STI

Question 1

How does chlamydia present in women?

Answer 1

Dysuria, vaginal discharge, Pelvic pain, intermenstrual bleeding, post coital bleeding, anorectal symptoms

complications in females - PID, infertility, ectopic pregnancy

Also reactive arthritis - urethritis, conjunctivitis, arthritis

(keratoderma blenorrhagicum can occur on soles of feet)

Question 2

Chlamydia in men

Answer 2

Dysuria, discharge, testicular pain, anorectal symptoms

complication in males: epydidymo-orchitis can occur

Also reactive arthritis - urethritis, conjunctivitis, arthritis

(keratoderma blenorrhagicum can occur on soles of feet)

Question 3

Treatment of Chlamydia

Answer 3

Azithromycin 1g stat

Asymptomatic ano rectal or in Pregnancy (only up to 18 weeks)

Doxycycline 100mg bd for seven days

Question 4

Management of Chlamydia/Gonorrhea after abx?

Answer 4

1. Screen for all STIs
2. No sex for one week
3. Contact trace partners for six months for chlamydia and 2 months for gonorrhea
4. Review in one week (at this visit: review symptoms, review contact tracing, sex education re: contraception, Cervical HPV/CST, Review compliance with meds)
5. Consider informing public health depending on state guidelines
6. TOC gonorrhea (all except urethral) in 2 weeks, TOC anorectal chlamydia and pregnant chlamydia in 4 weeks)
7. Test for re-infection in three months

If patient states their partner has gon/chlam - collect samples and test that day

Question 5

Causes of a painful penile ulcer

Answer 5

HSV

Chancroid

Question 6

Causes of a painless penile ulcer

Answer 6

Syphillis

Lymphogranuloma Venaereum (order chlamydia PCR - then if pos order serovars L1-L3)

Donavonosis

Question 8

What is the pathogen involved in chancroid

Answer 8

Haemophilus ducreyi

Question 9

Management of Chancroid

Answer 9

Azithromycin 1g PO stat

(often aquired overseas - asia, africa)

STI screening

Analgesia (painful ulcers)

No sex for seven days

contact tracing back to 2 weeks

No TOC needed

Provide patient with fact sheet

Notify public health department

Question 11

How does neonatal gonoccocal conjunctivitis present? Treatment

Answer 11

First 2-5 days of life

Acute, severe, hyperpurulent conjunctivitis

Treat with ceftriaxone 25mg/kg up to 125mg IM
Azithromycin 20mg/kilo orally daily for 3 days

Question 12

How does disseminated gonoccocal infection present

Answer 12

Arthritis (knee commonly)

Papular rash

Question 13

How does LGV present? Treatment?

Answer 13

Painless ulcer to anus or penis

Usually MSM (may have HIV)

needs swab for chlamydia PCR - if posiitive then LGV specific PCR

STI screening

Doxy 100mg bd for 3 weeks
Contact tracing

Notify public health dept

Question 14

Relatively painless ano-genital ulceration in ATSI, Asian, South American

Answer 14

Donavanosis

klebsiella granulomatis

Azithromycin 500mg daily for one week

Swab PCR donavonosis

May punch biopsy lesion

Question 16

What happens in primary syphilis

Answer 16

Incubation period of three weeks

Painless chancre (Spontaneous healing in a few weeks)

non tender

indurated base

if on anal.cervical skin or mouth may be unnoticed

Inguinal LN - rubbery non tender

Question 17

What happens in secondary syphillis

Answer 17

fever, malaise headache, lymphadenopathy

RASH in secondary syphilis

generalised - over trunk or just palms and soles of feet

Question 18

Treatment of primary, secondary, early latent syphilis ? Late latent?

Answer 18

Treat with Benzathine Penicillin 1.8g stat

For late latent 1.8 weekly for three weeks