STI treatment and investigation

Question 1

chlamydia 1st line

Answer 1

doxycycline 7 days BD

Question 2

chlamydia 2nd line

Answer 2

azithromycin 1g once then 500mg OD for 2 days

Question 3

chlamydia in pregnancy

Answer 3

azithromycin

Question 4

is there a TOC for chlamydia

Answer 4

no

Question 5

ix for chlamydia

Answer 5

NAAT

• male - first pass urine
• female - VVS

if symptomatic male - urethral swab for GS + Microscopy

Question 6

gonorrhoea 1st line

Answer 6

IM ceftriaxone 1g

Question 7

gonorrhoea needle phobic

Answer 7

oral cefixime 400mg + oral azithromycin 2g

both single dose

Question 8

gonorrhoea ix

Answer 8

NAAT

• male - first pass urine
• female - VVS

if symptomatic male - urethral swab for GS + Microscopy + NG culture

female - cervical swab - GS + microscopy + NG culture

Question 9

gonorrhoea and chlamydia ix in throat / rectum

Answer 9

throat- pharyngeal swab
rectum - anorectal swab
for NAAT

Question 10

is there a TOC for gonorrhoea

Answer 10

yes

Question 11

syphilis 1st line

Answer 11

benzathine penicillin IM

Question 12

syphilis 2nd line

Answer 12

doxycycline

Question 13

what is the TOC for syphilis

Answer 13

monitor VDLR levels

Question 14

examples of non-treponemal tests

Answer 14

rapid plasma reagin (RPR)

venereal diseases research laboratory (VDRL)

Question 15

examples of treponemal tests

Answer 15

TP-EIA (TP enzyme immunoassay)

TPHA - TP haemagglutination test

Question 16

treponemal test: positive

non-treponemal test: positive

Answer 16

active syphilis infection

Question 17

treponemal test: negative

non-treponemal test: positive

Answer 17

false positive

Question 18

treponemal test: positive

non-treponemal test: negative

Answer 18

successfully treated syphilis

Question 19

syphilis diagnostic test

Answer 19

swab of ulcer for treponema pallidum PCR

venous blood - syphillis IgG/IgM EIA

Question 20

syphilis screening

Answer 20

IgM/IgG Elise

Question 21

during latent syphilis how is it dx

Answer 21

serology

Question 22

tx herpes gingivostomatitis

Answer 22

oral aciclovir

chlorhexidine mouthwash

Question 23

tx herpes cold sores

Answer 23

topical aciclovir

Question 24

tx herpes genital sores

Answer 24

oral aciclovir

Question 25

ix herpes

Answer 25

swab of base of ulcer for NAAT / HSV PCR venous blood - HSV-type specific serology (only under specialist guidance)

Question 26

ix trichomoniasis

Answer 26

High vaginal swab - ideally posterior fornix wet mount and microscopy

Question 27

trichomoniasis tx

Answer 27

oral metronidazole 5-7 days or once off dose 2g

Question 28

tx genital warts - solitary keratinised

Answer 28

cryotherapy

Question 29

tx multiple non-keratinised genital wart

Answer 29

topical podophyllum

Question 30

2nd line treatment genital warts

Answer 30

imiquimod

Question 31

tx crabs

Answer 31

malathion lotion

Question 32

ix candidiasis (thrush)

Answer 32

not needed if clinical features highly suggestive if doubt female: swab of vaginal walls (HVS) for GS + microscopy, candida culture male: swab of sub-prepuce (penile) for candida culture +/- anti fungal susceptibility

Question 33

tx candidiasis (thrush)

Answer 33

oral fluconazole 150mg single dose

Question 34

tx candidiasis (thrush) 2nd line or pregnant

Answer 34

topical cotrimazole pessary

Question 35

what can be added to pessary / oral in tx of candidiasis (thrush) if vulval s/s

Answer 35

topical imidazole

Question 36

ix recurrent candidiasis (thrush)

Answer 36

HVS, OGTT

Question 37

tx recurrent candidiasis (thrush)

Answer 37

oral fluconazole induction 3 days then weekly for 6 months

Question 38

bacterial vaginosis ix

Answer 38

microscopy - clue cells - HVS | positive whiff test

Question 39

tx bacterial vaginosis

Answer 39

oral metronidazole 400mg BD 5 days | or 2mg once (latter not in breast feeding)

Question 40

tx bacterial vaginosis in pregnancy

Answer 40

oral metronidazole or topical clindamycin

Question 41

prostatitis ix

Answer 41

MSSU for C + S

Question 42

prostatitis tx

Answer 42

ofloxacin 14 days

Question 43

tx epididymo-orchitis

Answer 43

ceftriaxone 500mg IM single dose + doxycycline 100mg oral 10-14 days

Question 44

what tests are done for CT and NG as well as NAAT - male

Answer 44

if symptomatic - urethral swab for gram stain and microscopy NG culture

Question 45

what specimen is used for CT and NG in a male for gram stain and microscopy (and NG culture)

Answer 45

uretheral swab if symptomatic

Question 46

what specimen is used for NG gram stain and microscopy and culture in females

Answer 46

cervical swab

Question 47

HIV ix

Answer 47

venous blood | HIV Ab/Ag test