Contraception dominates the DFSRH curriculum, but STI management is the second most tested domain in the OTA — and the one candidates most frequently underestimate. If you study contraception thoroughly but skim STIs, you will lose marks on questions that reward straightforward clinical knowledge.
1. Chlamydia
The most commonly diagnosed STI in the UK. First-line treatment: doxycycline 100mg twice daily for 7 days. Alternative: azithromycin 1g stat (now second-line following updated BASHH guidelines showing doxycycline superiority). Test of cure recommended for pregnant women, those with persistent symptoms, and where adherence is uncertain. Partner notification: current and recent sexual contacts should be tested and treated. NCSP screening offered to under-25s.
2. Gonorrhoea
First-line: ceftriaxone 1g IM single dose. Culture and sensitivity testing is essential — gonorrhoea resistance is a growing concern. Test of cure is recommended for all cases at 2 weeks. Partner notification: essential, including contact tracing for recent partners.
3. Syphilis
Primary (chancre), secondary (rash, condylomata lata), and latent syphilis. First-line: benzathine penicillin G IM. Serological screening (RPR/VDRL for screening, FTA-Abs/TPHA for confirmation). Partner notification and contact tracing. Antenatal screening is routine in the UK.
4. Genital Herpes (HSV)
First episode: aciclovir 400mg three times daily for 5 days. Recurrent episodes: episodic treatment or suppressive therapy (daily aciclovir or valaciclovir). Counselling about transmission, condom use, and recurrence patterns. Management in pregnancy (risk of neonatal herpes if primary episode near term).
5. HIV Testing and Referral
Know when to offer HIV testing (all new sexual health attendees, all STI diagnoses, indicator conditions). Fourth-generation assays detect p24 antigen and antibodies. Reactive results require confirmatory testing. Immediate referral to specialist HIV services. PrEP awareness — know that it exists, who it is for, and how to refer.
6. Trichomoniasis
First-line: metronidazole 400mg twice daily for 5-7 days (or 2g stat). Partner notification and concurrent treatment. Common co-infection with other STIs — test comprehensively.
7. Genital Warts (HPV)
Caused by HPV types 6 and 11. Treatment options: podophyllotoxin (self-applied), imiquimod cream, cryotherapy, surgical removal. HPV vaccination programme (now gender-neutral) reduces incidence. Warts are not associated with cervical cancer (which is caused by high-risk HPV types 16/18).
8. Pelvic Inflammatory Disease (PID)
Clinical diagnosis (lower abdominal pain, cervical motion tenderness, adnexal tenderness). Empirical treatment: IM ceftriaxone + oral doxycycline + oral metronidazole. Important UKMEC implication: active PID is Category 4 for IUD/IUS initiation.
9. Partner Notification
Principles: confidential, voluntary, and supportive. Patient referral (the patient tells their partners) or provider referral (the clinic contacts partners with the patient's consent). Essential for gonorrhoea, chlamydia, syphilis, and HIV. The OTA may test when provider referral is appropriate.
10. Safeguarding in STI Contexts
Under-16s with STIs: consider Fraser/Gillick competence. Any STI in a child: mandatory safeguarding referral. Disclosure of sexual assault: follow local safeguarding pathways. The OTA tests recognition of safeguarding triggers in STI consultation scenarios.
How to Prepare
The iatroX DFSRH Q-Bank includes STI management questions mapped to the DFSRH curriculum. Ask iatroX provides instant reference for BASHH guidelines and STI management protocols. The adaptive spaced repetition ensures STI knowledge is maintained alongside contraception knowledge throughout your preparation.
Do not neglect STIs. The OTA tests them. The AHD tests them. Your patients need you to know them. And iatroX makes learning them systematic and retention durable.