STI

Question 1

What are some common presentations of STI

Answer 1

discharges from mouth or genital, genital lesions, warts

Question 2

What is the typical presentation of Neisseria gonorrhoea in men?

Answer 2

urethral discharge, pain due to clogged up urethra

Question 3

What are some presentation of Neisseria gonorrhoea with oral sex

Answer 3

pharyngitis, lymphadenopathy

Question 4

T/F Neisseria gonorrhoea is a gram +ve rod

Answer 4

False, it is gram -ve cocci

Question 5

What is the target adhesion site of Neisseria gonorrhoea

Answer 5

the columnar epithelial cells in urethra or cervix

Question 6

Why is Neisseria gonorrhoea infection more common in younger women?

Answer 6

Older women have squamous lining on cervix, offering more protection

Question 7

What does the histology of Neisseria gonorrhoea swab look like?

Answer 7

packed with neutrophils with phagocytosed diplococci

Question 8

What is the typical presentation of Neisseria gonorrhoea in female?

Answer 8

asymptomatic

Question 9

What is the reason for the increasing resistance of Neisseria gonorrhoea

Answer 9

exchange of genetic material with Neisseria in mouth during oral sex

Question 10

What is Fitz-Hugh-Curtis Syndrome?

Answer 10

A disseminated symptom of gonorrhoea, which involves bacteria ascending up the fallopian tube to infect around the liver

Question 11

T/F Gonorrhoea is the most common STI

Answer 11

False, it is second to Chlamydia

Question 12

What is the presentation of pelvic inflammatory disease?

Answer 12

tubal scarring + increased risk of infertility, fever, pelvic tenderness, discharge

Question 13

T/F Babies are subjected to gonorrhoea infection if the mum is infected

Answer 13

True, they are exposed during delivery, typically presents with purulent/scarring/perforation of cornea and blindness

Question 14

Why must we diagnose babies with gonorrhoea before any treatment?

Answer 14

We treat gonorrhoea with IV Cefotaxime, but if it’s other bacterial infection, we can just use topical antibiotic

Question 15

What is a better way to diagnose gonorrhoea (better than swab)

Answer 15

First void specimen

Question 16

What must we do when we culture Neisseria gonorrhoea

Answer 16

Use selective agar to inhibit normal flora to avoid lost of pathogen in the background

Question 17

T/F PCR of STI diagnosis routinely combines gonorrhoea and Chlamydia

Answer 17

True. It’s not as specific for gonorrhoea as there may be cross reaction with Neisseria spp.

Question 18

What is the treatment of gonorrhoea

Answer 18

Ceftriaxone (cephelosporin), working on cell wall

Azithromycin, working on 50s ribosome

Question 19

T/F vaccine is available for Neisseria gonorrhoea

Answer 19

False

Question 20

Which part of the Chlamydia cycle is infectious

Answer 20

Elementary bodies, which live outside the cells. Chlamydia is an obligate intracellular organism

Question 21

What is serovar (of Chlamydia)

Answer 21

they are serological variants, a way to characterise Chlamydia infections

Question 22

What does the elementary body turn into once it infects a cell?

Answer 22

reticulate body, which replicates and rupture into large numbers

Question 23

What is the presentation of Chlamydia in men

Answer 23

dysuria, meatal erythema (redness at tip of penis), clear urethral discharge, testicular pain, prostatitis

Question 24

What is the difference between discharge from Chlamydia and gonorrhoea?

Answer 24

Chlamydia - clear

Gonorrhoea - thick and obvious

Question 25

Chlamydia is usually asymptomatic in women, but what are the possible symptoms?

Answer 25

cervicitis endometriosis vaginal discharge, dysuria, pelvic pain if bacteria ascends

Question 26

Describe the process of Chlamydia Lymphogranuloma venereum (LGV)

Answer 26

Chlamydia can spread to local lymph nodes in a few weeks to cause a lot of suppuration. If not drained, they can cause fistula

Question 27

What are the possible symptoms of a baby infected with Chlamydia during delivery

Answer 27

conjunctivitis within 2 weeks | delayed pneumonia with staccato cough

Question 28

Why do we do follow up tests with patients treated for Chlamydia

Answer 28

there is a chance of reinfection or there may be a lack of response to initial treatment

Question 29

What are the options of treatment Chlamydia

Answer 29

Azithromycin or Doxycycline Avoid doxycycline for pregnant women

Question 30

T/F Trochomonas vaginalis is a gram +ve bacteria

Answer 30

False, it's a parasite with interesting mobility

Question 31

What is the quality of discharge from infection of Trochomonas vaginalis

Answer 31

frothy, green-yellow, more alkaline

Question 32

Aside from discharge, what are some other presentations of Trochomonas vaginalis

Answer 32

strawberry cervix due to erythema, friable mucus

Question 33

Is fixed gram stain a good technique for Trochomonas imaging?

Answer 33

No, wet-prep is better for observing its motility. Fix-stained Trochomonas just looks like neutrophil

Question 34

What are the options of treatment for Trochomonas vaginalis

Answer 34

Metronidazole or Tinidazole

Question 35

What is the presentation of primary syphilis

Answer 35

painless chancre

Question 36

What is the presentation of secondary syphilis?

Answer 36

systemic rash, lymphadenopathy, abdo pain from hepatitis

Question 37

T/F Early latent syphilis describes latency within 1 year

Answer 37

True, while late latent indicates 2 years after infection

Question 38

T/F You are much more infectious in early latent stage of syphilis

Answer 38

True, and it's also more likely to be asymptomatic

Question 39

Why is late latent syphilis harder to treat?

Answer 39

the organism has lower metabolic demand at this stage

Question 40

What is the presentation of tertiary syphilis?

Answer 40

gumma in joints and root of aorta, neurosyphilis which can lead to mental illness

Question 41

T/F Microscopy is a good technique to diagnose syphilis

Answer 41

False, Treponema pallidum doesn't gram stain well

Question 42

What is the treatment of syphilis?

Answer 42

Single dose of penicillin for primary and secondary infection. 3 weeks of weekly injection for late latent

Question 43

How does Mycoplasma genitalium present?

Answer 43

urethritis in men, cervicitis in women | acute endometriosis, PID

Question 44

How do we diagnose M. genitalium?

Answer 44

electron microscopy or NAAT (PCR, but not widely available)

Question 45

What is the treatment of M. genitalium

Answer 45

Azithromycin, but if fail, use Moxifloxacin