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Question 1
Correct
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A 25-year-old patient visits your clinic with concerns about a recent alteration in her usual vaginal discharge. She is not sexually active at the moment and has no other health issues. She does not report any itching symptoms but has observed a strong fishy odor in the discharge.
Which organisms should be the primary target for initial treatment in this scenario?Your Answer: Gardnerella vaginalis only
Explanation:Bacterial vaginosis (BV) is a common condition that affects up to a third of women during their childbearing years. It occurs when there is an overgrowth of bacteria, specifically Gardnerella vaginalis. This bacterium is anaerobic, meaning it thrives in environments without oxygen. As it multiplies, it disrupts the balance of bacteria in the vagina, leading to a rise in pH levels and a decrease in lactic acid-producing lactobacilli. It’s important to note that BV is not a sexually transmitted infection.
The main symptom of BV is a greyish discharge with a distinct fishy odor. However, it’s worth mentioning that around 50% of affected women may not experience any symptoms at all.
To diagnose BV, healthcare providers often use Amsel’s criteria. This involves looking for the presence of three out of four specific criteria: a vaginal pH greater than 4.5, a positive fishy smell test when potassium hydroxide is added, the presence of clue cells on microscopy, and a thin, white, homogeneous discharge.
The primary treatment for BV is oral metronidazole, typically taken for 5-7 days. This medication has an initial cure rate of about 75%. It’s crucial to provide special care to pregnant patients diagnosed with BV, as it has been linked to an increased risk of late miscarriage, early labor, and chorioamnionitis. Therefore, prompt treatment for these patients is of utmost importance.
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This question is part of the following fields:
- Sexual Health
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Question 2
Incorrect
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A 28-year-old woman comes in with a foul-smelling vaginal discharge and itching in the vulva area. She also experiences pain during urination but does not have an increased need to urinate. She has a 4-week-old baby whom she is currently nursing.
What is the most suitable treatment for her condition?Your Answer: Oral acyclovir
Correct Answer: Topical clotrimazole
Explanation:The most probable diagnosis in this case is vaginal thrush. Vaginal thrush is characterized by symptoms such as vulval irritation and itching, vulval redness, and a discharge that is often described as cheesy. Some women may also experience dysuria, which is pain or discomfort during urination, but without an increase in frequency or urgency. The recommended treatment for vaginal thrush is the use of antifungal agents, with topical azoles like clotrimazole or miconazole being commonly prescribed. It is important to note that breastfeeding patients should avoid taking oral terbinafine as it can pass into breast milk.
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This question is part of the following fields:
- Sexual Health
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Question 3
Incorrect
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A 25-year-old woman comes in seeking the morning after pill. She explains that she had unprotected sexual intercourse (UPSI) with her long-term partner within the past 48 hours. She is in good health and is eager to resume taking the oral contraceptive pill after addressing this situation.
What is the BEST choice for her in this case?Your Answer: Copper IUD
Correct Answer: Levonelle 1.5 mg
Explanation:Women have three options when requesting emergency contraception. The first option is Levonelle 1.5 mg, which contains levonorgestrel and can be used up to 72 hours after unprotected sexual intercourse (UPSI). If vomiting occurs within 2 hours of taking the tablet, another one should be given. Levonelle mainly works by preventing ovulation.
The second option is ulipristal acetate, the newest treatment available. It can be used up to 120 hours after UPSI. If vomiting occurs within 3 hours of ingestion, another tablet should be given. Ulipristal acetate also works by inhibiting ovulation. However, it should be avoided in patients taking enzyme-inducing drugs, those with severe hepatic impairment, or those with severe asthma requiring oral steroids.
The third option is the copper IUD, which can be fitted up to 5 days after UPSI or ovulation, whichever is longer. The failure rate of the copper IUD is less than 1 in 1000, making it 10-20 times more effective than oral emergency contraceptive options. It is important to note that Levonelle and ulipristal may be less effective in women with higher BMIs.
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This question is part of the following fields:
- Sexual Health
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Question 4
Incorrect
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A 25-year-old woman visits your office expressing concern about a recent unprotected sexual encounter that occurred three days ago. She is extremely anxious and determined to prevent pregnancy. The patient has a history of asthma and currently takes Clenil Modulite. Her BMI is 30.
What is the most appropriate choice for her in this situation?Your Answer: Loestrin 30
Correct Answer: Copper IUD
Explanation:Women have three options when requesting emergency contraception. The first option is Levonelle 1.5 mg, which contains levonorgestrel and can be used up to 72 hours after unprotected sexual intercourse (UPSI). If vomiting occurs within 2 hours of taking the tablet, another one should be given. Levonelle mainly works by preventing ovulation.
The second option is ulipristal acetate, the newest treatment available. It can be used up to 120 hours after UPSI. If vomiting occurs within 3 hours of ingestion, another tablet should be given. Ulipristal acetate also works by inhibiting ovulation. However, it should be avoided in patients taking enzyme-inducing drugs, those with severe hepatic impairment, or those with severe asthma requiring oral steroids.
The third option is the copper IUD, which can be fitted up to 5 days after UPSI or ovulation, whichever is longer. The failure rate of the copper IUD is less than 1 in 1000, making it 10-20 times more effective than oral emergency contraceptive options. It is important to note that Levonelle and ulipristal may be less effective in women with higher BMIs.
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This question is part of the following fields:
- Sexual Health
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Question 5
Incorrect
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A 25-year-old patient presents with concerns about a recent alteration in her usual vaginal discharge. She is not sexually active at the moment and has no other systemic health issues. She does not report any itching symptoms but has observed a strong fishy odor and a greyish-white appearance in the discharge.
What is the most probable organism responsible for this change?Your Answer: Chlamydia trachomatis
Correct Answer: Gardnerella vaginalis
Explanation:Bacterial vaginosis (BV) is a common condition that affects up to a third of women during their childbearing years. It occurs when there is an overgrowth of bacteria, specifically Gardnerella vaginalis. This bacterium is anaerobic, meaning it thrives in environments without oxygen. As it multiplies, it disrupts the balance of bacteria in the vagina, leading to a rise in pH levels and a decrease in lactic acid-producing lactobacilli. It’s important to note that BV is not a sexually transmitted infection.
The main symptom of BV is a greyish discharge with a distinct fishy odor. However, it’s worth mentioning that around 50% of affected women may not experience any symptoms at all.
To diagnose BV, healthcare providers often use Amsel’s criteria. This involves looking for the presence of three out of four specific criteria: a vaginal pH greater than 4.5, a positive fishy smell test when potassium hydroxide is added, the presence of clue cells on microscopy, and a thin, white, homogeneous discharge.
The primary treatment for BV is oral metronidazole, typically taken for 5-7 days. This medication has an initial cure rate of about 75%. It’s crucial to provide special care to pregnant patients diagnosed with BV, as it has been linked to an increased risk of late miscarriage, early labor, and chorioamnionitis. Therefore, prompt treatment for these patients is of utmost importance.
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This question is part of the following fields:
- Sexual Health
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Question 6
Incorrect
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A 2-month-old infant is born by vaginal delivery to a mother who is subsequently found to have a chlamydia infection. Treatment is initiated after the delivery, but unfortunately, the baby also develops an infection.
What is the most frequent manifestation of Chlamydia trachomatis infection in neonates?Your Answer: Encephalitis
Correct Answer: Conjunctivitis
Explanation:Conjunctivitis is the most frequent occurrence of Chlamydia trachomatis infection in newborns. Ophthalmia neonatorum refers to any cause of conjunctivitis during the newborn period, regardless of the specific organism responsible. Chlamydia is now the leading cause, accounting for up to 40% of cases. Neisseria gonorrhoea, on the other hand, only accounts for less than 1% of reported cases. The remaining cases are caused by non-sexually transmitted bacteria like Staphylococcus, Streptococcus, Haemophilus species, and viruses.
Gonorrhoeal ophthalmia neonatorum typically presents within 1 to 5 days after birth. It is characterized by intense redness and swelling of the conjunctiva, eyelid swelling, and a severe discharge of pus. Corneal ulceration and perforation may also be present.
Chlamydial ophthalmia neonatorum, on the other hand, usually appears between 5 to 14 days after birth. It is characterized by a gradually increasing watery discharge that eventually becomes purulent. The inflammation in the eyes is usually less severe compared to gonococcal infection, and there is a lower risk of corneal ulceration and perforation.
The second most common manifestation of Chlamydia trachomatis infection in newborns is pneumonia. Approximately 5-30% of infected neonates will develop pneumonia. About half of these infants will also have a history of ophthalmia neonatorum.
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This question is part of the following fields:
- Sexual Health
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Question 7
Correct
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A 45-year-old patient has been diagnosed with gonorrhea. You are preparing to initiate antibiotic treatment.
Which of the following antibiotic combinations would be the most suitable?Your Answer: Ceftriaxone and azithromycin
Explanation:Ceftriaxone is currently one of the limited antibiotics that effectively treats gonorrhoea. It is typically administered alongside azithromycin or doxycycline to enhance its effectiveness.
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This question is part of the following fields:
- Sexual Health
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Question 8
Incorrect
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A 32-year-old woman with a known history of HIV presents with multiple new small lumps around her anus and genitalia. During examination, two clusters of small lumps are observed. The lumps range in size from 1 to 5 mm, with two being pedunculated. They have a firm texture and exhibit colors ranging from grey to brown.
What is the SINGLE most probable diagnosis?Your Answer: Verruca vulgaris
Correct Answer: Verruca acuminata
Explanation:Verruca acuminata, also known as Condylomata acuminata, are genital warts. These warts are typically transmitted through sexual activity and are primarily caused by different subtypes of the human papillomavirus (HPV). They usually appear in clusters, can be pedunculated, and vary in size between 1-5 mm. Immunosuppression increases the risk, and some studies suggest that 25% of affected patients will acquire a second sexually transmitted infection.
Condylomata lata, on the other hand, are warty-plaque like lesions found on the genitals and perianal area during secondary syphilis.
Verruca vulgaris, commonly known as common warts, present as raised warts with a roughened surface. They are most frequently observed on the hands.
Verruca planae, which are smooth and flattened flesh-colored warts, can occur in large numbers. They are commonly seen on the face, hands, neck, wrists, and knees.
Lastly, Verruca plantaris, also known as plantar warts or verrucas, manifest as hard and painful lumps, often with black specks in the center. These warts are typically found only on pressure points on the soles of the feet.
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This question is part of the following fields:
- Sexual Health
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Question 9
Incorrect
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A young woman is referred to the GUM clinic for investigation of symptoms that can be associated with sexually transmitted infection. Following her assessment, she is diagnosed with gonorrhoea.
Which of the following is the most common presenting clinical feature of gonorrhoea in women?Your Answer: Anal discharge
Correct Answer: Urethritis
Explanation:Neisseria gonorrhoeae is a type of bacteria that is shaped like two spheres and stains pink when tested. It is responsible for causing the sexually transmitted infection known as gonorrhoea. This infection is most commonly seen in individuals between the ages of 15 and 35, and it is primarily transmitted through sexual contact. One important thing to note is that the gonococcal pili, which are hair-like structures on the bacteria, can change their appearance. This means that even if someone has recovered from a previous infection, they can still be reinfected due to the bacteria’s ability to change.
In men, the clinical signs of gonorrhoea include inflammation of the urethra, which is seen in approximately 80% of cases. Around 50% of men experience pain or discomfort during urination, and a mucopurulent discharge may also be present. Rectal infection is possible, although it is usually asymptomatic. In some cases, it can cause anal discharge. Pharyngitis, or inflammation of the throat, is also possible but typically does not cause any noticeable symptoms.
Women with gonorrhoea may experience a vaginal discharge, which is seen in about 50% of cases. Lower abdominal pain is reported in approximately 25% of women, and dysuria, or painful urination, is seen in 10-15% of cases. Pelvic or lower abdominal tenderness is less common, occurring in less than 5% of women. Additionally, women may have an endocervical discharge and/or bleeding. Similar to men, rectal infection is usually asymptomatic but can cause anal discharge. Pharyngitis is also possible in women, but it is typically asymptomatic.
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This question is part of the following fields:
- Sexual Health
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Question 10
Incorrect
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A middle-aged woman presents with symptoms that can be associated with sexually transmitted infection (STI). Following her investigations, she is diagnosed with the most common cause of STI in the UK.
Which of the following is the SINGLE most likely diagnosis?Your Answer: Genital herpes
Correct Answer: Chlamydia
Explanation:Chlamydia trachomatis is a type of Gram-negative bacteria that is responsible for causing the sexually transmitted infection known as chlamydia. This bacterium is typically either coccoid or rod-shaped in its appearance.
There are various serological variants of C. trachomatis, and each variant is associated with different patterns of disease. Specifically, types D-K are responsible for causing genitourinary infections.
In the United Kingdom, chlamydia is the most commonly diagnosed sexually transmitted infection (STI). It is also the leading preventable cause of infertility worldwide. Interestingly, around 50% of men infected with chlamydia do not experience any symptoms, while at least 70% of infected women are asymptomatic.
If left untreated, chlamydia can lead to various complications. In women, these complications may include pelvic inflammatory disease (PID), ectopic pregnancy, and tubal infertility. Men, on the other hand, may experience complications such as proctitis, epididymitis, and epididymo-orchitis.
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This question is part of the following fields:
- Sexual Health
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