STI's

Question 1

Describe chlamydia?

Answer 1

Gram negative bacterium
Trasmission: Vaginal, orally, anal
Highest incidence: 20-24 years

Question 2

What is the chlamydia presentation in a female?

Answer 2

post coital or intermenstrual bleeding
Lower abdo pain
Dyspareunia
Mucopurulent cervicititis

Question 3

What is the chlamydia presentation in a male?

Answer 3

urethral discharge
Dysuria
Urethritis
Epidiymo-orchitis

Question 4

How do you diagnose Chlamydia?

Answer 4

Test 14 days following exposure
NAAT - females (vulvovaginal swabs)
First void urine (males)
MSM and rectal swab if anal intercourse occured

Question 5

How do you treat chlamydia?

Answer 5

Azithromycin 1G stat

Doxycycline 100mg BD x 1 week

Question 6

Describe gonorrhoea?

Answer 6

Gram negative intracellular diplococcus

Question 7

Where are the primary sites of a gonorrhoea infection?

Answer 7

Mucous membranes of urethra, endocervix, rectum and pharynx

Question 8

What is the incubation period of urethral infections in a male?

Answer 8

2-5 days (short)

Question 9

Whats more likely, male to female transmission or female to male transmission?

Answer 9

F-->M = 20%
M-->F = 50-90%

Question 10

How does gonorrhoea present in males?

Answer 10

Asymptomatic in

Question 11

How does gonorrhoea present in females?

Answer 11

Asymptomatic in up to 50%
Dysuria
Pelvic pain
Pharngeal/rectal infections, mostly asymptomatic

Question 12

What are lower genital tract complications of gonorrhoea?

Answer 12

Bartholinitis
Tysonitis
Periurethral abscess
Epididymitis
Urethral stricture

Question 13

What are the upper genital tract complications of gonorrhoea?

Answer 13

Endometritis
PID
Hydrosalpinx
Infertility
Ectopic pregnancy
Prostatitis

Question 14

How do you diagnose gonorrhoea?

Answer 14

Microscopy- urethral (90-95% sensitivity) endocervical (37-50% sensitivity)
Culture
NAAT

Question 15

What is the treatment for gonorrhoea?

Answer 15

IM ceftriaxone 500mg

Azithromycin 1g

Question 16

What is the second line treatment for gonorrhoea?

Answer 16

Cefixime 400mg oral

Question 17

What is the incubation period of genital herpes?

Answer 17

3-6 days

Question 18

What is the duration of genital herpes primary infection?

Answer 18

14-21 days

Question 19

What are the symptoms of genital herpes?

Answer 19

Blistering and ulceration of external genitalia
Pain
External dysuria
Vaginal/urethral discharge
Local lympohadenopathy
Fever + myalgia

Question 20

Describe recurrent episodes of genital herpes?

Answer 20

Common with HSV-2
Often misdiagnosed as thrush
Usually unilateral, small blisters and ulcers
Minimal systemic symptoms, resolves within 5-7 days

Question 21

What is the management of genital herpes?

Answer 21

Swab base of ulcer for HSV PCR
Aciclovir orallly
Topical lidocaine 5% 
Saline bathing
Analgesia

Question 22

What is viral shedding?

Answer 22

Higher occurrence with HSV2 as opposed to HSV1

More frequent in first year of infection

Question 23

How do you treat Human Papilloma virus (genital warts)

Answer 23

Podophyllotoxin (warticon)
Imiquimod (Aldara) - immune modifier
Cryotherapy
Electocautery

Question 24

What organism causes Syphilis?

Answer 24

Treponema pallidum

Question 25

How can syphilis be transmitted?

Answer 25

Sexual contact Trans-placental/during birth Blood transfusions Non-sexual contact - healthcare workers

Question 26

What is the incubation period of Primary Syphilis?

Answer 26

9-90 days (mean of 21

Question 27

What is primary chancre?

Answer 27

Painless lesions

Question 28

What else is seen with syphilis?

Answer 28

non-tender local lympohadenopathy

Question 29

What is the incubation period of Secondary Syphilis?

Answer 29

6wks to 6 months

Question 30

What are the features of secondary syphilis?

Answer 30

``` Skin lesions Mucous membrane lesions Generalised lymphadenopathy Pathcy alopecia Condylomata Lata (highly infectious lesion, exudes a serum teeming with treponemes) ```

Question 31

How do you diagnose syphilis?

Answer 31

From lesions or infected lymph nodes Dark field microscopy PCR Serology for antibody to pathogenic treponemes

Question 32

What are non-treponemal serology tests?

Answer 32

VDRL - Venereal Disease Research Lab | RPR - Rapid Plasma Reagin

Question 33

What are Treponemal tests?

Answer 33

TPPA - Treponemal Pallidum Particle Agglutination ELISA/EIA - Enzyme Immunoassay (screening test) INNO-LIA - Line immunoassay FTA abs - Flourescent Treponemal Antibody absorbed

Question 34

What is the treatment for early syphilis?

Answer 34

2.4 MU Benzathine penicillin x1

Question 35

What is the treatment of late syphilis?

Answer 35

2.4 MU Benzathine penicillin x3

Question 36

What follow up serology tests are there for syphilis?

Answer 36

Until PRP is negative or serofast: - Titres should decrease fourfold by 3-6 months in early syphilis - Serological relapse/reinfection if titres increase by fourfold