step 2 - STI's

Question 2

what is lymphogranuloma vernum and how does it present?

Answer 2

strain of chlamydia
initially presents as painless transient papule or shallow ulcer
tertiary form presents as ‘anogenital syndrome’ with anal pruritis and discharge, rectal strictures, rectovaginal fistulas, elephanitis

Question 3

gold standard diagnostic technique for chlamydia

Answer 3

culture (and gram stain)
urine NAAT is best initial as it is rapid

Question 4

what will chalmydia show on gram stain

Answer 4

leukocytes but no bacteria as it is an intracellular organism

Question 5

abx treatment for chalmydia in pregnant patients

Answer 5

amoxicillin or azithromycin

Question 6

abx of choice for chlamydia treatment

Answer 6

doxycycline for 7 days or azithromycin once

note: it is worth adding ceftriazone to cover gonorrhoea as there may be co-infection

note: lymphogranuloma vernum strains will require prolonged course of 21 days

Question 7

25 year old patient presents with anal pruritus and discharge. mentions a shallow ulcer on his penis few months ago which resolved. ?diagnosis ?treatment

Answer 7

lymphogranuloma vernum strain of chlamydia

treat with doxycyline or azithromycin for 21 days

Question 8

patient with a history of chalmydia presents with pain in his knees and discharge from eyes bilaterally ?diagnosis

Answer 8

reiter’s syndrome
(urethritis, conjunctivitis, arthritis)

Question 9

abx treatment for gonorrhoea

Answer 9

IM ceftriaxone + oral azithromycin
treat with x2 antibiotics even if chlamydia isnt present due to high rates of abx resistance

Question 10

abx treatment for dissemninated gonococcal disease

Answer 10

IV ceftriazone for at last 24 hour2

Question 11

30 year old patient presents with painful erythematous lesions on the palms of his hands and sore joints that were initially in his wrists but now in knees and ankles. works as a banker, has multiple sexual partners, raely uses condoms. ?diagnosis ?treatment

Answer 11

dissminated gonoccal infection

• migratory polyarthritis
• tenosynovitis
• pustular skin lesions

treat with IV ceftriazone for at least 24 hours

Question 12

causes of false positive VDRL

Answer 12

infections (EBV, HSV, HIV, hepatitis)
SLE
rheumatic fever
rheumatoid arthritis
leprosy
IV drug use

Question 13

patient tests positive for RPR or VDRL test ?next step

Answer 13

confirm with treponema specific test i.e. FTA-ABS

Question 14

patient tests for positive for RPR or VDRL test then tests negative for treponema specific test i.e. FTA-ABS ?next step

Answer 14

obtain non-treponemal titres
if negative then likely false positive

Question 15

treatment for syphillis in a pregnant patient who is penicillin allergic

Answer 15

patient must be de-senstized and treated with penicillin

(if non-pregnant then could treat with tetracycline)

Question 16

treatment for syphillis in penicillin allergy

Answer 16

doxycyline/tetracycline for 14 days

if neurosyphillis then must be desensitized and treated with penicillin

Question 17

beefy red painless genital ulcer

Answer 17

granuloma inguinale (caused by klebsiella)

• raised red lesions with white border
• rolled edges with granulation tissue

Question 18

abx for granuloma inguinale

Answer 18

red beefy painless ulcer caused by klebsiella

treat with azithromycin or doxycyline

Question 19

abx for chancroid

Answer 19

painful genital ulcer caused by haemophillus ducreiy

treat with azithromycin or ceftriaxone