Sexually Transmitted Infections

Question 1

define bacterial vaginosis

Answer 1

a bacterial overgrowth of gardenerella vaginalis leading to vaginal discharge with an associated fishy odour

Question 2

diagnostic criteria of bacterial vaginosis

Answer 2

Amstel criteria - 3/4 must be present to confirm diagnosis

Question 3

criteria of Amstel criteria for bacterial vaginosis

Answer 3

vaginal pH >4.5
homogenous grey discharge
whiff test- 10% potassium hydroxide produces fishy odour
clue cells present on wet mount

Question 4

management of bacterial vaginosis

Answer 4

oral metronidzaole (400mg 2XD for 5-7days) or clindamycin

Question 5

management of bacterial vaginosis in pregnancy

Answer 5

oral metronidzaole (400mg 2XD for 5-7 days) or intravaginal gel (1XD for 5 days)

Question 6

risks associated with bacterial vaginosis in pregnancy

Answer 6

preterm rupture of membranes

premature labour

Question 7

define genital chlamydia infection

Answer 7

an infection caused by chlamydia trachomatis bacterium

Question 8

clinical features of chlamydia

Answer 8

can be asymptomatic but can present with:

urethral discharge and dysuria in men

dysuria, intermenstrual bleeds and vaginal discharge in women

Question 9

investigations of chlamydia

Answer 9

endo-cervical swab for NAAT

urine and urethral swab for NAAT

Question 10

management of chlamydia

Answer 10

doxycycline BD for 7 days OR azithromycin 1g single dose

Question 11

define genital candidiasis

Answer 11

an infection caused by candida albicans

Question 12

risk factors of genital candidiasis

Answer 12

pregnancy
antibiotics
immunosuppression

Question 13

clinical features of genital candidiasis in women

Answer 13

itching 
thick white curdly discharge 
sour milk odour 
dysuria 
superficial dyspareunia (painful intercourse)

Question 14

clinical features of genital candidiasis in men

Answer 14

soreness
pruritis
redness

Question 15

management of genital candidiasis

Answer 15

intravaginal antifungal cream/pessary

oral antifungal

Question 16

examples of intravaginal antifungal creams/pessarys

Answer 16

clotrimazole
econazole
miconazole
fenticonazole

Question 17

examples of oral antifungals

Answer 17

fluconazole

itraconazole

Question 18

management of genital candidiasis in pregnancy

Answer 18

clotrimazole

miconazole

Question 19

define molluscum conatgiosum

Answer 19

an infection caused by the poxvirus that is transmitted via skin-skin contact

Question 20

clinical features of molluscum contagiosum

Answer 20

small and smooth pearly coloured papules with central area of umbilication

Question 21

management of molluscum contagiosum

Answer 21

can clear spontaneously after 3mnths

cryotherapy

Question 22

define gonorrhoea

Answer 22

a STI caused by Neisseria gonorrhoea - a gram -ve diplococci

Question 23

clinical features of gonorrhoea in men

Answer 23

mucopurulent or purulent discharge 
dysuria 
anal discharge 
perianal/anal pain 
pruritus 
pharyngeal infection

Question 24

clinical features of gonorrhoea in women

Answer 24

increase or altered vaginal discharge (mucopurulent)
lower abdominal pain
contact-induced bleeds
dysuria

Question 25

investigation of gonorrhoea

Answer 25

nucleic acid amplification test (NAAT) via vulvovaginal swab or first-pass urine sample

Question 26

management of gonorrhoea

Answer 26

ceftriaxone (500mg IM) or oral azithromycin (1g)

Question 27

define trichomoniasis

Answer 27

a sexually transmitted infection caused by flagellated protozoan trichomonas vaginalis

Question 28

clinical features of trichomoniasis

Answer 28

can be asymptomatic but if symptomatic: women - frothy yellow discharge - vulval itching - dysuria - offensive odor - lower abdominal discomfort men - dysuria - uretheral discharge

Question 29

investigations of trichomoniasis

Answer 29

NAAT for T.vaginalis and other STIs via high vaginal swab or urethral swab or first-void urine

Question 30

management of trichomoniasis

Answer 30

``` avoidance of sexual intercourse for 1wk following treatment oral metronidazole (2g single dose or 400-500mg 2XD for 5-7 days) ```

Question 31

define genital herpes

Answer 31

an infection with herpes simplex virus (HSV-1 or HSV-2) that causes oral, genital and ocular ulcers

Question 32

most common cause of genital herpes

Answer 32

HSV-2

Question 33

clinical features of first episode of genital herpes

Answer 33

``` multiple painful blisters that develop into erosions and ulcers vaginal or urethral discharge local oedema tingling/neuropathic pain fever headache dysuria malaise ```

Question 34

investigations of genital herpes

Answer 34

viral culture of site swabs | PCR or NAAT of ulcer base

Question 35

supportive management of genital herpes

Answer 35

saline bathing oral analgesics topical lidocaine increase fluid intake

Question 36

medical management of genital herpes

Answer 36

aciclovir (400mg 3XD for 5 days) | valciclovir (500mg 2XD for 5 days)

Question 37

medical management of genital herpes in pregnancy

Answer 37

oral aciclovir (400mg 3XD)