STI and GI Tract

Question 1

how are infections transmitted during sex

Answer 1

trauma
IV drug user
fomties
ingestion 
sexual/genital secretions 
direct inoculation

Question 2

risk factors for STIs

Answer 2

<25 years old
change in sexual partner
non condom use
men who have sex with men (MSM)
Hx of STI
large urban areas
social deprivation 
black ethnicity

Question 3

where do STIs affect in the GI tract

Answer 3

can effect everywhere

Question 4

where does hepatitis A/B/C effect in GI tract

Answer 4

liver biliary tract

Question 5

where does shigella affect the GI tract

Answer 5

small and large bowel

Question 6

where does amoebiasis affect the GI tract

Answer 6

large bowel

Question 7

where does giardia affect the GI tract

Answer 7

small bowel

Question 8

transmission of gonorrhoea

Answer 8

direct contact mucosal surfaces with infected secretions;
anal sex
trans mucosal spread
fomite

Question 9

symptoms of rectal gonorrhoea

Answer 9

short incubation period
lower abdominal pain
diarrhoea
rectal bleeding
anal discharge (mucus)
tenesmus 
change in bowel habit 
may be asymptomatic

Question 10

associated symptoms of rectal gonorrhoea

Answer 10

urethral/vaginal discharge

dysuria

Question 11

tests for gonorrhoea

Answer 11

proctoscopy
PCR
gram stain rectal swab

Question 12

pathology of gonorrhoea

Answer 12

inflamed mucosae

purulent exudate

Question 13

complications of gonorrhoea

Answer 13

abscess formation

increased susceptibility/transmissibility of HIV

Question 14

management of gonorrhoea

Answer 14

ceftriaxone
test of cure
public health interventions

Question 15

how is chlamydia transmitted

Answer 15

direct contact mucosal surfaces with infected secretions;
anal sex
trans mucosal spread
fomite

Question 16

symptoms of rectal chlamydia

Answer 16

mostly asymptomatic 
milder than gonorrhoea 
anal discomfort/itch
anal discharge (mucus/blood)
low abdominal pain 
altered bowel habit
associated symptoms

Question 17

tests for chlamydia

Answer 17

proctoscopy
gram stain rectal swab
CT
PCR

Question 18

management for chlamydia

Answer 18

doxycycline
test of cure
public health interventions

Question 19

epidemiology of lymphogranuloma venereum

Answer 19

MSM (+HIV)
associated with;
group sex
drug use
syphilis
hepatitis C

Question 20

primary clinical features of lymphogranuloma venereum

Answer 20

ulcer

Question 21

secondary clinical features of lymphogranuloma venereum

Answer 21

inguinal syndrome

ano-rectal syndorme

Question 22

tertiary clinical features of lymphogranuloma venereum

Answer 22

strictures
fistulae
geneital elephantiasis

Question 23

tests for lymphogranuloma venereum

Answer 23

full STI screen

fexi-sigmoidoscopy

Question 24

management for lymphogranuloma venereum

Answer 24

doxycycline

public health interventions

Question 25

pathology of Lymphogranuloma venereum

Answer 25

friable rectal mucosa large ulcers contact bleeding

Question 26

why is test of cure important

Answer 26

if treatment does not cure diagnosis e.g. piles | may be differential diagnosis e.g. Lymphogranuloma venereum

Question 27

primary clinical features of syphilis

Answer 27

solitary painless ulcer

Question 28

secondary clinical features of syphilis

Answer 28

``` mucosal patches and ulcers mouth, anogenital, rectal condylomata lata systemic inflammation (eye) hepatitis proctoscopy-colitis ```

Question 29

symptoms of syphilis

Answer 29

``` multi-systemic disease; pain defaecation blood mixed in stools crampy abdominal pains rash lymphadenopathy ```

Question 30

tests for syphilis

Answer 30

colonoscopy | rectal biopsy

Question 31

management for syphilis

Answer 31

benzathene penicillin public health interventions follow-up serology

Question 32

how is herpes transmitted

Answer 32

ano-genital | oro-anal

Question 33

symptoms of herpes

Answer 33

``` pain ulcers painful defaecation bleeding peri-anal mucosa (may extend into rectum) viraemic symptoms (primary infection) ```

Question 34

how is human papilloma virus transmitted

Answer 34

ano-genital | oro-anal

Question 35

signs of HPV

Answer 35

anal warts - can extend to rectum

Question 36

complications of HPV

Answer 36

increasing prevalence of AIN and anal cancers in MSM and HIV+ people

Question 37

HIV and the GI tract

Answer 37

gut associated lymphoid tissue is the largest immune compartment - GI in constant state of physiological inflammation depletion of intestinal GALT

Question 38

clinical presentation of GALT loss

Answer 38

``` unknown HIV enteropathies opportunistic infeciton persistent immune activation - microbial translocation accelerated immunosenescence ```