Sexually transmitted infections

Question 1

Anogenital warts/Condyloma acuminata:
definition, lesions, sites

Answer 1

HPV induced benign proliferative lesions in the anogenital region

Papules and plaques: Asymptomatic, fleshy, pointed, pink
Hypertrophic masses: Cauliflower like lesions

Males : Coronal sulcus, frenulum
Female: Posterior fouchette

Question 2

Histopathology of condyloma acuminatum

Answer 2

koilocytes: squamous epithelial cell, central hyperchromatic nucleus, perinuclear halo

Question 3

Complications of CA

Answer 3

Obstruction of labour
Large papilomatosis of infant

Question 4

Treatment of CA

Answer 4

Non pregnant:
Podophyllin
Imiquimod

Pregnant:
Cryotherapy
TCA

Question 5

Urethritis:
Definition
Causative organisms

Answer 5

Inflammation of urethra leading to urethral discharge

Gonococcal: Neisseria gonorrheae
Non gonococcal :
Chamydia trachomatis
Ureoplasma urealyticum
Mycoplasma genitalis
Trichomonas vaginalis

Question 6

Difference between gonococcal and non gonococcal urethritis

Answer 6

Causative organism
Incubation period
Constitutional symptoms
Dysuria
Discharge(profuse purulent, scanty mucoid)

Question 7

Diagnostic criteria of urethritis

Answer 7

1. Visible abnormal discharge: mucoid/purulent/mucopurulent
2. Gram stain (urethral swab) : > 2 WBCs/oil immersion field
3. First void urine: > 10 WBCs/high power field

Question 8

Investigations for urethritis

Answer 8

1. Diagnostic criteria
2. Gram staining : Appearance of polymorphonuclear leucocytes
   Gonococcal : Gram negative diplococci seen intracellularly
   Non gonococcal : No intracellular pathogens seen
3. Culture media : Modified thayer martin medium (selective for gonococci)
4. NAAT

Question 9

Diagnosis of gonococcal urethritis

Answer 9

1. Direct smear examination(Gram stain)
2. Culture : gold standard:
   Non specific: Chocolate agar (McLeod’s) - dark brown colonies
   Specific: Modified thayer martin - dark brown opaque colonies, Modified newyork city - Red translucent colonies, Neisseria clear medium clear colonies
3. Transport : Stuart’s medium
4. Non culture diagnostic tests: NAAT, PCR, Transcription mediated amplification (TMA)

Question 10

Partner management of gonococcal urethritis

Answer 10

All partners within 60 days of contact period - traced, evaluated and presumptively treated

> 60 days - not needed

Question 10

Treatment for gonococcal urethritis

Answer 10

NACO 2024 guidelines

1. First line : Inj. Ceftriaxone 500 mg IM stat
2. Alternatives :
   Cefixime 800 mg single dose
   CDC alternatives Inj. Gentamicin 240 mg IM stat
   Tab Azithromycin 2 g single dose

Disseminated gonorrhea:
Ceftriaxone 1 g IV or IM every 24 hours
alt: cefotaxim, ceftizoxime

Question 11

Vaginal discharge syndrome

Answer 11

Candidiasis
Trichomoniasis
Bacterial vaginosis

Question 12

Candidiasis:
Causative organism
Discharge
Treatment
How to differentiate the species of candida

Answer 12

Candida albicans
Curdy white discharge
Fluconazole
Chrom agar

Question 13

Trichomoniasis:
Causative organism
Clinical features
Treatment

Answer 13

Trichomonas vaginalis

Greenish yellow frothy discharge
Strawberry cervix/colpitis macularis

Metronidazole 500 mg BD * 7 days

Question 14

Etiopathogenesis of bacterial vaginosis

Answer 14

Decreased lactobacillus -> decreased lactic acid -> vaginal pH > 4.5

Increased anaerobes :
Prevortella
Mobilincus
Gardenerella

Question 15

Diagnostic criteria of bacterial vaginosis

Answer 15

Amsel’s criteria: Any 3 of the 4 should be positive to diagnose the disease

1. Vaginal discharge:
   Homogenous
   White
   Adherent
2. Vaginal pH > 4.5
3. Whiff test/amine test: Vaginal discharge + KOH -> Fishy odour
4. Wet mount > 20 % clue cells (vaginal epithelial cells covered by adherent bacteria)

Question 16

Risk factors for bacterial vaginosis

Answer 16

Early sexual activity
Multiple sexual partners
New male or female partner
Women using IUD’s
Lack of condom use
Vaginal douching

Question 17

Clinical features of bacterial vaginosis

Answer 17

Half of the women are asymptomatic
Malodorous (especially after intercourse), homogenous white non viscous discharge
Smoothly coats vaginal walls
Pruritus, pain during coitus
Lower abdominal pain at times

Question 18

Other tests for bacterial vaginosis

Answer 18

DNA probe test
Proline aminopeptidase activity(card test)
Gas liquid chromatography
Succinate to lactate > 0.4

Question 19

Complications of bacterial vaginosis

Answer 19

Non pregnant:
1. Acquisition of STIs like HIV, gonorrhea, chlamydia, HSV
2. UTI
3. PID, endometritis
4. Post hysterectomy cuff cellulitis

Pregnancy:
1. Reduced chance of IVF
2. Second trimester abortion
3. Preterm labour, PROM, LBW
4. Postpartum endometritis

Question 20

Treatment of Bacterial vaginosis

Answer 20

Recommended regimens:
Metronidazole 500 mg oral BD * 7 days
or
Metronidazole gel 0.7% one full applicator (5 g) intravaginally ,OD for 5 days
or
Clindamycin cream 2% one full applicator (5 g) intravaginally at bed time for 7 days