Sexually Transmitted Infections

Question 1

List 5 infections commonly transmitted via anilingus

Answer 1

Amoeba
Cryptosporidia
Giardia
Shigella
HAV

Question 2

What kind bacteria is gonorrhoea?

Answer 2

Gram negative diplococci

Question 3

What is the incubation period of gonorrhoea?

Answer 3

2-7 days

Question 4

What is the most common presentation of gonorrhoea in females?

Answer 4

Asymptomatic

Question 5

What is the most common presentation of gonorrhoea in females?

Answer 5

Urethritis with thick, creamy urethral discharge (can block urethra and cause pain)

Question 6

What other kinds of presentations can be caused by gonorrhoea besides urethritis?

Answer 6

Oral sex involving transmission of gonorrhoea can result in pharyngitis and lymphadenopathy

Question 7

What are some of the symptoms of gonorrhoea dissemination?

Answer 7

Arthritis
Maculopapular rash
Meningitis
Endocarditis
Epididymitis
Peri-hepatitis

Question 8

What STIs can cause PID?

Answer 8

Gonorrhoea
Chlamydia
Mycoplasma genitalium

Question 9

What is neonatal gonococcal opthalmia?

Answer 9

Gross purulent conjunctivitis in 1st week of life

Can cause perforation and blindness by days 2-5

Question 10

How is neonatal gonococcal opthalmia treated?

Answer 10

IV cefotaxime for a week

Also irrigate eyes regularly

Question 11

What diagnostic specimens are taken in a case of suspected gonorrhoea?

Answer 11

Cervical swab into charcoal transport
Male urethral swabs
Urine
Others (conjunctiva, pharyx, skin lesions, anal, CSF, blood, synovial fluid)

Question 12

What laboratory investigations are used for gonorrhoea?

Answer 12

Non-selective CBA in CO2
Selective Thayer-Martin agar
Culture for antibiotic sensitivities

Question 13

What is the most common diagnostic method used for gonorrhoea and chlamydia?

Answer 13

NAAT from genital swabs or first void urine

Question 14

What is the disadvantage of NAAT for gonorrhoea?

Answer 14

May have cross reaction with mucosal commensal Neisseria spp.

Question 15

What other infection is gonorrhoea especially associated with?

Answer 15

Chlamydia (~50% of cases)

Question 16

How is gonorrhoea treated?

Answer 16

Ceftriaxone IM/IV AND azithromycin orally

Question 17

Does gonorrhoea show increasing antibiotic resistance?

Answer 17

Yes

Question 18

What kind of organism is chlamydia?

Answer 18

Obligate IC parasite

Question 19

What kind of epithelium do chlamydia and gonorrhoea like to infect?

Answer 19

Columnar

Question 20

Which serovars of chlamydia cause genital infection?

Answer 20

D-K

Question 21

What symptoms does chlamydia cause in females and males?

Answer 21

Females: cervicitis, endometritis, vaginal discharge, urethritis, dysuria, irregular bleeding, pelvic pain
Males: urethritis with clear urethral discharge, dysuria, meatal erythema, testicular pain, prostatitis
BUT frequently asymptomatic for both

Question 22

Which serovars of chlamydia cause lymphogranuloma venereum?

Answer 22

L 1-3

Question 23

What is LGV?

Answer 23

Invasive lymphatic infection causing suppurative lymphadenopathy
Can cause procto-colitis with strictures in MSM

Question 24

What syndromes can neonatal chlamydia infection cause?

Answer 24

Conjunctivitis (25%)

Pneumonia (10%)

Question 25

Is culture performed routinely for chlamydia?

Answer 25

No

Question 26

When is test of cure required for chlamydia?

Answer 26

Post procedure Pregnancy Performed 4-6 months post-treatment

Question 27

How is chlamydia treated?

Answer 27

``` Azithromycin orally (IV if severe PID) OR doxycycline orally (avoid in pregnancy) ```

Question 28

What kind of organism is trichomonas vaginalis?

Answer 28

Flagellated protozoan

Question 29

What symptoms does trichomonas commonly produce?

Answer 29

Often asymptomatic Can present with frothy, green-yellow discharge Cervical erythyma and friability Pruritis, dysuria and abdominal pain

Question 30

What does trichomonas increase the risk of?

Answer 30

HIV transmission

Question 31

What laboratory testing is performed for trichomonas?

Answer 31

High Vaginal Swab (HVS; "wet prep" microscopy or culture) Urine (for PCR) Sometimes seen on Pap smear

Question 32

How is chlamydia treated?

Answer 32

Metronidazole or tinidazole orally | Clindamycin cream

Question 33

What is treponema pallidum infection called?

Answer 33

Syphilis

Question 34

What methods of laboratory detection are used for syphilis?

Answer 34

Microscopy | Serology

Question 35

What are non-treponemal serological tests? When are they used?

Answer 35

Ab to cellular lipids and lecithin (e.g. VDRL, RPR) | Useful for screening and monitoring therapy (positive 4-8 weeks post-infection)

Question 36

What may cause FPs in non-treponemal tests?

Answer 36

CT disorders, viral infections, IVDU, pregnancy

Question 37

What are treponemal tests? When are they positive?

Answer 37

E.g. EIA, TPHA, TPPA, FTA-Abs | Positive slightly earlier than non-treponemal and remain positive for life

Question 38

How is mycoplasma genitalium diagnosed?

Answer 38

NAAT

Question 39

Is mycoplasma genitalium antibiotic resistant?

Answer 39

Yes

Question 40

What symptoms does mycoplasma genitalium cause?

Answer 40

Urethritis in men | Cervicitis and acute endometritis in women

Question 41

What infections may predispose to HIV transmission?

Answer 41

Trichomonas vaginalis | Mycoplasma genitalium

Question 42

How is mycoplasma genitalium treated?

Answer 42

Azithromycin | Moxifloxacin (but expensive)