A 19-year-old woman is reviewed in the genitourinary medicine clinic. She presented with vaginal discharge and dysuria. Microscopy of an endocervical swab showed a Gram-negative coccus that was later identified as Neisseria gonorrhoea. This is her third episode of gonorrhoea in the past two years.
What is the most likely complication from repeated infection?
Correct Answer D: Infertility secondary to pelvic inflammatory disease (PID) is the most common complication of gonorrhoea. It is the second most common cause of PID after Chlamydia. Arthropathy may occur but it is far less common.
Lymphogranuloma venereum is caused by Chlamydia trachomatis.
Gonorrhoea:
Gonorrhoea is caused by the Gram negative diplococcus Neisseria gonorrhoea. Acute infection can occur on any mucous membrane surface, typically genitourinary but also rectum and pharynx. The incubation period of gonorrhoea is 2-5 days.
Features:
Management:
Disseminated gonococcal infection (DGI) and gonococcal arthritis may also occur, with gonococcal infection being the most common cause of septic arthritis in young adults. The pathophysiology of DGI is not fully understood but is thought to be due to haematogenous spread from mucosal infection (e.g. Asymptomatic genital infection). Initially there may be a classic triad of symptoms: tenosynovitis, migratory polyarthritis and dermatitis.
Later complications include septic arthritis, endocarditis and perihepatitis (Fitz-Hugh-Curtis syndrome).
Key features of disseminated gonococcal infection:
The most appropriate treatment for cutaneous larva migrans is:
Correct Answer A:
Nematodes:
Ancylostoma braziliense:
Strongyloides stercoralis:
Toxocara canis:
A 19-year-old medical student undergoes primary immunization against hepatitis B. His post immunization bloods are reported as follows:
What is the most appropriate course of action?
Correct Answer C:
Hepatitis B:
Hepatitis B is a double-stranded DNA virus and is spread through exposure to infected blood or body fluids, including vertical transmission from mother to child. The incubation period is 6-20 weeks. Immunization against hepatitis B:
Complications of hepatitis B infection:
Management of hepatitis B:
Oral antiviral medication is increasingly used with an aim to suppress viral replication (not in dissimilar way to treating HIV patients):
Which one of the following is least associated with a false negative tuberculin skin test?
Correct Answer D: Severe renal failure may cause a false negative test but CKD stage 3 would not.
Tuberculosis: screening The Mantoux test is the main technique used to screen for latent tuberculosis. In recent years the interferon gamma blood test has also been introduced. It is used in a number of specific situations such as:
Mantoux test:
False negative tests may be caused by:
Heaf test:
The Heaf test was previously used in the UK but has been since been discontinued. It involved injection of PPD equivalent to 100,000 units per ml to the skin over the flexor surface of the left forearm. It was then read 3-10 days later.
A 24-year-old woman presents due to an itchy vulva and pain during sex. She also mentions a green, offensive vaginal discharge for the past 2 weeks.
What is the most likely diagnosis?
Correct Answer D:
Vaginal discharge: Vaginal discharge is a common presenting symptom and is not always pathological.
Common causes:
Less common causes:
Key features of the common causes are listed below:
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