STIs

Question 1

What is the most common STI in the UK?

Answer 1

chlamydia

Question 2

What organism causes chlamydia infections?

Answer 2

Chlamydia trachomatis

Question 3

How do women present with chlamydia?

Answer 3

usually asx but if women gets symptoms: discharge, inflammed cervix, dysuria, IMB/PCB, dyspareunia, fever

Question 4

How do men present with chlamydia?

Answer 4

Men tend to have either classical urethritis with dysuria and urethral discharge or epididymo-orchitis presenting as unilateral testicular pain ± swelling. Fever may also be a presenting feature in men.

Question 5

Ix and mx for chlamydia?

Answer 5

investigate with a nucleic acid amplification tests

treat with 7 days doxycycline or stat azithrithromycin

Question 6

How does gonorrhoea present?

Answer 6

similar presentation to chamydia

Question 7

What is the mx for gonorrhoea?

Answer 7

ceftriaxone IM stat

Question 8

What is PID (pelvic inflammatory disease)?

Answer 8

Infection of uterus/fallopian tubes/ovaries

Question 9

What are the sx of PID?

Answer 9

Bilateral lower abdominal pain.
Deep dyspareunia.
Abnormal vaginal bleeding (postcoital, intermenstrual or menorrhagia).
Fitz Hugh Curtis
Vaginal or cervical discharge that is purulent.

Question 10

What are the signs of PID?

Answer 10

Lower abdominal tenderness (usually bilateral).
Mucopurulent cervical discharge and cervicitis seen on speculum examination.
Cervical motion tenderness and adnexal tenderness on bimanual vaginal examination.
Fever above 38°C (but may be apyrexial).

Question 11

What is the cause of PID?

Answer 11

STI

Question 12

How is Non-Specific Urethritis diagnosed?

Answer 12

purulent discharge, urethral smear/ first pass urine shows positive for polymorphonuclear cells

Question 13

What is epididymorchitis, and how is it caused?

Answer 13

• inflammation of epididymis/ testis (hard to distinguish between inflammation of the two so name is used)
• secondary to STI, UTI, mumps

Question 14

What is the organism that causes genital warts?

Answer 14

HPV (Human papillomavirus)

Question 15

Describe the presentation of a genital wart

Answer 15

flesh coloured, cauliflower top,keratinised appearance
painless
diagnosed via appearance

Question 16

What is the mx of genital warts?

Answer 16

Manage with nitrous oxide or podophyllotoxin

Question 17

What is the organism that causes herpes?

Answer 17

HSV (herpes simplex virus)

Question 18

How does herpes present?

Answer 18

open, splits, painful sores
lymphadenopathy
discharge
erythema

Question 19

What are the two different types of herpes?

Answer 19

type 1 = cold sores- although in UK is now most common cause of genital infections, type 2 =anogenital association

Question 20

How is herpes diagnosed?

Answer 20

viral culture/ PCR swab

Question 21

What is the mx of herpes?

Answer 21

acyclovir

Question 22

Describe primary vs secondary vs tertiary syphilis?

Answer 22

-Primary syphilis (2-3 weeks to three months after contact with the germ) - one or more ulcers on your genital region or mouth, which are usually painless and go away on their own after about six weeks.

Secondary syphilis - a non-painful rash, especially on hands and feet; feeling generally unwell and tired; swollen glands; joint pains and warty lumps on the genitals.

Tertiary syphilis (many years after first infection) - serious complications affecting the nervous system, heart, blood vessels and skin.

Question 23

What organism causes syphilis?

Answer 23

Treponema pallidum

Question 24

mx of syphilis?

Answer 24

Treat with IM penicillin

Question 25

What is the pathophysiology of HIV?

Answer 25

HIV binds to CD4 receptors on helper T-lymphocytes, monocytes, macrophages and neural cells. CD4 cells migrate to the lymphoid tissue where the virus replicates and then infects new CD4-positive cells. As the infection progresses, depletion or impaired function of CD4 cells predisposes to the development of immune dysfunction.

Question 26

How may HIV present?

Answer 26

seroconversion illness: fever, malaise, myalgia, pharyngitis, headaches, diarrhoea, neuralgia or neuropathy, lymphadenopathy and/or a maculopapular rash persistent generalised lymphadenopathy symptomatic infection: fever, night sweats, diarrhoea, weight loss AIDs: opportunistic infections

Question 27

How may heptatitis B present?

Answer 27

jaundice, anorexia, RUQ pain, fever, progressive dark urine and pale faeces, ascites, encephalopathy

Question 28

What is candidiasis?

Answer 28

Caused by fungal infection, present with soreness, redness and discharge treat with azoles

Question 29

What is bacterial vaginosis presenting sxs?

Answer 29

unpleasant fishy smelling discharge, thin and white/ grey, sometimes pain

Question 30

What is lichen sclerosus?

Answer 30

white, thick patches itches Pain can occur if there are fissures or erosions, leading to dyspareunia. linked to vulval cancer

Question 31

What is asked in a sexual health history?

Answer 31

HPC, past GUM, sexual history of last 3-12 months, abx? - can give false positives, last intercourse, regular or casual partner, male or female, condom use, type of infection Menstrual cycle, pregnancy, contraception, cervical Last voided urine- men If have HIV or syphilis go back further in hx of partners

Question 32

when should you examine in sexual health?

Answer 32

if symptomatic

Question 33

What investigations are done for a symptomatic vs asx woman?

Answer 33

asx: Vaginal chlamydia and gonorrhoea swab Bloods for HIV and syphilis sx: Same as asymptomatic plus high vaginal swab for bacterial vaginosis, trichomonas vaginalis and candida Cervical swab for slide and gonorrhoea Dipstick urinalysis

Question 34

Presentation of T. vaginalis?

Answer 34

-discharge- frothy, yellow, bad smell -itching -dysuria -strawberry cervix (men usually asx)

Question 35

What investigations are done for a symptomatic vs asx hetero men?

Answer 35

asx: First void urine for chlamydia and gonorrhoea Bloods for syphilis and HIV sx: same as asx plus Urethral swab for slide and gonorrhoea

Question 36

What investigations are done for asx MSM?

Answer 36

First void urine for chlamydia and gonorrhoea Bloods for syphilis and HIV pharyngeal swab for chlamydia and gonorrhoea rectal swab for chlamydia and gonorrhoea Plus blood for hep B

Question 37

What ix are done for symptomatic MSM?

Answer 37

asymptomatic tests plus: Urethral and rectal slides Urethral, rectal and pharyngeal culture plates

Question 38

Who else is Hep B testing done for (apart from MSM)?

Answer 38

Also do Hep B for sex workers, IVDU, and those from Africa, Asia and eastern Europe (or their partners have these risk factors)

Question 39

What is the mx for Trichomoniasis?

Answer 39

metronidazole

Question 40

What is the mx for Bacterial Vaginosis?

Answer 40

Metronidazole is the antibiotic of choice for treating bacterial vaginosis. Metronidazole specifically targets anaerobic bacteria. This is given orally, or by vaginal gel. Clindamycin is an alternative but less optimal antibiotic choice.

Question 41

What is seen on microscopy for BV?

Answer 41

Bacterial vaginosis gives “clue cells” on microscopy. Clue cells are epithelial cells from the cervix that have bacteria stuck inside them, usually Gardnerella vaginalis.

Question 42

WHat is the sx for PID?

Answer 42

``` Sepsis Abscess Infertility Chronic pelvic pain Ectopic pregnancy Fitz-Hugh-Curtis syndrome ```

Question 43

What is Fitz-Hugh-Curtis Syndrome?

Answer 43

Fitz-Hugh-Curtis syndrome is a complication of pelvic inflammatory disease. It is caused by inflammation and infection of the liver capsule (Glisson’s capsule), leading to adhesions between the liver and peritoneum. Fitz-Hugh-Curtis syndrome results in right upper quadrant pain that can be referred to the right shoulder tip if there is diaphragmatic irritation.