STIs

Question 1

What is the most oncogenic type of HPV?

Answer 1

Type 16

Question 2

What HPV types can cause genital warts?

Answer 2

Types 6 and 11

Question 3

What causes syphillis?

Answer 3

Treponema Pallidum - spirochaete

Question 4

What are the features of primary syphillis?

Answer 4

Chancre at site of infection- usually painless

local non-tender lymphadenopathy

Question 5

What are some features of secondary syphillis?

Answer 5

• Systemic symptoms like fever, lymphadenopathy
• Typical rash- seen on palms and sole
• Snail track ulcers

Question 6

What is the treatment for syphillis, early and late stage?

Answer 6

Early- 2.4 MU Benzathine Penicillin stat

Late= 2.4 MU Benzathine Penicillin weekly for 3 weeks

Follow up serologically

Question 7

What causes genital herpes?

Answer 7

HSV1 or HSV2

Question 8

What herpes virus causes cold sores?

Answer 8

HSV1

Question 9

What is the treatment of genital herpes?

Answer 9

Aciclovir 400mg TDS (5/7)

Can also consider topical lidocaine ointment 5% if very painful

Saline bathing and analgesia

Question 10

How is a diagnosis of herpes made?

Answer 10

Swab in virus transport medium of de-roofed blister

PCR test

Question 11

Viral shedding is more common is HSV2

True or False

Answer 11

True

Question 12

In what kind of herpes virus are recurrent episodes more commonly seen?

Answer 12

HSV2

Question 13

Describe primary infection with HSV?

Answer 13

Tends to have more severe symptoms that recurrant episodes

Incubation is 3-6 days

Duration is around 14-21 days

Question 14

What causes Gonorrhea?

Answer 14

Gram negative diplococci- Niesseria Gonorrhoeae

Question 15

What is the first line treatment for gonorrhea?

Answer 15

Ceftriaxone 1G IM

Question 16

What is the 2nd line treatment of Gonorrhea?

Answer 16

Cefixime 400mg oral plus Azithromycin 2G

Only if IM injection in contra-indicated or refused by the patient

Question 17

How is Gonorrhea tested for?

Answer 17

NAATs

• Male- first pass urine sample
• Rectal and throat swabs
• Eye swabs
• Test for both gonorrhea and chlaymidia

Question 18

What is the most commonly seen STI in the UK?

Answer 18

Chlamydia

Question 19

What are the 3 serological groups of chlamydia?

Answer 19

• Serovars A-C= occular infection, Trachoma
• Serovars D-K= Genital infection
• Serovars L1-L3= Lymphogranuloma Venerum- genital ulcerative disease

Question 20

What is the treatment for Chlamydia?

Answer 20

Doxycycline 100mg BD for 1 week

2nd line= Azithromycin 1G stat followed by 500mg daily for 5 days

Question 21

How is chlamydia diagnosed?

Answer 21

NAATs- samples are taken from;

• Males- first pass urine sample
• Females- VVS, can be taken by patient
• Rectal and throat swabs
• Eye swabs

Question 22

What is Fitz Hugh Curtis syndrome?

Answer 22

A complication of PID.

Causes perihepatitis- a piano string from the liver capsule. Causes RUQ pain.

Question 23

What might vaginal discharge look like in bacterial vaginosis?

Answer 23

Thin, white discharge

Question 24

What would clue cells indicate?

Answer 24

Bacterial Vaginosis

Question 25

What criteria is used to diagnose Bacterial Vaginoisis?

Answer 25

Amsel's Criteris. 3/4 must be present * thin, white, homogenous discharge * clue cells on microscopy- stippled vaginal epithelial cells * vaginal pH of \>4.5 * positive whiff test- addition of potassium hydroxide results in fishy oddour

Question 26

How is bacterial vaginosis treated?

Answer 26

Oral metronidazole for 5-7 days

Question 27

What is bacterial vaginosis?

Answer 27

An overgrowth of aneorbic organisms like Gardnerella Vaginalis. Leads to a fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH

Question 28

What would a strawberry cervix support a diagnosis of?

Answer 28

Trichomonas Vaginalis

Question 29

Describe the discharge seen in Trichomonas Vaginalis?

Answer 29

Offensive. Frothy yellow-green

Question 30

What is Trichomonas Vaginalis?

Answer 30

A highly motile, flagellated protozoan parasite. STI.

Question 31

What would investigation show in Trichomonas Vaginalis?

Answer 31

Microscopy of a wet mount shows motile trophozoites

Question 32

What is the treatment for trichomonas vaginalis?

Answer 32

Oral metronidazole for 5-7 days

Question 33

What are some factors that make Vaginal Candiasis more likely to develop?

Answer 33

* Diabetes Mellitus * Drugs- antibiotics, steriods * pregnancy * immunosupression- HIV

Question 34

What might this discribe- cottage-cheese, non-offensive discharge?

Answer 34

Vaginal Candidiasis

Question 35

How can Vaginal Candidiasis be managed?

Answer 35

* Local- clotrimazole pessary (clotrimazole 500mg PV stat) * Oral- Itraconazole 200mg PO bd for 1 day or fluconazole 150mg PO stat * If pregnant only local treatment