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GOSH > Complications in sexual health > Flashcards

Complications in sexual health Flashcards

1
Q

What investigations should you do if someone has pain passing faeces and a sexual history indicating risk of STI?

A

Proctoscope

Microscopy of any discharge/ulcerated/inflamed areas

Viral swabs for HSV and syphilis

Chlamydia and gonorrhoea NAATs testing - first pass urine, rectal, pharynx

Culture for gonorrhoea from sexually exposed sites

Bloods: HIC
Syphilis
Hep B and C

Stool samples (if diarrhoea - ?shigella)

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2
Q

What are some sexually–acquired causes of proctitis?

A

Lymphomagrnauloma venerum (LGV)

Gonorrhoea

Non-LGV chlamydia

Herpes

Shigella

Hepatitis

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3
Q

What are some NON sexually-acquired causes of proctitis?

A

inflammatory bowel disease

haemorrhoids/polyps

malignancy

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4
Q

What is lymphogranuloma venerum (LGV)?

A

Caused by 1 of 3 serovars of chalmydia

More common in dense sexual networks eg. sex parties, chem sex, Hep C outbreaks

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5
Q

How might LGV present: 1) in MSM

2) ‘classically’?

A

1) haemorrhage proctitis (direct mucosal spread)

2) less common. Ulceration, inguinal lymphadenopathy, buboes

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6
Q

How is LGV diagnosed?

A

If chlamydia NAAT comes back positive, send sample off to central lab for testing

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7
Q

How is LGV managed?

A

Abstain
Partner notification
Safer sex advice
WP blood testing

3 week course of doxycycline 100mg

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8
Q

What should you include in a follow up of LGV?

A

Ensure symptoms resolved

Assess whether there is any permanent damage (fibrosis, strictures, fistulae) - may require surgical involvement

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9
Q

What are some of the permanent damages that can be caused by LGV?

A

Fibrosis
Strictures
Fistulae

More common in those who haven’t been treated

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10
Q

What can cause testicular pain?

A

infections
trauma
torsion
tumours

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11
Q

What investigation should you do for someone presents with rectal symptoms and the main one of these is diarrhoea?

A

Stool samples - shigella

common in MSM

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12
Q

What is one of the most important questions to ask someone who presents with testicular pain?

A

Onset

If it was quick onset, think about torsion

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13
Q

How might acute epididymo-orchitis present?

A 
Pain
Sweeping
Inflammation
of epididymis +/- testes
(must exclude torsion)

O/E: tenderness on affected side (may billet)
Palpable swelling of epididymis
Urethral discharge
secondary hydrocele
erythema and/or oedema of affected scrotum
pyrexia

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14
Q

What investigations should you do for someone in whom you suspect acute epidymo-orchitis?

A

Microscopy/urethral or FPU (looking for urethritis)
Gonorrhoea and chlamydia

Urethral culture (gonorrhoea)

NAATs (FPU) (chlamydia and gonorrhoea)

Dipstick and MSU +/- culture (nitrites and leucocyte positive = UTI)

Doppler US (assess flow)
IgM/IgG serology (mumps)
AAFB: x3 early morning samples (TB)
Urinary pathogen (structural abnormalities)

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15
Q

How would you treat acute epididymo-orchitis?

A

Abstain from sexual intercourse until patient and partner fully treated

Ceftriaxone, prolonged course of doxycycline 10-14 days

STI unlikely: oxaflocin/ciprofloxacin

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16
Q

What are some complications associated with acute epididymo-orchitis?

A

Hydrocele

Abscess

17
Q

What are some local complications of STI?

A

PID
Endometriosis
Salpingitis

Tubal infertility
Ectopic pregnancy

Fitz-Hugh Curtis syndrome (peri hepatitis)

Bartholin’s abscess

Epididymo-orchitis
Prostatitis
Proctitis

18
Q

What are some skin and mucus manifestations of STIs?

A

Conjunctivitis - direct inoculation

  • chlamydia (unilateral, low grade irritation, normal chlamydia treatment)
  • Gonorrhoea (purulent discharge, 3 days treatment)

SARA: sexually acquired reactive arthritis

Disseminated gonococci infection

19
Q

What is SARA?

A

Sexually acquired reactive arthritis associated with HLA-B27

Sterile inflammation of synovial membranes, tendons, fascia

Triad: urethritis, arthritis, conjunctivitis +/- cutaneous signs eg. keratoderma blenorrhagica, circinate balanitis. Oral ulceration, uveitis, cardio/neuro involvement.

20
Q

How does disseminated gonococcal infection spread? What symptoms does this cause?

A

Haematogenous

Skin lesions
Artralgia
Arthritis
Tenosynovitis

21
Q

What are some complications of chlamydia in pregnancy?

A

IUGR
Premature rupture of membranes
Pre-term delivery
Low birth weight

22
Q

What are some complications of gonorrhoea in pregnancy?

A

Low birth weight

Preterm birth

23
Q

Which STIs can cause complications in pregnancy?

A

Chlamydia
Gonorrhoea
TV
BV

24
Q

How does ophatlmia neonatorum present?

A

Conjunctivitis
Chemises (oedema of conjunctiva)
Purulent exudate

25
Q

How soon does ophatlmia neonatorum present?

A

1-2 weeks of life (if caused by chlamydia)

Within 5 days (if, less commonly, due to gonorrhoea)

26
Q

How would you investigate/diagnose ophthalmia neonatorum?

A

NAATs: chlamydia and gonorrhoea from everted eyelid (NOT just discharge)

Gram stain and culture (gonorrhoea)

STI screen in parents

27
Q

How would you treat ophthalmia neonatorum?

A

systemic erythromycin

cephalosporin (eg. ceftriaxone) for gonorrhoea

28
Q

What are some complications of chlamydia in the neonatal period?

A

Ophthalmia neonatorum

Neonatal pneumonitis

29
Q

When, after birth, does neonatal pneumonitis develop?

A

1-3 months of age

30
Q

What are some features of neonatal pneumonitis?

A

Staccato cough (dry, high-pitched)

Tachypnoea

31
Q

How would you diagnose neonatal pneumonitis?

A

CXR: hyperinflation/ bilateral diffuse infiltrates

Nasopharyngeal swabs/tracheal aspirate - NAAT chlamydia testing

32
Q

How would you treat a baby with neonatal pneumonitis?

A

Systemic antibiotics: erythromycin

Screen and treat parents

GOSH (33 decks)

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