

Question 10

State the cause, clinical features, diagnostic methods and treatment options for syphilis.

Answer 10

Syphilis
Causes
• Treponema pallidum
• Bacteria

Clinical features
• Chancre
• Painful ulcers in secondary stage

Diagnostic methods
• Serology
• Dark field microscopy

Treatment
• Penicillin

Question 11

Identify oral lesions associated with gonorrhoea and chlamydia

Answer 11

Gonorrhoea and Chlamydia
• Oral gonorrhoea and chlamydia are usually asymptomatic
• Patients who are symptomatic may present with multiple ulcers with a fiery red appearance and a white pseudomembrane

Question 12

Identify oral lesions associated with HIV

Answer 12

HIV patients usually experience candidiasis which can have the following patterns:
• Thrush that can be scraped off
• Erythematous: smooth, red atrophic patches
• Hyperplastic leucoplakia: white plaques that cannot be wiped off
• Angular cheilitis

Question 13

Identify oral lesions/ conditions associated with syphilis

Answer 13

Syphilis
• Primary syphilis: chancre a painless genital ulcer
• Secondary syphilis: painful rough, red or reddish brownpapules
• Congenital syphilis: Hutchinson’s teeth (widely spaced teeth that are smaller than normal)

Question 14

Identify conditions associated with Herpes

Answer 14

Herpes simplex 1 usually causes cold sores

Question 15

Outline how STI’s are managed

Answer 15

• Facilitate presentation
• Diagnosis should be quick & accurate
• Appropriate treatment
• Counselling / harm minimisation
• Contact tracing

Question 16

Outline how HPV is managed

Answer 16

• Vaccines given to pre- adolescent girls and boys

* These vaccines can help prevent other genital tract and anal cancers

Question 17

Explain how HIV works

Answer 17

• Is a virus that replicates itself within the bloodstream
• The virus attaches to CD4 cells (helper T cells) and replicates itself by over taking cell machinery and integrating itself with the host DNA
• During this process, the infected CD4 cells die, releasing the HIV to go infect more CD4 cells
• The virus causes a drop in CD4 cell count

Question 18

Identify the modes of transmission with HIV, and what it isn’t transmitted by

Answer 18

Contact with infected bodily fluids through mucous membranes/ non intact skin
• Semen
• Vaginal secretions
• Blood

Low transmission:
• Oral sex, however it may occur only when there is a breach of the mucous membrane

Not transmitted by 
• Social contact 
• Aerosol spread 
• Faecal-oral route 
• Urine

Question 19

List HIV oral associated conditions

Answer 19

• Periodontal infections
• Candidiasis, erythematous
• Herpes
• HIV associated salivary gland disease

Question 20

List ways STI/HIV can be prevented or managed

Answer 20

• Condoms
• Fewer partners
• Circumcision
• Treating STIs: Pre and Post exposure prophylaxis
• Treatment as Prevention
• Easy availability of HIV/STIs testing
• Needle & Syringe exchange
• Secure blood supply
• Prevention of Mother to Child Transmission (MTCT)