STIs 2

Question 1

commonest bacteria STI

Answer 1

chlamydia

Question 2

mocopurulent discharge from the penis and painful urination is what

Answer 2

gonorrhoea

Question 3

chancre develops at what stage of syphilis

Answer 3

primary

Question 4

which infection leads to PID in women

Answer 4

chlamydia

Question 5

which STI is known as the great imitator because its symptoms resemble other infections

Answer 5

syphilis

Question 6

when is the HPV vaccine recommended for females

Answer 6

11-13

Question 7

viral shedding is higher with which type of genital herpes simplex virus

Answer 7

HSV 2

Question 8

chlamycida - GS
transmission
age

Answer 8

GN bacterium
vaginal, oral, anal
20-24s

Question 9

pathogenesis of chlamydia

Answer 9

unclear
chlamydia can cause PID in 50%
PID increases risk of ectopic preg by 10% and carries a risk of tubal factor infertility of 15-20%

Question 10

presentation of chlamydia in a female

Answer 10

post coital or inter menstrual bleeding
lower abd pain
dyspareunia
mucopurulent cervicitis

Question 11

male presentation of chlamydia

Answer 11

urethral discharge
dysuria
urethritis
epididymis-orchitis

Question 12

cx of chlamydia

Answer 12

PID
tubal damage
chronic pelvic pain
tranmission to neonate (17% conjunctivitis, 20% pneumonia)
adult conjunctivitis - occaisionally
sexually acquired reactive arthritis /reiters - commoner in men
Fitz - high - curtis syndrome (perihepatitis)

Question 13

dx and rx of chlamydia

Answer 13

test 14 days following exposure
NAAT - females (vulvovaginal swab), males - first void urine
MSM - add real swab if receptive anal sex

azithromycin 1g stat
doxycycline 100mg BD x 1 week if rectal chlamydia

Question 14

gonorrhoea GS

sites of infection

Answer 14

GN intracellular diplococcus

mucous membranes of urethra, endocervix, rectum and pharynx

Question 15

incubation/transmission of G

Answer 15

incubation period of urethral infection in men is shorter (2-5days)
20% of risk from infected women to male partner
50-90% risk from infected man to female partner

Question 16

presentation in males - G

Answer 16

asymp in less than 10%
urethal discharge - purulent and green/yellow
dysuria
pharyngeal/rectal infections which are mostly asymp

Question 17

females presentation - G

Answer 17

asymp in almost 50%
increased/altered vaginal discharge in 40%
dysuria
pelvic pain in <5%
pharyngeal and rectal infection are usually asymp

Question 18

cx of G

Answer 18

3% in females and <1% in males

lower genital trat - bartholinitis, tysonitis, periurethral anscess, rectal abscess, epididymitis, urethral stricture

upper genital tract - endometritis, PID, hydrosalpinx, infertility, ectopic pregnancy, prostatitis

Question 19

cx of G

Answer 19

3% in females and <1% in males

lower genital trat - bartholinitis, tysonitis, periurethral anscess, rectal abscess, epididymitis, urethral stricture

upper genital tract - endometritis, PID, hydrosalpinx, infertility, ectopic pregnancy, prostatitis

Question 20

dx of G

Answer 20

microscopy - urethral 90-95% sensitivity, endocervical 37-50% sensitivity

culture >95% sensitivity (male urethra), 80-92% sensative (female endocx)

NAATs>96% sensitiivty (both in symp and asymp)

Question 21

rx of G

Answer 21

ceftriaxone 500mg IM 1st line
cefixime 400mg PO - if IM injection contra indicated or refused

azithromycin 1g given regardless of chlamydia result

test of cure in all px

Question 22

genital herpes pattern

Answer 22

primary infection
non primary first episode
recurrent infection

Question 23

GH primary infection incub
duration
symptoms

Answer 23

3-6 days
14-21 days

blistering and ulceration of the external genitalia
pain
external dysuria
vaginal or urethral discharge
local lymphadenopathy
fever and myalgia

Question 24

recurrent episodes GH
more common with what
mis dx as what
symptoms

Answer 24

more common with HSV2

thrush

unilateral small blisters and ulcers, minimal systemic symptoms

resolves within 5-7 days

Question 25

management of GH

Answer 25

``` swab base of ulcer for HSV PCR oral acyclovir consider topical lidocaine if painful saline bathing analgesia ```

Question 26

viral shedding common with which type when who reduced by what

Answer 26

following HSV 2 is commoner than for HSV 1 more frequent in the first year of infection more individuals with frequent recurrences reduced by suppressive therapy

Question 27

HPV is the commonest what | life time risk of acquiring it

Answer 27

viral STI in the UK | 80%

Question 28

``` HPV genotypes total certain low risk high risk ```

Answer 28

>170 40 infect anogenital epithelium 6, 11, 42, 43, 44 16, 18, 31, 33, 35, 45, 51, 52, 66

Question 29

HPV transmission incub

Answer 29

80% of the population are exposed 10% harbour detectable infection 1% develop anogentail warts likely to have acquired form asymp partner incub 3 weeks to 9 months

Question 30

HPV immunology

Answer 30

spontaneous clearance of warts 20-34% clearance with treatment 60% persistence despite treatment 20%

Question 31

anogenital warts caused by which type of HPV

Answer 31

>90% by 6/11

Question 32

HPV treatment

Answer 32

podophyllotoxin (wart icon) - cytotoxic, not licensed for extra genital warts iminquimod - immune modifier, for all anogenital warts cryotherapy - cytolytic can require repeat treatments electrocautery

Question 33

HPV vaccination

Answer 33

MSM and HIV+ included

Question 34

syphillis transmission classification

Answer 34

sexual contact, transplacental/during birth, blood transfusions, non sexual contact congenital, acquired

Question 35

acquired syphilis types of infections

Answer 35

early have primary, secondary and early latent late non infectious have late latent and tertiary

Question 36

primary syphilis incub period lesion sites other signs

Answer 36

9-90 days (mean of 21days) lesions - primary chancre - painless, appear at site of inoculation sites are genital 90% of the time non tender local lymphadenopathy

Question 37

secondary syphilis incub period signs

Answer 37

6 weeks - 6 months skin - macular, follicular/pustular rash on palms and soles lesions of mucous membranes generalised lymphadenopathy patchy alopecia condylomata lata (most infectious lesion in syphilis)

Question 38

dx of syphilis

Answer 38

demonstration of trepnonema palladium from lesions of infected LNs - dark field microscopy, PSCR serological testing - detects AB to pathogenic treponemes

Question 39

serological testing in syphilis

Answer 39

non-treponema - VDRL, RPR (rapid plasma reagin) treponema - TPPA, ELISA/EIA (screening test), INNO-LIA, FTA abs

Question 40

rx and follow up in syphilis

Answer 40

early - 2.4 MU benzathine penicillin x1 late 2.4 MU benzathine pencilline x3 until RPA is negative to serofast tires should decrease fourfold by 3-6 months in early serological relate/reinfection if titres increase by fourfold