Y4 tutorial STI

Question 1

What test is used test for chlamydia and gonorrhoea?

Answer 1

NAAT (nucleic acid amplification test)

Question 2

How do you get the sample for a NAAT in men and in women?

Answer 2

Men - first void urine

Women - lower vaginal swab (can be self obtained)

Question 3

What things may you need a high vaginal swab for?

Answer 3

BV
Candida
TV (in Grampian use NAAT as more sensitive)

Question 4

What is the most common STI in the UK?

Answer 4

Chlamydia

Question 5

How can chlamydia present?

Answer 5

Asymptomatic in 70% women, 30% men
Men - discharge, dysuria, urethral itch
Women - post-coital bleeding, IMB, dysuria, deep dysparenuia, pelvic pain

Question 6

What are complications of chlamydia in men?

Answer 6

Epididymo-orchitis

Question 7

What are complications of chlamydia in women?

Answer 7

PID

Infertility

Question 8

What causes lymphogranuloma venereum?

Answer 8

Chlamydia trachomatis-3 serovars

Question 9

Who is LVG mostly seen in?

Answer 9

MSM

Question 10

How does LVG tend to present?

Answer 10

Rectal pain
Anorectal bleeding
Mucoid and/or haemopurulent rectal discharge
Tenesmus
Constipation or other symptoms of lower GI inflammation
(Mimics IBS)

Question 11

How is an uncomplicated chlamydia infection treated?

Answer 11

Doxycycline 100mg bd 7d and abstain for duration of course

If CI multidose azithromycin (1g stat, then 500mg daily for 2d)

Question 12

What is an essential part of treating STIs?

Answer 12

Contact tracing and notification

Question 13

How is LGV managed?

Answer 13

Doxycycline 100mg twice daily for 3 weeks

Question 14

What is a gonorrhoea infection a marker of?

Answer 14

High risk sexual behaviour

Question 15

Why has gonorrhoea infections increased?

Answer 15

Due to PrEP effect (more MSM having unrprotected sex)

Question 16

What kind of pathogen is gonorrhoea?

Answer 16

Gram negative diplococcus

Question 17

What kind of tissue does gonorrhoea infect?

Answer 17

Mucous membranes - urethra, endocervix, rectum, pharynx, conjuctiva

Question 18

What is the incubation period of gonorrhoea?

Answer 18

2-5 days

Question 19

How does gonorrhoea tend to present in men?

Answer 19

Urethral infection: Urethral discharge, dysuria, can be asymptomatic
Rectal infection: usually asymptomatic, may get anal discharge, perianal pain/discomfort
Pharyngeal infection: usually asymptomatic

Question 20

How does gonorrhoea tend to present in women?

Answer 20

Similar to chlamydia

Question 21

What is the first line treatment for uncomplicated gonorrhoea?

Answer 21

1g ceftriaxone
REVIEW after 14d for test of cure

If ceftriaxone refused oral cefixime 400mg single dose + oral azithromycin 2g should be used

Question 22

What does mycoplasma genitalium cause?

Answer 22

Non-gonococcal urethritis

Question 23

Who should you test for MG?

Answer 23

Those with recurrent/persistent symptoms

Question 24

What ist he first line treatment of MG?

Answer 24

Doxycycline

But may req. treatment with moxifloxacin as many are resistant

Question 25

List causes of 'lumps' on the genitalia

Answer 25

``` Genital warts Molluscum contagiosum Bartholin's abscess Cysts/abscesses Dermatoses Malignancies Normal findings ```

Question 26

What strains of HPV cause genital warts?

Answer 26

6 and 11

Question 27

What strains of HPV cause cervical cancer?

Answer 27

16, 18

Question 28

What is the name of the quadrivalent vaccine that protects against HPV strains 6, 11, 16, 18?

Answer 28

Gardasil

Question 29

What is the investigation for HSV?

Answer 29

PCR from ulcers/vesicular fluid

Question 30

How do you treat HSV infection?

Answer 30

Aciclovir PO | Analgesics

Question 31

What is the incubation period of syphillis?

Answer 31

10-90 days

Question 32

How can syphillis be transmitted?

Answer 32

Sexually Blood borne (rare) Transplacental after 9 weeks

Question 33

What are the stages of syphillis?

Answer 33

Primary Secondary Latent Teritary

Question 34

What happens in primary stage of syphillis?

Answer 34

Painless ulcers + associated lymphadenopathy

Question 35

What is the commonest mode of transmission of syphillis?

Answer 35

Orogenital contact

Question 36

What happens in secondary syphillis?

Answer 36

Haematogenous dissemination so systemically unwell (malaise, fever, myalgia, rash, lympadenopathy)

Question 37

What are features of tertiary syphillis?

Answer 37

Gumma Cardiovascular issues Neurosyphillis

Question 38

What stage of syphillis carries the greater risk in pregnancy?

Answer 38

Early syphillis

Question 39

What consequences to the foetus can syphillis in pregnancy lead to?

Answer 39

Spontaneous abortion Preterm labour Perinatal death Congenital syphillis infection

Question 40

Someone presenting to ENT with ______ should be considered to be tested for syphilis.

Answer 40

Sensorineural deafness

Question 41

Someone presenting to dermatology with ______ should be considered to be tested for syphilis.

Answer 41

Unexplained skin changes

Question 42

Someone presenting to ophthalmology with ______ should be considered to be tested for syphilis.

Answer 42

Interstitial keratitis

Question 43

Someone presenting to haematology with ______ should be considered to be tested for syphilis.

Answer 43

Unexplained lympadenopathy

Question 44

Someone presenting to cardiology with ______ should be considered to be tested for syphilis.

Answer 44

Conduction defects Aortic regurg Aortic aneurysm

Question 45

Someone presenting to neurology with ______ should be considered to be tested for syphilis.

Answer 45

Meningovascular Argyll Roberston pupils General paralysis of the insane Tabes dorsalis

Question 46

within what time frame should HIV PEPSE be given?

Answer 46

72 hours

Question 47

Who should be considered for HIV PEPSE?

Answer 47

Anyone who has had a significant exposure to HIV

Question 48

What does HIV PEPSE involve?

Answer 48

Combination of antiretrovirals (3 drugs - Truvada and Raltegravir) taken for 1 month

Question 49

What drug is used for HIV PrEP?

Answer 49

Truvada

Question 50

What is the discharge in gonorrhoea like?

Answer 50

Profuse | Pussy

Question 51

What is the discharge in chlamydia like?

Answer 51

Milky, less than in gonorrhoea

Question 52

When should you test for HIV after someone has taken PEPSE?

Answer 52

4 weeks after stopping the antivirals

Question 53

What are complications of gonorrhoea?

Answer 53

Urethral strictures Epididymitis Salpingitis

Question 54

What are key features of a disseminated gonococcal infection?

Answer 54

Tenosynovitis Migratory polyarthritis Dermatitis Later complications include septic arthritis, endocarditis, perihepatitis (Fitz-Hugh-Curtis syndrome)