STI

Question 1

how to diagnose gonorrhoea
when to do
specimen in men and women
sending culture

Answer 1

no earlier than 3 days after sexual contact
swab in women
urine first pass in men
both send for NAAT
if positive send culture to identify resistant strains

Question 2

NGU organisms-5

Answer 2

chlamydia 11-50%
mycoplasma genitalium 6-50%
ureaplasma 5-26%
trachomatis vaginalis 1-20%
adenoviruses

Question 3

what is chlamydia

Answer 3

gram negative coccoid obligate intracellular parasite

Question 4

asymptomatic chlamydia in men and women

Answer 4

70% of women and 50% of men

Question 5

incubation period chlamydia

how to contact trace

Answer 5

3-14 days

6 months

Question 6

microscopy diagnosis criteria for NGU

Answer 6

more than 5 polymorphnuclear leucocytes per high powered field

Question 7

gonorrhoea contact tracing

Answer 7

symptomatic last 2 weeks of last partner if longer than 2 weeks
asymptoamtic
abstain sexual intercourse until 7 days after treatment finishes

Question 8

mycoplasma
how to diagnose
treatment

Answer 8

difficult to diagnose
no diagnostic test
no cell wall
treat if recurrent urethritis
azithromycin 1g single dose

Question 9

trichomonas vaginalis type bacteria

treatment

Answer 9

Trichomonas vaginalis is an anaerobic, flagellated protozoan parasite and the causative agent of trichomoniasis.
7 days metronidazole or tindazole 2g single dose

Question 10

HSV
which type in genitalia
how causes latent infection
how diagnose

Answer 10

HSV 2 more recurrent and more common in genitalia
infects epithelial cells then nerve endings, move along axon to establish persistant infection in sacral ganglia
in reactivation virus travels down nerve axon to skin and mucosal surfaces

Question 11

reactivation triggers for HSV

Answer 11

local trauma
surgery
UV light
immunosuppresion 
fever

Question 12

complications of HSV

Answer 12

aspetic meningitis
autonomic dysfunction
urinary retention

Question 13

treatment HSV

Answer 13

all patients with first symptomatic episode should receive anti viral therapy
oral aciclovir or valacyclovir or famciclovir

Question 14

syphilis organism name type

Answer 14

trponema pallidum

coiled spirochete bacterium

Question 15

higher rate of HIV infection compared to general population in syphylis

Answer 15

77 times higher

Question 16

incubation period primary syphilis

Answer 16

contact to development of chancre is 10-90 days

Question 17

characteristics chancre syphylis

Answer 17

painless
single
indurated 
clean base
discharging clear serum
usual inguinal LN
may look similar herpes

Question 18

how long chancre takes to heal

Answer 18

3-8 weeks

Question 19

secondary syphylis symptoms

Answer 19

macupapular non itchy rash on palms and soles and vagina mucosal lesions
fever
LN
bacteraemia lasts 3-5 months after initial infections
vasculitis, hepatitis, iritis, nephritis, neurological problems

Question 20

how many develop tertiary syphilis from secondary

Answer 20

15-40%

Question 21

how many develop tertiary syphilis from secondary

Answer 21

15-40%

Question 22

tertiary syphilis time after initial infection

types 3

Answer 22

3-15 years
gummatous syphilis chornic soft tumours gummas can occur anywhere
cardiovascular syphilis aortitis and aortic aneurysm
neurosyphilis

Question 23

tests for syphilis
antibody test
when positive

Answer 23

treponemal and non treponemal test
serology detection anti treponemal antibodies using VDRL test of non specific antigen
or specific treponemal antigens
antibody tests usually positive 2-5 weeks after infection

Question 24

syphilis test using microscopy

Answer 24

dark field microscopy
seroud fluid from chancre
has to be done within 10 mins of getting sample

Question 25

syphilis test using microscopy

Answer 25

dark field microscopy seroud fluid from chancre has to be done within 10 mins of getting sample

Question 26

other tests syphilis

Answer 26

direct fluorescent antibody | PCR

Question 27

treatment syphilis

Answer 27

penillin, long acting procaine penicillin 600mg IM daily for 10 -12 days or infection bezathine penicillin 2.4g per week for two weeks

Question 28

what reaction can occur in primary syphilis

Answer 28

Jarisch Herxheimer reaction in 50% of primary adn 90% of secondary being treated endotoxin release when large numbers organisms killed abx, mild fever, malaise, headache few hours, can be severe reaction in tertiary syphilis

Question 29

other infections causing ulcer 4

Answer 29

chancroid granuloma inguinalae (donovanosis) Lymphogranuloma venereum molluscum contagiosum

Question 30

organism of chancroid

Answer 30

haemophilus ducreyi gram negative north india and malawi tender papules developing into pustules then ulcers, regional LN

Question 31

``` granumloma inguinale organism symptoms may mimic risk group person ```

Answer 31

``` klebsiella granulomatis rare ulcerative STI anal sex progressive painless uclers no LN SCC may mimic this so biopsy if fail resolve ```

Question 32

``` lymphogranuloma venereum organism symptoms laterality increasing incidence ```

Answer 32

``` chlamydia also known durand nicolas favre diease painful femoral or inguinal LN known as buboes typically unilateral no visible genital lesions increasing incidence MSM ```

Question 33

``` molluscum contagiosum type of virus area of genitals how manage which groups get infected when resolve appearance of lesion ```

Answer 33

double stranded DNA virua can be genitals, buttocks, upper thighs, pubic region high prevalance HIV children often infected smooth dome shaped papules central umbilication manage conservatively if no IC resolve in 6-12 months

Question 34

``` HPV type of virus which subtypes cervical cancer which serotype penile cancer which are low risk oncogenic and what do they cause which causes buscke lowenstein tumour ```

Answer 34

double stranded DNA virus HPV 16 and 18 high risk mucosal types responsible cervical cancer HPV 16 ascc most with SCC sertoype 6 and 11 non oncogenic, responsible anogenital warts

Question 35

``` HPV vaccine which serotypes two types vaccines which at risk group used for how to give vaccine dose ```

Answer 35

gardasil 6,11,16,18 bivalent prevent HPV causing 70% cervical cancers quadrivalent also includes prevention 90% genital warts, can be used in males to prevent genital warts and anal cancer high risk MSM dose three IM injections over 6 month period

Question 35

``` HPV vaccine which serotypes two types vaccines which at risk group used for how to give vaccine dose ```

Answer 35

gardasil 6,11,16,18 bivalent prevent HPV causing 70% cervical cancers quadrivalent also includes prevention 90% genital warts, can be used in males to prevent genital warts and anal cancer high risk MSM dose three IM injections over 6 month period

Question 36

HIV type of virus what is HIV test initial screening test supplemental test

Answer 36

single stranded RNA virus initial test screen anti HIV antibodies EIA confirmed by supplemental antibody tests, HIV-1 RNA assay

Question 37

urological manifestation HIV renal prostate testicle

Answer 37

``` clinical TB of GU tract renal abscess, infection with aspergillus, toxoplasma prostatitis usually ecoli can be fungi epididymal testicular infections renal failure microscopic haematuria ```

Question 38

most common intrascrotal pathology with HIV

Answer 38

testicular atrophy

Question 39

risk of cancer with HIB | which type of testicular cancer

Answer 39

higher risk testicular tumours renal cancer penile cancer seminoma 20-50 times, no increased risk non seminoma

Question 40

risk of cancer with HIB | which type of testicular cancer

Answer 40

higher risk testicular tumours renal cancer penile cancer seminoma 20-50 times, no increased risk non seminoma

Question 41

stones and HIV | what is incidence of stones

Answer 41

``` increased risk with protease inhibitors indinavir can form cystals in urine up to 22% radiolucent on x ray and CT but if mixed with ca can be radioopaque ```

Question 42

look back periods for chlamydia and gonorrhoea

Answer 42

Chlamydia 1 month, symptomatic males 6 months or last partner if longer, asymptomatic males and all females Gonorrhoea 2 weeks symptomatic males 3 months or last partner if longer, asymptomatic males and all females

Question 43

treponemal syphilis test

Answer 43

Because of the possibility of false positives with nontreponemal tests, confirmation is required with a treponemal test, such as treponemal pallidum particle agglutination (TPHA) or fluorescent treponemal antibody absorption test (FTA-Abs).

Question 43

treponemal syphilis test

Answer 43

Because of the possibility of false positives with nontreponemal tests, confirmation is required with a treponemal test, such as treponemal pallidum particle agglutination (TPHA) or fluorescent treponemal antibody absorption test (FTA-Abs).

Question 44

NICE more likley man has STI 4 factors

Answer 44

Have had more than one partner in the last year Have a recent new partner Have had a previous STI Are aged 25 or younger

Question 45

sexual history 12

Answer 45

When did you last have sexual intercourse? With a man or woman? Were they a casual or regular partner? Where were they from? In which country did you have sex? What kind of sex did you engage in? For each type, for example, oral/vaginal/anal did you use a condom? For heterosexual sex was any contraception used? Relate risk of pregnancy Does your partner have any symptoms? Have you had any other partners in the last six weeks? If so return to question 2. Did you have pain during or after intercourse? Have you had any previous STI? Have you ever had a sexual health check up before? Have you ever had an HIV/hepatitis/syphilis test before? Have you ever been vaccinated against hep A/B or ever had hepatitis?

Question 46

type of urine sample first void

Answer 46

Sample also referred to as a first morning specimen. This sample is collected the first time the patient urinates in the morning. A first voided specimen is the most concentrated and is the preferred specimen for pregnancy testing, bacterial cultures and microscopic examinations

Question 47

gonorrhoea other sides

Answer 47

rectum eyes throat joints

Question 48

gonorrhoea other sides

Answer 48

rectum eyes throat joints

Question 49

gram staining principles

Answer 49

gram positive has thick cell wall of peptidoglycan which retains colour of crystal violet gram negative thinner cell wall retains red of safranin

Question 50

gram stain technique

Answer 50

cyrstal voilet all purple, add iodine add alcohol, gram positive purple from cystal violet, grame negative colourness add safranin red, gram negative turns red