Sexually transmitted infections

Question 1

Management of Pelvic inflammatory disease with suspected gonococcal infection (gonorrhoea)

Answer 1

Recommended treatment for high-risk gonococcal infection includes ceftriaxone (1g IM) followed by 14 days of metronidazole (400mg orally twice daily) and doxycycline (100mg orally twice daily).

Question 2

Management of Trichomonas Vaginalis

Answer 2

Metronidazole 400–500 mg twice daily for 5–7 days

Question 3

What is the classic presentation of Trichomonas Vaginalis?

Answer 3

Post-coital bleeding, a malodorous green discharge, dyspareunia, vulvo-vaginal irritation and urethritis.

pH >4.5

Examination reveals cervicitis, with erythema of the cervix. “Strawberry cervix”

Question 4

What are the primary features of Syphilis?

Answer 4

Chancre - painless ulcer
Lymphadenopathy
often not seen in women (the lesion may be on the cervix)

Question 5

What causes Syphilis?

Answer 5

spirochaete Treponema pallidum

Question 6

Secondary features of Syphilis (6-10 weeks after primary infection)

Answer 6

• fever
• rash on trunk, palms and soles
• buccal ulcers
• condylomata lata (warty lesions)

Question 7

Tertiary features of Syphilis

Answer 7

Gummas (granulomatous lesions of the skin and bones)
Ascending aortic aneurysms
General paralysis of the insane
Tabes dorsalis - slow degeneration of the nerve cells and nerve fibers that carry sensory information to the brain
Argyll-Robertson pupil - bilateral small pupils that fail to constrict in response to bright light but exhibit constriction during near vision tasks

Question 8

Causative organism of Chlamydia

Answer 8

Chlamydia trachomatis

Question 9

Female specific chlamydia symptoms

Answer 9

cervicitis (discharge, bleeding), dysuria

Question 10

Male specific chlamydia symptoms

Answer 10

urethral discharge, dysuria

Question 11

Potential complications of chlamydia

Answer 11

1. pelvic inflammatory disease
2. endometritis
3. increased incidence of ectopic pregnancies
4. infertility
5. reactive arthritis
6. perihepatitis (Fitz-Hugh-Curtis syndrome) - RUQ pain

Question 12

How is chlamydia detected?

Answer 12

nuclear acid amplification tests (NAATs) are now the investigation of choice.

In women: vulvovaginal swab

In men: urine test

Question 13

Treatment for chlamydia infection

Answer 13

doxycycline (7 day course)

If contraindicated, azithromycin (1g od for one day, then 500mg od for two days)

Question 14

Treatment for chlamydia infection in pregnancy

Answer 14

Azithromycin 1g stat is the drug of choice ‘following discussion of the balance of benefits and risks with the patient’

Question 15

What organism causes gonorrhoea?

Answer 15

Gram-negative diplococcus Neisseria gonorrhoeae.

Question 16

Features seen in male gonorrhoea

Answer 16

urethral discharge, dysuria

Question 17

Features seen in female gonorrhoea

Answer 17

cervicitis, leading to vaginal discharge

Question 18

Local complications of gonorrhoeal infection

Answer 18

urethral strictures - strictures in the urethra
epididymitis - inflammation of the testis
salpingitis - inflammation of the fallopian tubes

Question 19

First line treatment for gonorrhoeal infection

Answer 19

Single dose of IM ceftriaxone 1g
If sensitivities are known, then oral ciprofloxacin 500mg should be given

Question 20

What is given to patients who are needle phobic (For gonorrhoea tx)?

Answer 20

oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose) should be used

Question 21

What is the most common cause of septic arthritis in young adults?

Answer 21

gonococcal infection

Question 22

Common complication of gonorrhoea

Answer 22

Disseminated gonococcal infection

Question 23

Triad of DGI

Answer 23

tenosynovitis, migratory polyarthritis and dermatitis.

Question 24

What is seen on wet mount microscopy slide for Trichomonas?

Answer 24

Motile trophozites

Question 25

What causes bacterial vaginosis?

Answer 25

Gardnerella vaginalis, causes a fall in lactic acid producing aerobic lactobacilli, raises the vaginal pH above 4.5

Question 26

Features of BV

Answer 26

vaginal discharge: 'fishy', offensive asymptomatic in 50%

Question 27

What are Amsel's criteria for BV diagnosis?

Answer 27

1. thin, white homogenous discharge 2. clue cells on microscopy: stippled vaginal epithelial cells 3. vaginal pH > 4.5 4. positive whiff test (addition of potassium hydroxide results in fishy odour)

Question 28

If a patient is symptomatic for BV, what treatment is recommended?

Answer 28

Oral metronidazole for 5-7 days

Question 29

Causative organisms of Pelvic inflammatory disease

Answer 29

Chlamydia trachomatis + the most common cause Neisseria gonorrhoeae Mycoplasma genitalium Mycoplasma hominis

Question 30

What is Pelvic Inflammatory disease?

Answer 30

a term used to describe infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries and the surrounding peritoneum. It is usually the result of ascending infection from the endocervix.

Question 31

What is a Jarisch-Herxheimer reaction?

Answer 31

Reaction to intramuscular benzathine penicillin for syphilis treatment. Not anaphylaxis, it is due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment

Question 32

If a patient with BV does not want metronidazole, which treatment can be given?

Answer 32

Topical clindamycin cream 2%

Question 33

Why is BV ALWAYS treated in pregnancy?

Answer 33

BV results in an increased risk of preterm labour, low birth weight and chorioamnionitis, late miscarriage