STIs

Question 1

What is the most common bacterial STI?

Answer 1

chlamydia

Question 2

24 y/o man presents with discharge from penis and pain passing urine - diagnosis?

Answer 2

gonorrhoea

Question 3

In which stage of syphilis does a chancre develop?

Answer 3

primary

Question 4

Viral shedding is higher in which strain of herpes simplex virus?

Answer 4

HSV2

Question 5

What type of organism is chlamydia trachomatis?

Answer 5

gram negative obligate intracellular bacterium

Question 6

22 y/o female presents with post-coital bleeding, lower abdomen pain, dyspareunia and mucopurulent vaginal discharge.
Diagnosis and treatment?

Answer 6

chlamydia and doxycycline 100mg bd for 1 week

Question 7

What are some of the complications of a chlamydia infection?

Answer 7

PID
Tubal damage
Chronic pelvic pain
Transmission to neonate 
Reactive arthritis 
Fitz-Hugh-Curtis syndrome

Question 8

A baby is born with sticky looking eyes - what do you swab for?

Answer 8

chlamydia

Question 9

What is the triad of reactive arthritis?

Answer 9

urethritis
arthritis
conjunctivitis

Question 10

Which complication of a CT infection involves peri-hepatitis?

Answer 10

Fitz-Hugh-Curtis syndrome - liver capsule inflammation creating piano-string adhesions between the liver, abdomen & diaphragm.

Question 11

You should test women >25 y/o with vaginal discharge for CT as this is the most likely diagnosis.
T/F?

Answer 11

FALSE

more likely to be candida or BV

Question 12

What is LGV, in who is it seen and what are the symptoms?

Answer 12

Lymphogranuloma venereum Serovars L1-L3 of CT

Diagnosed tropical cases & MSM - rectal pain, discharge and bleeding - similar to IBD.

Question 13

How would you diagnose chlamydia in patients (male & female)?

Answer 13

NAAT: females –> vulvovaginal swab

males –> first void urine

Question 14

What is the 1st line treatment for chlamydia?

Answer 14

doxycycline 100mg bd for 1 week

Question 15

what is the 2nd line treatment for chlamydia?

Answer 15

azithromycin 1g stat followed by 500mg daily for 2 days

Question 16

What is an emerging STI associated with non-gonococcal urethritis and PID?

Answer 16

mycoplasma genitalium

Question 17

What are serovars A-C of chlamydia?

Answer 17

trachoma (eye infection) - not an STI

Question 18

What are serovars D-K of chlamydia?

Answer 18

genital infection

Question 19

What type of organism is gonorrhoea?

Answer 19

gram negative intracellular diplococcus

Question 20

Where are the primary site of infection of gonorrhoea?

Answer 20

mucous membranes of the urethra, endocervix, rectum and pharynx.

Question 21

What are the differing age categories for males and females in gonorrhoea?

Answer 21

men 20-24

women <20

Question 22

Who is at higher risk of contracting gonorrhoea from an infected partner - males or females?

Answer 22

females at higher risk of contracting it from infected male partner (50-90% risk)

Question 23

23 y/o male presents with green discharge from penis and pain when peeing. He recently (3 days ago) had insertive anal sex with another man whom he has just met.
Diagnosis and when to test?

Answer 23

gonorrhoea
urethral infection incubation time is short in men (2-5 days) however test at 14 days since tested at same time as chlamydia using NAATs.

Question 24

what are the tests for gonorrhoea and when are they done?

Answer 24

NAATs = screening
Microscopy if symptomatic
Culture if microscopy +ve or contact of GC

Question 25

What is the 1st line treatment for gonorrhoea?

Answer 25

ceftriaxone 1g IM

Question 26

What is the 2nd line treatment of gonorrhoea?

Answer 26

cefixime 400mg oral + azithromycin 2g oral

Question 27

What is the typical duration of a primary infection of genital herpes?

Answer 27

14-21 days

Question 28

20 y/o female patient presents with blistering of external genitalia, 8/10 pain, vaginal discharge and a tender groin. She reports feeling flu-like this week but is otherwise normally healthy. Diagnosis?

Answer 28

genital herpes | primary infection

Question 29

20 y/o female patient presents with small blisters and ulcers on her external genitalia, they are unilateral and have been present for 4 days. They are mildly sore and sometimes have the feeling of tingling. She has had a similar episode once before, it was worse but she didn't have any treatment. Diagnosis?

Answer 29

Recurrent infection of genital herpes (probably HSV2)

Question 30

What can you reassure a patient with HSV1 about?

Answer 30

they will have cold sores and only experience an attack once every 12-18 months.

Question 31

What is the treatment for HSV?

Answer 31

oral acyclovir 400mg tds for 5-7 days

Question 32

What additional treatment would you consider prescribing if a case of genital herpes is particularly painful?

Answer 32

topical lidocaine 5% ointment

Question 33

What therapy can you give to reduce the amount of viral shedding?

Answer 33

suppressive therapy - aciclovir 2x daily for 12 months

Question 34

What is the most common viral STI in the UK?

Answer 34

HPV

Question 35

Anogenital warts are caused by a high-risk HPV strain. | T/F?

Answer 35

FALSE | low-risk strain: 6-11

Question 36

Which strain of HPV cause palmoplantar warts?

Answer 36

1 & 2

Question 37

Which strain of HPV cause cancers & which ones?

Answer 37

16 & 18 | cervical, anal, penile, vulval, oropharyngeal

Question 38

What treatment can you give to someone with anogenital warts?

Answer 38

podophyllotoxin (Warticon) - cytotoxic imiquimod - immune modifier cryotherapy electrocautery

Question 39

Which treatment option for HPV can be used on all anogenital warts?

Answer 39

imiquimod

Question 40

What is the organism behind syphilis?

Answer 40

treponema pallidum - subspecies pallidum

Question 41

How is syphilis usually transmitted?

Answer 41

sexual contact trans-placental/during birth blood transfusions non-sexual contact (healthcare)

Question 42

Male patient presents having noticed an ulcer on his penis which is painless. He also has non-tender but enlarged lymph nodes in his groin. He reports having sex with a prostitute last week. Diagnosis and treatment?

Answer 42

primary syphilis | 2.4 MU Benzathine penicillin x1

Question 43

List some of the signs/symptoms of secondary syphilis.

Answer 43

Macular, follicular or pustular rash on palms & soles. Lesions of mucous membranes. Generalised lymphadenopathy Patchy alopecia

Question 44

What is the name for the most highly infectious lesion in syphilis?

Answer 44

condylomata lata

Question 45

What technique is used to diagnose syphilis?

Answer 45

Primary: dark ground microscopy, PCR, IgM Secondary: serology (specific & non-specific)

Question 46

What is the treatment for late syphilis?

Answer 46

2.4 MU Benzathine penicillin x3

Question 47

What is the organism behind pubic lice?

Answer 47

phthirus pubis

Question 48

What is the treatment for pubic lice?

Answer 48

malathion lotion

Question 49

26 y/o lady presents with concern about increased, coloured discharge from vagina. She is worried it smells bad. What is your diagnosis and treatment?

Answer 49

bacterial vaginosis | metronidazole 7 days

Question 50

Protozoan parasite which causes purulent, frothy vaginal discharge and irrigation in females.

Answer 50

trichomonas vaginalis

Question 51

How would you diagnose this vaginal parasite and treat it?

Answer 51

high vaginal swab for microscopy | oral metronidazole

Question 52

What are some predisposing factors to a candida infection?

Answer 52

recent antibiotic therapy high oestrogen levels poorly controlled diabetes immunocompromised patients

Question 53

What is the classical PC for candida infection?

Answer 53

intensely ITCHY white vaginal discharge

Question 54

What organism is commonest in a candida infection?

Answer 54

candida albicans

Question 55

What is the diagnostic test for candida infection?

Answer 55

high vaginal swab for culture

Question 56

What treatment options are there for a candida infection?

Answer 56

topical clotrimazole pessary or cream | oral fluconazole

Question 57

Which bacteria predominate in normal vaginal flora?

Answer 57

lactobacillus species e.g. L. crispatus and L. jensenii

Question 58

What type of organisms are lactobacillus spp.?

Answer 58

gram positive bacilli