Thursday, February 17, 2011


Date : 24th August, 2004 Time : 1.30 p.m. – 4.30 p.m.
Answer All questions.
Each question to be answered in a separate book.
1. A recently diagnosed 28 year old HIV infected women with a CD4 I cell count of
180/mm3 and a viral load of 65,000 copies/ml is referred by a Gynaecologist to the
STD clinic. Her husband is abroad on business and his HIV status is not known.
She requests advice on contraception and says she is considering starting
antiretroviral therapy.
Discuss the advantages and disadvantages of the contraceptive options available
with reference to both her HIV status and potential HIV management.
(100 marks)
2. A study was conducted to assess the effectiveness of a new antibiotic in the
treatment of gonorrhoea. Out of 400 newly diagnosed patients with gonorrhoea
200 were randomly allocated to receive the new treatment and the other 200
received the standard antibiotic.
Among the patients who received the new antibiotic 190 were cured and in the
other group 160 were cured.
2.1 What kind of study is this? (10 marks)
2.2 Explain why the patients were randomly allocated to the two
groups. (20 marks)
2.3. Describe the other important measures taken in this kind of
study to reduce bias. (30 marks)
2.3 What statistical test would you perform on the above data ? Give
reasons for your choice. (Please note that you are not expected
to perform the test.) (20 marks)
2.4 Indicate how you would present the above data as a graph by
drawing a rough sketch (20 marks)
3. You are newly appointed as a MO/STD in charge of a peripheral STD clinic that
is administered by the provincial health authorities. Underutilization of this
clinic by the people who need STD cars is a significant finding of your initial
3.1 Describe with examples possible contributing factors for above finding.
(25 marks)
3.2 What steps can you take to improve this condition ? (25 marks)
3.3 Enumerate the key people with whom should establish cordial
relationship to achieve your objective. (15 marks)
3.4 Until you improve adequate clinic utilization by the needy
people in your area, how would you (35 marks)
4. Screening for syphilis is considered a public health priority.
4.1 List five opportunities available to screen women for syphilis.(15 marks)
4.2 Give an indicator that can be easily calculated monthly from
records maintained in the antenatal clinic to assess each of the
i. Coverage of antenatal syphilis screening.
ii. Treatment coverage for syphilis. (20 marks)
4.3 Suggest recommendations with justification to improve
antenatal VDRL coverage. (65 marks)
5. The available statistics at the National STD AIDS control programme in Sri
Lanka, show a declining trend in the incidence of gonorrhoea during the last two
decades (from 1981 t0 2002). This scenario has changed recently and the
statistical returns for the year 2003 clearly indicate a sudden increase of the
number of reported cases of gonorrhoea.
5.1 Discuss the possible reasons for this change in trend. (50 marks)
5.2 As the medical officer in charge of a provincial STD clinic what
are the measures you would take to control this situation in
your area. (50 marks)

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