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Reproductive Health (Y4) > 10- Sexual health and presentation of STI > Flashcards

10- Sexual health and presentation of STI Flashcards

1
Q

sexual history

A
  • introduction and confirmation of patients identity
  • presenting complaint
  • history of presenting complaint
  • past medical hisotry
  • drug history
  • females only: gynae/pregnancies/menstrual/ cervical smear/ HPV vaccine/ contraception
  • social hisotry
  • sexual hisotry
  • BBV risk assessment
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2
Q

presenting complaints in females/ trans males

A
  • Vaginal Discharge
  • Genital Lumps/ulcers
  • Intermenstrual and post-coital
    bleeding
  • Deep and superficial dyspareunia
  • Dysuria and urinary frequency
  • Abdominal pain
  • STI contact/sexual
    assaults/contraception/TOP/sexua
    l dysfunction
  • Rectal symptoms
  • Asymptomatic screens
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3
Q

presenting complaint males/ trans females

A
  • Urethral discharge
  • Dysuria and urinary frequency
  • Genital lumps/ulcers
  • Testicular pain/swelling
  • Rectal symptoms
  • Sexual dysfunction and assaults
  • Asymptomatic screens
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4
Q

sexual history questions

A
  • past history STI
  • last episode of sex
  • male/ female/ trans?
  • sexual contact- regular or casual?
  • duration of sexual relationship
  • Condoms?
  • type of sex- particularly MSM insertive/ receptive, active/passive/top/bottom
  • partner symptoms
  • partner details for contact tracing
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5
Q

blood born virus’

A

Hep B, Hep C, HIV

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6
Q

BBV risk factors

A

o Sexual partner MSM
o Swingers
o Partners from high risk countries/with known infection o Blood products before 1985 or abroad
o Paid for sex/ been paid for sex
o Tattoos/piercings – reputable place/disposable needles/abroad

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7
Q

general principles for intimate examination

A
  • Explain the rationale/expectations for the examination
  • Consent with option to stop the examination at any point
  • Offer a chaperone and document(declined/accepted/chaperone name)
  • Privacy for dressing/undressing
  • Expose only the area needed for examination
  • Keep discussion relevant: no personal comments
  • Inspect and palpate in a systematic way
  • Good lighting and positioning will aid inspection
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8
Q

male genital examination

A
  • Inspect and palpate Inguinal Region
  • Inspect Pubic area and Scrotum
  • Inspect Penis (fully retract foreskin)
  • Palpate scrotal contents
  • MSM
    ~~~
  • Perianal
  • Anal/rectum examinations with proctoscope
  • if symptomatic
    ~~~
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9
Q

symptomatic male investigation

A

1) Urethral smear
- Gonorrhea (GC)
- Chlamydia (NGU)
2) First pass urine
- GC/ NGU dual Naats tes
3) Blood
- HIV/ symphitlis
- +- Hep B/C
4) Other swabs
- MC and S
- candida
- herpes

MSM- may need rectal and pharyngeal swabs and cultures

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10
Q

asymptomatic male investigations

A

1) First pass urine
- GC/ NGU dual Naats tes
2) Blood
- HIV/ symphitlis
- +- Hep B/C

MSM- may need rectal and pharyngeal swabs and cultures

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11
Q

female genital examination

A
  • Lithotomy Position (allows good visualisation)
  • Inspect and palpate inguinal region Inspect pubic area, labia majora, minora and perianal areas
  • Speculum Examination
  • Bimanual Examination (if indicated)
    ~~~
  • Abdominal pain
  • Deep dyspareunia
    ~~~
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12
Q

lithotomy position

A
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13
Q

bimanual examination

A

for abdominal pain or deep dyspareunia

  1. separate labia with gloved left hand
  2. slowly insert index finger and middle finger into the vagina and palpate cervix
  3. left hand then palpates uterus and adnexa abdominally
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14
Q

speculum examination

A
  • use lubricant and warm speculum if possible
  • hold speculum in dominant hand
  • part labia with non domnant hand
  • slow insert and open speculum blades to visualse the cervix
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15
Q

additional examination

A
  • anorectal examination (left lateral position)
  • examination of other sites: oral cavity
    skin
    eyes
    joints
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16
Q

investigations for a symptomatic female

A

1) High vaginal loop swab for microscopy and pH testing: TV, BV, candida
2) Vulvovaginal swab ‘daul NAAT’ (may need throat and rectal)
- chlamydia
- gonorrhoea
3) Bloods
- HIV
- syphillis
- Hep B/C
4) History/examination dependent
- high vaginal charcoal swab - TV (trichomoniasis) also for microscopy
- gonorrhoea cultures- endocervical
- herpes simples virus PCR
- urinalysis
- pregnancy test

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17
Q

investigations for asymptomatic females

A

1) Self-taken vulvo-vaginal swab “dual NAAT’- Chlamydia and gonorrhoea
2) serology
- STS
- HIV
3) Urinalysis/ pregnancy test

18
Q

trends of STIs

A

 Increase chlamydia/gonorrhoea
 Decrease genital warts

19
Q

STIs more common in

A
  • men than women maybe due to lack of symptoms
  • can co-exist with other STIs and common route of transmission
20
Q

RF for STI

A
  • Multiple sexual partners
  • No barrier contraception
  • Early age first intercourse
  • Certain sexual practices e.g. sexual acts that can tear or break the skin
21
Q

key STIs in the UK

A

o Chlamydia
o Syphilis
o Herpes
o Gonorrohea
o HIV
o HPV
o Hepatitis B/C
o Trichomoniasis

Non-sti’s
o Bacterial vaginosis
o Thrush

22
Q

key presentations of STI

A
  • altered discharge (urethral/ vaginal)
  • genital lesions
23
Q

history for altered discharge

A
24
Q

vaginal secretions can be

A

physiological and pathological

if pathological
- vaginal
- cervical

25
Q

Investigations for vaginal dicharge

A

1) Examination (including vaginal pH)
2) High vaginal swab
- cultire for Trich vaginalis, candida
- wet mount
- gram stain

3) Vulvovaginal swab
- NAAT for N.gonorrhoeae and C.trachomatis

4) Endocervical swah
- gonorrhoea culture

other tests
- pregnancy
- HSV PCR from cervix

26
Q

colour of discharge- candidiasis

A

white
cheesy/ curd like

27
Q

colour and consistency of discharge- bacterial vaginosis

A

off white
fishy
homogenous consistency

28
Q

colour and consistency of discharge- Trichomonas Vaginalis

A

-yellow
- putrid
- frothy
- blood staining

29
Q

male urethral discharge

A
  • gonococcal urethritis
  • chlamydia
  • non-specific urethritis
30
Q

differential diagnosis for sores/ lesions

A

◦ Syphilis
◦ Herpes simplex
◦ Lymphogranuloma
venereum
◦ Aphthous ulceration
◦ Trauma

31
Q

diagnose the sore

A

syphillus

32
Q

diagnose the sore

A

HSV
herpes simplex virus

33
Q

HSV on cervix

A
34
Q

anal herpes

A
35
Q

extragenital herpes

A
36
Q

types of herpes simpelx virus

A

HSV 1- orofacial
HSV 2- genital

37
Q

herpes zoster

A
38
Q

tropical ulcer disease

A
  • donovanosis
  • chancroid
  • lyphogranuloma venereum
39
Q

diagnose the sore

A

genital warts- HPV

40
Q

DD for genital warts

A
  • Fordyce spots
  • molluscum contagiosum
  • condylomata lata (secondary syphillus)
  • VIN/PIN
41
Q

causes of genital sore summary

A

Infective
◦ Candida
◦ Herpes simplex
◦ Herpes zoster
◦ Syphilis
◦ Tropical diseases.-
LGV, Granuloma inguinale, Chancroid

Non infective
Trauma
- Physical
- Chemical

Dermatological conditions
- Fixed drug reactions
- Beçhets
- Apthosis
- Lichen planus
- Pemphigus
- Malignancy

Reproductive Health (Y4) (34 decks)

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