Infections - STIs

Question 1

How can STis occur?

Answer 1

skin on skin contact or exchange of bodily fluids during insertive vaginal or anal sex

Question 2

Epidemiology - Chlamydia + gonorrhoea

Answer 2

most common worldwide
rate at its highest 15-19 and 20-24

gonorrhoea is the second most common bacteria sexually TI

Question 3

Epidemiology - Syphilis + Herpes simplex

Answer 3

Syphilis - ^ in recent years

Herpes; 6% of all diagnosed STIs

Question 4

Uncomplicated Genital Chlamydia

Answer 4

causes inflammation of urethra in men and cervis/ urethra in women

asymptomatic in - 70% women
50% - men

Trachomatis - cause

Question 5

What is the assessment for chlamydia?

Answer 5

samples for nucleic acid amplifications tests (NAATs)

Question 6

Chlamydia test WOMAN

Answer 6

a vulvo-vaginal or endocervical swab

first urine sample can be collected

Question 7

Chlamydia test MEN

Answer 7

A FCU specimen of choice
urethral swab is an alt.

Question 8

Symptoms of chlamydia in women

Answer 8

heavier periods

abdomen/ pelvic pain

vaginal discharge

irregular periods

bleeding between periods

pain during urination

pain and bleeding during and after sex

Question 9

Symptoms of chlamydia MEN

Answer 9

pain during urination

pain in testicles

swelling in testicles

swelling of testicles

burning or itching of urethra

white/ watery or cloudy discharge from penis

Question 10

Tests for chlamydia are recommended if a sexually active person has the following symptoms and signs

Answer 10

In women: post-coital or intermenstrual bleeding, increased or purulent vaginal discharge, mucopurulent cervical discharge, deep dyspareunia, dysuria, pelvic pain and tenderness, an inflamed or friable cervix.

In men: dysuria, urethral discharge, urethral discomfort, epididymo-orchitis or reactive arthritis

Question 11

Complications of chlamydia LEAD TO&raquo_space;>

Answer 11

Pelvic inflammatory disease (PID)
Epididymo-orchitis
Lymphogranuloma venereum (LGV)
Sexually acquired reactive arthritis (SARA)
Perihepatitis
Adverse outcome in pregnancy
Conjunctivitis
Anxiety and psychological distress

Question 12

How should I manage a person with suspected or confirmed chlamydia?

Answer 12

confirmed > refer to genito-urinary medicine (GUM) clinic > manage in GUM clinic ( if poss) / manage in primary care (not poss) > offer written info, advice to treat partner, treat, investigations, arrange follow up, refer if poss

Question 13

Management of chlamydia: non-pregnant adults and children over age of 13 years:

Answer 13

1st line: doxycycline 100mg bd for 7 days

if contraindicated or not tolerated = azithromycin 1g orally as a single dose fro 1 day > 500mg orally OD for 2 days

Question 14

Managment for pregnant women

Answer 14

Azithromycin, 1g orally for 1 day > 500mg orally OD for 2 days

Erythromycin 500mg qds daily for 7 days or erythromycin 500mg bd for 14 days

or

amoxicillin 500mng tds for 7 days

Question 15

Gonorrhoea - cause?

Answer 15

Gram- negative neisseria gonorrhoeae

Question 16

What does gonorrhoea affect?

Answer 16

mucous membranes of urethra, endocervix, rectum, pharynx and conjunctiva

Question 17

How is gonorrhoea transmitted?

Answer 17

direct inculation of secretions from one mucous membrane to another

infection of eye most commonoly results from autoinoculation

Gonococcol infection among infants > exposure to infected cervical exudates at birth

Question 18

Symptoms of gonorrhoea WOMEN

Answer 18

vaginal discharge

burning/painful urination

bleeding between periods

Question 19

Symptoms of gonorrhoea MEN

Answer 19

penile discharge

burning urination

testicular swelling

Question 20

Assessment of gonorrhoea:

Answer 20

nucleic acid amplification tests (NAATs) or by culture

Question 21

What specimens get tested fro culture = gonorrhoea?

Answer 21

urethral, endocervical, neovaginal, anorectal and phatyngeal swabs

Question 22

How should I manage a person with suspected gonorrhoea?

Answer 22

confirm > refer to GUM > (if poss) manage in GUM clinic / (not poss) manage in primary care > prescribe AB, screening for other STIs and HIV, patient-led partner notification, info, follow up

Question 23

Antibiotic choices for the treatment of gonorrhoea:
uncomplicated

Answer 23

antimicrobial susceptibility KNOWN:
cipofloxacin 500mg orally as single do

antimicrobial susceptibility UNKNOWN: Caftriaxone 1g intramuscular (IM) injection as a single dose

Question 24

Antibiotic choices for the treatment of gonorrhoea: people with allergy/ needle phobia or comntraindications:

Answer 24

Gentamicin 240mg Im as single dose plus azithromycin 2g orally

OR
cefixime 400mg orally as single dose plus azithromycin 2g orally

Question 25

Antibiotic choices for the treatment of gonorrhoea: people with penicillin allergy

Answer 25

cefriaxone and cefixime suitabkle treatment options unless history of hypersensitivity e.g. to a beta-lactam antibacterial agent

Question 26

Antibiotic choices for the treatment of gonorrhoea: pregnant or breastfeeding

Answer 26

ceftriaxone 1g Im injection as a single dose azithromycin 2g as single oral dose DO NOT prescribe CRIPOFLOXACIN

Question 27

Prognosis - gonorrhoea

Answer 27

most solve spontaneously

Question 28

Complications of untreated gonorrhoea

Answer 28

men ; epididymo-orchitis, prostatitis, infertility, urethral structure, infection of mullerian or cowper glands women ; PID, pregnancy complications

Question 29

Syphilis - caused by:

Answer 29

spirochete bacterium Treponema pallidum

Question 30

Untreated syphilis: persist for years > what stages?

Answer 30

early syphilis; 3 stages primary, secondary and early latent syphilis Late syphilis; 2 stages Late latent syphilis and tertiary syphilis

Question 31

Complications syphilis:

Answer 31

Neurosyphilis Cardiovascular syphilis Gummatous syphilis Adverse outcomes in pregnancy. Facilitation of HIV transmission.

Question 32

symptoms of syphilis:

Answer 32

chancres (sores) hair loss swollen lymph nodes sore throat rash

Question 33

Assessment of syphilis

Answer 33

suspect if: Genital lesion(s) - Chancre Associated regional lymphadenopathy A non-pruritic maculopapular rash Moist wart-like lesions (condylomata lata) Patchy lesions on the oral mucosa (‘snail tract’ lesions). Generalized lymphadenopathy. Unexplained neurological or ophthalmological symptoms.

Question 34

How should I manage a person with suspected syphilis?

Answer 34

confirm > refer to GUM > (poss) manage in GUM clinic / (not poss) primary care > explain conditions + risk factors, discuss prevention, discuss GUM and screening for other STIs

Question 35

syphillis treatment with Benzathine benzylpenicillin: LATE stage (latent seropositive)

Answer 35

2.4 million units once weekly for 3 weeks

Question 35

syphilis Treatment with Benzathine benzylpenicillin adult - PRIMARY / SECONDARY STAGE

Answer 35

2.4 million units as single dose

Question 36

how to prevent syphilis?

Answer 36

use condom complete treatment if you and your partner have it do not share sex toys do not share needles if you inject drugs

Question 37

MCQ: When untreated, which ONE of the following sexually transmitted infections (STIs) can cause neurological damage, blindness and cardiovascular disease?

Answer 37

Chlamydia

Question 38

MCQ: Destie is a 32 year-old pregnant woman. She underwent screening for STIs but she has no symptoms of infection. However, her first pass urine is positive for Chlamydia trachomatis on NAAT. Which of these treatment options would you recommend?

Answer 38

Azithromycin, 1 g orally for 1 day, then 500 mg orally once daily for 2 days