STIs

Question 1

Examples

Answer 1

3Hs: Hepatits, Herpes, HIV
Trichomonas vaginalis
Gardnerella vaginalis
Treponema pallidum
Chlamydia trachomatis
Neisseria gonorrhoeae

Question 2

What is Trichomonas vaginalis

Answer 2

It is an Anaerobic Protozoon, which causes trichomoniasis

Symptoms include a fishy bubbly thin discharge and on speculum examination ‘strawberry’ cervix is visible

Question 3

Investigations of Trichomonas vaginalis

Answer 3

Cervical smear
Rapid antigen testing
PCR technique

Question 4

Treatment of Trichomonas vaginalis

Answer 4

Metronidazole

Intravaginal clotrimazole during pregnancy

Question 5

Complications of Trichomonas vaginalis

Answer 5

Increased risk of HIV infection
Increased risk of cervical cancer
Increased risk of preterm delivery

Question 6

What is Gardnerella vaginalis

Answer 6

Facultative anaerobic coccobacillus that causes bacterial vaginosis (‘fishy odour’ and grey discharge)
This is NOT an STI, but does cause vaginal discharge andis included in differential diagnosis with chlamydia and gonorrhoea
Rarely causes complications

Question 7

Investigations of Gardnerella vaginalis

Answer 7

Microscopy - clue cells observed

Question 8

Treatment of Gardnerella vaginalis

Answer 8

Metronidazole or Clindamycin

Question 9

Name of bacteria that causes chlamydia

Answer 9

Chlamydia trachomatis

Question 10

Name of diplococcus bacteria that causes gonorrhoea

Answer 10

Neisseria gonorrhoeae

Question 11

Name of organism that causes syphilis

Answer 11

Treponema pallidum

Question 12

What is Treponema pallidum

Answer 12

Spirochaete that causes syphilis

Question 13

Pathology of Treponema pallidum (infection stages)

Answer 13

Chancre: painless superficial infection
Disseminated disease: systemic involvement, rash seen on palms and soles
Cardiac and neurological involvement

Question 14

Investigations of Treponema pallidum

Answer 14

Venereal Disease Research Laboratory (VDRL) test
Rapid plasma regain (RPR) test
Treponema pallidum particle agglutination
Fluorescent treponemal antibody absorption (FTA) test
Treponema pallidum haemagglutination (TPHA) test
Treponema pallidum particle agglutination (TPPA) test
Treponemal enzyme immunoassay (EIA)

Question 15

Treatment of Treponema pallidum

Answer 15

Procaine pencillin G
Doxycycline
Erythromycin
Azithromycin

Give prophylactic prednisolone if patient has neurosyphilis (avoids Jarisch-Herxheimer reaction caused by endotoxins)

Question 16

Complications of Treponema pallidum

Answer 16

Gumma formation
Meningitis
Stroke
Heart valve damage

Question 17

What is Chlamydia trachomatis

Answer 17

Gram-negative bacterium that causes chlamydia

Question 18

Investigations of Chlamydia trachomatis

Answer 18

Chlamydia cell culture
Nucleic acid amplification test (NAAT)
Direct fluorescent antibody test (DFA)

Question 19

**Treatment of Chlamydia trachomatis

Answer 19

Azithromycin or Doxycycline

Question 20

Complications of Chlamydia trachomatis

Answer 20

Pelvic inflammatory disease
Urethritis
Infertility
Postpartum endometritis

Question 21

What is Neisseria gonorrhoeae

Answer 21

Gram-negative diplococcus that causes gonorrhoea

It is sometimes asymptomatic or presents with discharge

Question 22

Investigations of Neisseria gonorrhoeae

Answer 22

Nucleic acid amplification test (NAAT)

Cultured on Chocolate agar

Question 23

Treatment of Neisseria gonorrhoeae

Answer 23

Azithromycin or Ceftriaxone

Question 24

Complications of Neisseria gonorrhoeae

Answer 24

Pelvic inflammatory disease
Infertility
Dissemination of bacteria

Question 25

What types of swabs should be taken from males and females

Answer 25

Males - first pass urine
Female - vulvovaginal self-swab
Oral/anal swabs if oral/anal sex

Question 26

Conservative management of patient diagnosed with chlamydia

Answer 26

Sexual partners should be traced, patient should be advised to avoid sexual intercourse until course of treatment is completed
Counselling on importance of safe sex.