STIs self learning package

Question 1

Gonorrhoea is caused by?

Answer 1

Neisseria gonorrhoea

Question 2

Symptoms of gonorrhoea in men

Answer 2

10% assymptomatic

thick profuse, yellow discharge, dysuria. rectal & pharyngeal infection, often assymptomatic

Question 3

Symptoms of gonorrhoea in women

Answer 3

>50% assymptomatic
vaginal discharge, dysuria or intermenstrual/post-coital bleeding

Question 4

Complications of gonorrhoea

Answer 4

Male- epidyymitis
female- PID, bartholin’s abcess

Both- acute monoarthritis (elbow/shoulder)
disseminated gonococcal infection: skin lesions, pustular with halo

Question 5

incubation period of gonorrhoea

Answer 5

Average 5 to 6 days. Range 2 days to 2 weeks (if get symptoms at all).

Question 6

Who are most cases of Ghonorrhoea found in?

Answer 6

MSM
much less common than chlamydia

Question 7

How is gonorrhoea diagnosed

Answer 7

Nucleic Acid Amplification Test (NAAT) on urine or swab from an exposed site – vagina, rectum, throat. Could be self-obtained or clinician-obtained.
Gram stained smear from urethra/cervix/rectum in symptomatic people.
Culture of swab-obtained specimen from an exposed site using highly selective lysed blood agar in a 5% CO2 environment. Should be done for all confirmed cases to assess antibiotic sensitivity.

Question 8

Treatment of gonorrhoea

Answer 8

Blind treatment with ceftriaxone 1g im. Can also treat according to antibiotic sensitivities.

Question 9

Follow up for cases of gonorrhoea

Answer 9

Test of cure at 2 weeks and test for reinfection at 3 months

Question 10

Chlamydia- caused by?

Answer 10

Chlamydia trachomatis serovars D to K

Question 11

Symptoms of chlamydia in men, women and both

Answer 11

men: >70% asymptomatic
Slight watery discharge, dysuria
women: >80% asymptomatic. Vaginal discharge, dysuria, intermenstrual/post-coital bleeding
Both: conjuctivitis

Question 12

Complications of chlamydia in men, women and both

Answer 12

Men: epidydmitis

Women: PID, ectopic pregnancy, pelvic pain & infertility (only in 1%)

Both: reactive arthritis/reiter’s syndrome- urethritis/cervicitis + conjuctivitis + arthritis

Question 13

Who is chlamydia most often found in

Answer 13

Common
most cases in people under 25, especially sexually active teenage women

Question 14

Diagnosis of chlamydia

Answer 14

First void urine in men
Swab from cervix, urethra, rectum

All specimens tested using NAAT

Question 15

Treatment of chlamydia

Answer 15

Doxycycline 100mg bd 1 week
Azithromycin 1g po once pregnant

Question 16

Flollow up for chlamydia treatment

Answer 16

Test for re-infection at 3-12 months. earlier test of cure not needed unless symptoms persist

Question 17

Cause of herpes

Answer 17

Herpes simplex virus types 1 and 2

Question 18

Symptoms of herpes

Answer 18

80% have no symptoms. The rest have recurring symptoms – monthly, annually. Burning/itching then blistering then tender ulceration.
Tender inguinal lymphadenopathy. Flu-like symptoms.
Dysuria, Neuralgic pain in back, pelvis and legs,

Question 19

Complications of herpes

Answer 19

Autonomic neuropathy (urinary retention), neonatal infection, secondary infection

Question 20

Incubation period of herpes

Answer 20

About 5 days to months
some people never report symptoms

Question 21

How common is HIV?

Answer 21

Very common ~ 15-20% of UK population has it. Both strains equally common in genital infection. Roughly equal between sexes. HSV2 is important co-factor for HIV transmission.

Question 22

Diagnosis of HIV

Answer 22

Clinical impression.
Swab from lesion tested using PCR.

Question 23

Describe the treatment of HIV, in the case of a Primary outbreak

Answer 23

Aciclovir: various regimens – eg 400mg tds for 5 days Lidocaine ointment

Question 24

Describe the treatment of HIV, in the case of infrequent recurrences:

Answer 24

Lidocain ointment
aciclovir 1.2g once daily until symptoms are gone (1-3 days)

Question 25

Describe the treatment of HIV, in the case of frequent recurrences:

Answer 25

Aciclovir 400bd long term- as supression

Question 26

Cause of trichomoniasis

Answer 26

Trichomonas vaginalis

Question 27

Symptoms of trichomoniasis

Answer 27

Men: Usually asymptomatic Women: 10-30% asymptomatic Profuse thin vaginal discharge - greenish, frothy and foul smelling. Vulvitis.

Question 28

Is trichomoniasis common & who is it most common in

Answer 28

Uncommon, approx 100/yr in Grampian. More common in middle aged women than some other STIs are.

Question 29

Complications of trichomoniasis

Answer 29

Miscarriage & preterm labour

Question 30

Diagnosis of trichomoniasis

Answer 30

PCR on vaginal swab Point of care: microscopy of wet preparation of vaginal discharge

Question 31

Treatment of trichomoniasis

Answer 31

Metrondiazole 400mg po bd for 5 days or 2g single dose

Question 32

Anogenital warts; caused by

Answer 32

Human Papilloma Virus types 6 and 11 (and occasionally type 1). (NB different strains from those that cause cervical cancer.

Question 33

Symptoms of anogenital warts

Answer 33

Lumps with a surface texture of a small cauliflower. Occasionally itching or bleeding especially if perianal or intraurethral.

Question 34

how much of the population gets genital HPV during their life

Answer 34

90% of UK population have a genital HPV infection at some point in their life. Only about 20% of those infected with a wart-causing strain of human papilloma virus get warts. A drop in cases is anticipated in response to quadrivalent HPV

Question 35

Any common complications of anogenital warts?

Answer 35

None common. Neonatal laryngeal papillomatosis.

Question 36

Diagnosis of anogenital warts

Answer 36

Appearance. Biopsy if unusual – to exclude intraepithelial neoplasia, but this is rarely needed

Question 37

Treatment of anogenital warts

Answer 37

Podophyllotoxin (brands warticon and condyline), imiquimod (brand Aldara). Both home treatments. Others – cryotherapy

Question 38

Causes of syphillis

Answer 38

Treponema pallidum subspecies pallidum

Question 39

Symptoms/stages of syphillis

Answer 39

Diverse. Often entirely asymptomatic or mild symptoms Primary- local ulcer (chancre) Secondary- rash, mucosal ulceration, neuro symptoms, patchy alopecia, others Early latent- no symptoms but \<2 years since caught Late latent- no symptoms but \>2 years since caught Tertiary- neurological, cardiovacular or gummatous (skin lesion)- all very rare

Question 40

Who is most commonly affected by syphillis

Answer 40

MSM

Question 41

Complications of syphillis?

Answer 41

neurosyphilis – cranial nerve palsies are commonest, cardiac or aortal involvement. Congenital syphilis (extremely rare in Scotland).

Question 42

Incubation period of syphillis

Answer 42

9 to 90 days until appearance of chancre. But can be asymptomatic.

Question 43

Diagnosis of syphillis

Answer 43

Clinical signs Serology for TP IgGEIA, TPPA and RPR PCR on sample from an ulcer

Question 44

Treatment of syphillis

Answer 44

Early (\<2 yrs and no neurological involvement): Benzathine penicillin 2.4 MU im once Or Doxycycline 100mg bd po 2 weeks Late (\>2 years) and no neurological involvement Benzathine penicillin 2.4MU im weekly for 3 doses Doxycycline 100mg bd po 28 days