Sexual health conditions (FCM)

Question 1

What is Proctitis and what are the signs and symptoms of this ? (5 Symptoms)

Answer 1

Inflammation of the lining of the rectum.

Symptoms:

• PR bleeding
• PR discharge
• Diarrhoea
• Rectal pain
• Tenesmus / feeling like you need to pass stool

Question 2

What STI may cause reactive arthritis?

Answer 2

Chlamydia

Question 3

How is Chlamydia?

Answer 3

• Refer the patient to a GUM clinic
  But, if they want to be treated in primary care…

Non pregnant-
1. Doxycycline 100mg BD for 7/7

Pregnant/ first line contraindicated-

1. Azithromycin 1g orally for 1 day then 500mg OD for 2 days
2. OR Erythromycin 500mg QDS for 7/7 or Erythromycin 500mg BD for 14/7

Question 4

What is Syphilis? and what are the risk factors? (6 things)

Answer 4

An infectious disease caused by bacteria (Spirochete bacterium Treponema palladium) generally transmitted through sexual contact.

Risk factors:

• Unprotected sex
• Multiple sexual partners
• Previous/ current diagnosis of STI
• Needle sharing
• Social vulnerability (homeless, poverty, migrant, refugee)
• MSM

Question 5

How is Syphilis treated?

Answer 5

1. Refer to the GUM clinic (for medications)
2. Advise to avoid sexual contact until diagnosis/ treatment
3. Contact tracing

Question 6

Signs and symptoms of Syphilis? (5 points: primary and secondary syphilis)

Answer 6

Symptoms may come and go for at least 2 years

1. Chancre (painless genital ulcers with a clean base and sharp borders) THIS INDICATES PRIMARY SYPHILIS
2. Non- pruritic maculopapular rashes (that last 2-6 weeks)
3. Moist wart like lesions (condylomata lata) - usually develops at sites of skin friction e.g perianal/ vulval regions/ under breasts
4. Lymphadenopathy
5. Unexplained neurological signs (Hearing loss, meningitis, ocular disease et )

POINTS 2-5 = SECONDARY SYPHILIS

Question 7

How is Gonorrhoea treated?

Answer 7

1. GUM clinic referral

If in GP:
1. IM Ceftriaxone 1g single dose

if not tolerated:
2. Cefixime 400mg orally single dose + azithromycin 2g orally

3. Follow up 1 week after treatment to make sure sx resolved and check adherence

If also infected with chlamydia then encourage Doxycycline 100mg BD for 7/7

Question 8

What are some ddx when thinking about a patient presenting with a flu like illness after unprotected sex? ( 4things)

Answer 8

1. HIV
2. Hepatitis B or C
3. Flu
4. Syphilis

Question 9

How is herpes treated?

Answer 9

Acyclovir 400mg TDS for 5/7

Question 10

How do you treat genital warts?

Answer 10

Freezing or 0.5% podophyllotoxin solution gel or cream

Question 11

If you don’t freeze molluscum, how long does it typically take to clear?

Answer 11

24-36 months