Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 3a > GU + Sexual health > Flashcards

GU + Sexual health Flashcards

1
Q

Bacterial vaginosis

A

The overgrowth of ANAEROBIC bacteria in the vagina, caused by the LOSS of LACTOBACILLI.

NOT AN STI but is a RFx for STIs - can occur alongside other infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Role of lactobacilli in healthy vagina

A

Produce LACTIC ACID - keeps vagina ACIDIC (<4.5)

When reduced numbers of lactobacilli - becomes ALKALINE allowing ANAEROBIC bacteria to multiply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Examples of anaerobic bacteria associated with bacterial vaginosis

A
  • Gardnerella vaginalis (most common)
  • Mycoplasma hominis
  • Prevotella species
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

RFx for bacterial vaginosis

A
  • Multiple sexual partners
  • Excessive cleaning of vagina
  • Recent antibiotics
  • Copper coil
  • SMOKING

Less common if on combined pill/using condoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Sx of bacterial vaginosis

A

Strong fishy odour of watery grey/white discharge
- the discharge is homogenous + coating the walls of vagina + vestibule

(50% asymp; itching/irritatiion or pain = suggests other cause)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Bacterial vaginosis investigations

A
  • speculum examination to check discharge (not always required if v typical/low risk of STI)
  • VAGINAL SWAB:
    • pH paper shows >4.5
    • CHARCOAL SWAB for MICROSCOPY
      • CLUE CELLS on microscopy (epithelial cells so covered in bacteria their edges are grainy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bacterial vaginosis management

A

Asymp = none; generally can self resolve

  • METRONIDAZOLE (only works on ANAEROBIC) - ORAL or VAGINAL GEL
    • 2nd: Clindamyicin
  • Swab for STIs + assess risk of other pelvic infection
  • Give advice/info
      • Don’t drink while on metranidazole

Can prevent with ACIDIFIED VAGINAL GEL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Complications of Bacterial vaginosis

A
  • Risk of catching STIs
  • Miscarriage
  • Preterm delivery
  • Premature rupture of membranes
  • Chorioamnionitis
  • Low birth weight
  • Postpartum endometritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Balanitis

A

Inflammation of the glans penis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Balanitis Sx

A
  • Inflamed (red, swollen, itchy, sore)
  • Dysuria
  • Discharge from under foreskin/bleeding
  • Difficulty pulling back foreskin (may be normal in children)
  • Odour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Investigation of balanitis

A
  • Clinical presentation
  • charcoal swab for microscopy if infection suspected (or first catch urine)
  • biopsy if extensive skin change / scarring

May do blood tests if severe: Blood glucose??

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Balanitis Tx

A

Core treatment:

  • Saline washes
  • Ensuring to clean properly under foreskin
  • 1% hydrocortisone if more severe irritation - for a SHORT TIME

Depends on cause:

  • Steroid cream
    • Mild = dermatitis, circinate balanitis (reative arthritis)
    • High potency = lichen sclerosus
  • Antifungal cream
    • topical CLOTRIMAZOLE
  • Antibiotics
    • oft oral FLUCLOX / clarithro (as staph and strep B are most common bacterial causes)
    • Metronidazole if anaerobic bacteria

May remove foreskin if recurrent (or for lichen sclerosus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of balanitis

A
  • not washing
  • irritation from soaps/condoms
  • DIABETES -> THRUSH
  • STI including TRICHOMONAS VAGINALIS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Thrichomoniasis

A

STI caused by Trichomonas vaginalis (flagellate protozoa)
- in urethra (male/female) and vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Thrichomoniasis presentation

A

50% asymp

  • Vaginal discharge (typical = frothy yellow green but can vary; may smell fishy)
  • Itching
  • Dysuria
  • Dyspareunia (painful sex)
  • Balanitis

Strawberry cervix from inflam + multiple tiny haemorrhaeges (on examinarion) AND ACIDIC pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Trichomoniasis Dx

A
  • CHARCOAL SWAB + MICROSCOPY
    • ideally from POSTERIOR FORNIX (behind cervix) but self taken works too
  • urethral swab or first-catch urine in men
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Trichomoniasis Mx

A
  • Refer to GUM
  • CONTACT TRACING
  • METRONIDAZOLE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Trochomoniasis complication

A

Increases risk of:

  • Contracting HIV by damaging the vaginal mucosa
  • Bacterial vaginosis
  • Cervical cancer
  • Pelvic inflammatory disease
  • Pregnancy-related complications such as preterm delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Herpes simplex virus (HSV)

A
  • HSV-1 = typically cold sores
  • HSV-2 = typically genital herpes

Can also cause apthous ulcer, herpes keratitis (eye inflam), herpetic whitlow (painful lesion on fingers)

Both common in UK

Oft asymp - spread through mucous membranes/secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

HSV goes dormant in the associated sensory nerve gangioln. Which are these usually?

A
  • Trigeminal nerve ganglion - HSV1
  • Sacral nerve ganglion - HSV2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Genital herpes Sx

A

Typically ~2weeks after contracting + lasting 3 weeks (most intense) - any proceeding reactivation usually milder/shorter

  • Ulcers/blisters
  • Neuropathic pain
  • FLU-LIKE (fatigue, headache)
  • DYSURIA
  • INGUINAL LYMPHADENOPATHY
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Genital herpes Dx

A

Contact trace (including ask about cold sores)

Clinical diagnosis
- Confirm with VIRAL PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Genital herpes Tx

A
  • Refer to GUM

ACICLOVIR (regeime depends)

Additional measures, including to manage the symptoms include:

  • Paracetamol
  • Topical lidocaine 2% gel (e.g. Instillagel)
  • Cleaning with warm salt water
  • Topical vaseline
  • Additional oral fluids
  • Wear loose clothing
  • Avoid intercourse with symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Genital herpes complication

A

Vertical transmission via lesions during delivery of baby
- low risk if recurrent
- if primary give prophylactic ACICLOVIR even after initial course finished
- if contracted before 28 wks - might still consider vaginal delivery if asymp; after 28 wks do C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Chancroid

A

STI caused by FASTIDIOUS, GRAM -VE COCCOBACBILLI, Haemophilus ducreyi

Typically in resource-poor countries

OFT CO-FACTOR IN HIV transmission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Chancroid RFx

A
  • Multiple sexual partners/contacts with sex workers
  • Unprotected sex
  • SUBSTANCE ABUSE (HIGH RISK BEHAVIOUR esp for things like crack cocaine)
  • MALES
  • Lack of circumcision
  • Poor hygine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Chancroid Sx

A
  • GENITAL PAPULES ( Early stage)
  • GENITAL ULCERS (later)
    • sharply defined, undermined, irregular border
  • Lymphadenitis/buboes - usually UNILATERL (+ painful)

Typical STI Sx: discharge, pain

Sometimes rectal pain/bleeding +/- rectovaginal fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Chancroid Dx

A
  • Clinical + charcoal swab -> MS+C
  • Bloods - serology +/- antigen testing if available
  • Ulcer biopsy

Rule out other STIs + TEST FOR HIV (serum ELISA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Chancroid Tx

A

ANTIBIOTICS:
- Azithromycin or Ceftriaxone
- CIPROFLOXACIN or ERYTHROMYCIN if HIV +ve
- Don’t give Ciprofloxacin if PREG

Lymph node aspiration +/- incision + drainage (as needed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Genital warts

A

Common STI caused by HPV (usually 6 + 11)

  • Esp in 16 - 25 y/o
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Genital warts RFx

A
  • Intercourse from earlier age + more lifetime partner
  • Immunocompromise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Genital warts Sx

A

Oft asymp

Usual stuff: itching, pain, bleeding

Can get haematuria/abnormal stream if inside urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Genital warts Dx

A

Clinical

Can biopsy if severe/not responding to treatment - check for dysplasia

ano/urethroscopy as required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Genital warts Tx

A
  • Topical posophyllotoxin (SE: irritant) - not recommended if preg
  • Cryotherapy, surgical excision, Tricholoro/bichloroacetic acid (high recurrance)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

National Chlamydia Screening Programme

A

Tests every sexually active person under 25 y/o annually over with every new sexual partner

Re-test 3 months after treatment (if +ve) to ensure no re-infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is commonly tested at an STI screening

A
  • Chlamydia + Gonorrhoea (NAAT (swab, urine or urethral) + charcoal for both)
  • Syphilis (blood test)
  • HIV (blood test)
  • swabs from any ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What types of tests are used for STI testing

A
  • Charcoal swabs (in Amies transport medium) -> MS+C
  • Nucleic Acid Amplification Test (NAAT)
    • specifically for Chlamydia + Gonorrhoea (+ mycoplasma genitalium)
    • endocervical swab is gold but can self-swab/first catch urine

Can also be an pharyngeal or rectal swab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Chlamydia Sx

A

Oft Asymp

Consider if sexually active +:

Female:

  • Abnormal vaginal discharge
  • Pelvic pain
  • Abnormal vaginal bleeding (intermenstrual or postcoital)
  • Painful sex (dyspareunia)
  • Painful urination (dysuria)

Male:

  • Urethral discharge or discomfort
  • Painful urination (dysuria)
  • Epididymo-orchitis
  • Reactive arthritis
39
Q

Chlamydia potential examination findings

A
  • Pelvic or abdominal tenderness
  • Cervical motion tenderness (cervical excitation)
  • Inflamed cervix (cervicitis)
  • Purulent discharge
40
Q

Chlamydia Tx

A

Check local guidelines but:

doxycycline 100mg twice a day for 7 days - 1st
- DON’T USE IF PREG

Preg alts:
Azithromycin 1g stat then 500mg once a day for 2 days
Erythromycin 500mg four times daily for 7 days
Erythromycin 500mg twice daily for 14 days
Amoxicillin 500mg three times daily for 7 days

No sex; Contact tracing; STI screening; advice + safeguarding

41
Q

Chlamydia complications:

A

Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Lymphogranuloma venereum
Reactive arthritis

In preg:

Preterm delivery
Premature rupture of membranes
Low birth weight
Postpartum endometritis
Neonatal infection (conjunctivitis and pneumonia)

42
Q

Lymphogranuloma Venereum (LGV)

A

Affects lymphoid tissue around site of chlamydia infection - more common in MSM

43
Q

Stages of Lymphogranuloma venereum (LGV)

A
  • Primary: Painless ulcer (penis, vagina or rectum)
  • Secondary: Lymphadenitis
  • Tertiary: Proctitis. Proctocolitis -> Pain, chnage in bowel, tenesmus, discharge.
44
Q

LGV Tx

A

Doxycycline 100mg twice daily for 21 days (1st)

Erythromycin, azithromycin and ofloxacin are alternatives

45
Q

Order of swabbing for STIs

A
  • NAAT first
  • Charcoal swab
46
Q

Double vs triple swabs for STI screening

A
  • Double swabs: a NAAT swab (endocervical or vulvovaginal) and a high vaginal charcoal media swab.
  • Triple swabs: a NAAT swab (endocervical or vulvovaginal), a high-vaginal charcoal media swab and an endocervical charcoal media swab.
47
Q

Which group has highest incidence of STIs

A

MSM

48
Q

Gonorrhoea pathophys

A
  • Gram -VE Nisseria gonorrhoeae DIPLOCOCCI (2nd mc in UK)
  • Transmitted VIA MUCOUS SECRETIONS - oft through unprotected sex OR vertically during birth
    - Frequently found in throat
    - doesn’t necessarily have to be through direct innoculation
  • Strong affinity for mucous membranes
    - uterus, urethra, cervix, fallopian tubes, ovaries, testicles, rectum, throat, sometimes eyes
49
Q

STI RFx

A
  • Aged <25 YEARS
  • MSM
  • Living in high density urban areas
  • MULTIPLE SEXUAL PARTNERS
  • Previous/current STI
50
Q

Gonorrhoea Px

A

More likely to have Sx than chlamydia - more so in MEN:

  • Odourless, purulent discharge - possibly green or yellow, oft thin + watery
    - occasionally easily induced cervical bleeding e.g. post-coital
  • Dysuria; Dyspareunia
  • Pelvic pain (Female)
  • Testicular pain / swelling (epididymo-orchitis)

Congunctivitis -> ERYTHEMA + purulent discharge

REctal infection + Pharyneal infection oft asymp
- rectal discomfort + discharge
- sore throat
- Sometimes prostatitis

51
Q

Gonorrhoea Ix

A
  • Nucleic Acid Amplification Test (NAAT)
    - Endocervical/Vaginal
    - First pass urine
  • Charcoal bacterial swab -> MS+C
    - Endocervical / urethral
    - Urethral/meatal swab
52
Q

Gonorrhoea Mx

A
  • IM CEFTRIAXONE 1g - if sensitivites not known
    - 500mg ORAL CIPRO - if sensitivites known
  • Screening
  • CONTACT TRACING
  • Encourage safe sex + abstain from sex
    - Finish antibiotics
  • Advice
  • Safeguarding in young people
53
Q

Complications of gonorrhoea

A
  • PELVIC INFLAM DISEASE
    - chronic pain, INFERTILITY + ectopic preg
  • Epididymo-orchitis / Prostatitis (rarely causes infertility)
  • CONJUNCTIVITIS
    - esp in vertical transmission to baby -> Associated with SEPSIS
  • Urethral strictures
  • DISSEMINATED GONOCOCCAL INFECTION (septic)
  • Skin lesions
  • SEPTIC ARTHRITIS
  • Endocarditis
  • Fitz-Hugh-Curtis syndrome
54
Q

Disseminated Gonococcal Infection

A
  • Non-specific SKIN LESIONS
  • PolyARTHRALGIA / Migratory Polyarthritis
  • Tenosynovitis
  • SYSTEMIC - Fever, fatigue etc (septic)
55
Q

Fitz-Hugh-Curtis syndrome

A

Complication of PID

  • Inflam + infection of LIVER CAPSULE
    -> ADHESIONS between liver + peritoneum
    -> RUQ pain (referred to shoulder)
    -> Tx with laproscopy + adhesiolysis

Bacteria can spread from pelvis via peritoneal cavity, lymph or blood

56
Q

Syphilis pathophys

A

Transmitted by SPIROCHETE, Gram -VE Treponema pallidum subspecias pallidum
- it is MOTILE + can enter through broken skin / intact mucus membrane
- Bacteria divide + Chancre (hard ulcer) forms at site after 2-3 wks (incubation period)
- Primary syphilis
- Can progress into oblitering arteritis (endothelial proliferation -> lumen narrowing) -> multi-system ischaemia + Sx

Via blood, bodily fluids + vertically (through placenta)

57
Q

Syphilis RFx

A
  • Unprotected sex
  • Multiple sexual partners
  • MSM
  • HIV infection
58
Q

Stages of Syphilis

A
  • Primary (on average within 21 days of infection: 9-90 days)
    - CHANCRE
  • Secondary syphilis (Usually after 3 months /4-10 wks)
  • After 3-12 weeks of 2ndry -> LATENT SYPHILIS
  • After ~2 years = LATE LATENT
  • TERTIARY (no longer infectious - many years later)
    - Gummatous syphilis
    - Neurosyphilis
    - Cardiosyphilis
59
Q

Secondary Syphilis Px

A
  • Non-painful/-itchy SKIN RASH
    - Typically on hands + feet
    - FEVER, MALAISE, Arthralgia, HEadaches
    - Weight loss; Painless LYMPHADENOPATHY
    - CONDYLOMATA LATA (plaque-like warts in moist areas e.g. axilla, inner thighs, anogenital)
    - Silvery grey lesions on mucosa
    - Can start getting neuro, eye + liver Sx (or really any type infection)
    - Alopecia (moth eaten appearance)

Basically just systemic infection

60
Q

Gummatous syphilis

A

Granulomas in BONE, SKIN, MUCOSA of URT, mouth + viscera / connective tissue

61
Q

Neurosyphilis

A
  • Tabes dorsalis
    – ataxia, numb legs, absence of deep tendon reflexes, lightning pains, loss of pain and temperature sensation, skin and joint damage.
  • Dementia
    – PROGRESSIVE cognitive impairment, mood alterations, psychosis.
  • Meningovascular complications
    – cranial nerve palsies, stroke, cerebral gummas.
  • Argyll Robertson pupil
    – constricted and unreactive to light, but reacts to accommodation
62
Q

Syphilis Examination

A
  • Genitals
  • Skin + mucosa
  • Neuro
  • MSK (esp in congenital)
  • Cardio (for signs of AORTIC REGURG)
  • Neuro
63
Q

Syphilis Ix

A
  • Treponema pallidum PCR
  • Syphilis point of care test
  • DARK FILED/GROUND MICROSCOPY of chancre fluid (move v quick)
  • Serology:
    - Treponemal tests (tho might not be indicative of syphilis)
    - Treponemal ELISA (IgG/IgM - always +ve after infection)
    - TPPA (+ve for life)
    - Non-treponemal (non-specific; in titres)
    - detect autoantibodies -> RPR / VDRL
    - high in early disease, falls = Tx success OR progression to LATE
    - False +ve in inflam / preg
  • Lumbar puncture in neurosyphilis
64
Q

Syphilis Mx

A

BENZATHINE PENICILLIN 2.4 MU IM - in buttocks

  • Early = 1 INJECTION
  • Late infection = 3 INJECTIONS (once weekly)

Alt = DOXYCYCLINE 100mg Bidaily (can’t use in preg)

  • Early = 14 days
  • Late = 28 DAYS

Ceftriaxone can also work

Need more later on to cover slow growing, late latent treponema

+ just general STI stuff e.g. contact tracing, screening, follow-up, education

65
Q

Jarisch Herxheimer reaction

A

Inflam response 2ndry to DEATH OF TREPONEMES

  • Flu like illness WITHIN 24hrs of Tx
  • Only supportive UNLESS cardio / neurosyphilis -> give ORAL STEROIDS before Abx
66
Q

When is syphilis followed up

A

RPR/VDRL bloods at 3, 6 + 12 months

67
Q

Signs of congenital syphilis

A

Early:

  • ## haemorrhagic rhinitis

Late (at least 2 yrs after birth):

  • Interstitial keratitis
  • Cluttons joint
  • Hutchinson’s incisors
  • Mulberry molars
  • High arched palat
  • Rhagades (peri-oral fissures)
  • Sensorineural deafness
  • Saddle nose
  • Cranial frontal bossing
68
Q

Other forms of Treponemal infections

A
  • Yaws (bones + joint)
  • PInata (skin)
  • Bejel (chronic skin + tissue)

Commonly seen in older people with dementia: Trep Ab +ve, RPR negative
- (symptomatic tertiary syphilis usually RPR +ve)

Tx to cover late latent syphilis just incase

69
Q

HSV transmission

A
  • Direct via mucosa / skin breaks
  • Higher risk of transmission if visible lesions
  • 80% UNAWARE
  • Asymp viral shedding MORE FREQUENT (more common in genital HSV-2 + esp in first 12 months + in peri-flare periods)

More common in younger people due to not having had previous exposure

Sx can RECCUR

70
Q

HSV stages / natural progression

A
  • 1st infection then LETENT in ANTERIOR HORN CELL in local sensory ganglion
  • REactivation: can be symp lesions or asymp but INFECTIOUS + shedding
  • After 1st Sx episode usually get it ~4 times in a year but the longer you have -> fewer recurrences
71
Q

HSV Px

A
  • Painful ulcer
  • Dysuria
  • Vaginal/urethral discharge
  • Systemic Sx (fever, myalgia)
  • Blistering
  • Tender lymphadenopathy
72
Q

HSV Dx

A
  • NAAT HSV DNA (high specific + sensitive)
    - can differentiate HSV-1 and HSV-2
  • Viral culture (specific but sensitivity declines as lesions heal)
  • Type-specific SEROLOGY
    - useful in preg: can check if they have Ab in blood = she was already infected so she will pass immunity to child so don’t have to do c-section
  • Antigen detection (to check response to antiviral)
  • Cytological examination
73
Q

HSV Tx

A

General:

  • Saline bathing
  • Analgesia
  • Topical anaesthetic

Antiviral:

  • Aciclovir (44mg TDS or 200mg 5 daily)
  • Valaciclovie
74
Q

Genital HSV complications

A
  • Hospitalisation for URINARY RETENTION
    - Consider SUPRAPUBIC if catheterisation but avoid altogether if possible
  • ASEPTIC MENINGISM
  • Severe constitutional Sx
  • Super-infection
  • Autoinoculation
  • Neonatal HSV if during 3rd trimester
75
Q

HSV prevention

A
  • Safe sex
  • Anti-viral prophylaxis SOMETIMES (can still pass on to other even with this)
    - given for preg, frequent shedders etc
  • SCREEN for STIs
76
Q

RFx for developing thrush/candidiasis

A
  • Increased oestrogen (e.g. in preg)
  • Poorly controlled diabetes
  • Immunosuppression
  • Broad-spec Abx

The candida (usually albiacans) can already be colonising vagina and just not presenting

77
Q

Candidiasis Px

A
  • Thick, white discharge that does not typically smell
  • Vulval and vaginal ITCHING, Irritation or discomfort

More severe:

  • Erythema
  • Fissures
  • Oedema
  • Dyspareunia
  • Dysuria
  • Excoriation (skin wears off)
78
Q

Candidiasis Ix

A
  • Vaginal pH (swab + pH paper) to differentiate
    - bacterial vaginosis + trichomoniasis = pH >4.5
    - Candidiasis = pH <4.5
  • CHARCOAL swab + Microscopy (confirms)

Start giving Tx based on clinical Px tho

79
Q

Candidiasis Tx

A
  • Intravaginal antifungal cream - CLOTRIMAZOLE
    - Single dose of 5g of 10% cream at night
  • Antifungal pessary - CLOTRIMAZOLE
    - can do 500mg for 1 night OR 200mg each for 3 nights
  • Oral antifungal - FLUCONAZOLE
    - typically only need 1 dose of 150mg

Options include Canesten Duo - OVER-THE-COUNTER
- includes 1 fluconazole tablet + clotrimazole cream for external vulva Sx

If recurrent (>4 / year) -> treat with induction + mainteneance over 6 months (oral or vaginal)

80
Q

What is one side effect of antifungal creams/pessaries

A

Can damage latex + prevent spermicides from working so need alt contreception

81
Q

HIV epid

A
  • HIV-1 most common
  • HIV-2 more common in WEST AFRICA
82
Q

Seroconversion meaning

A

The transition from the point of viral infection to when the antibodies are made

  • e.g. this the time period when the initial HIV infection presents with flu-like Sx
83
Q

Transmission of HIV

A
  • Unprotected sex (more likely to infect in MSM?)
  • Vertical transmission (pregnancy, birth, breastfeeding)
  • Mucous membrane, blood / open wound exposure to infected BLOOD / Bodily fluids
84
Q

HIV screening

A

Routinely offered at sexual health, antenal and substance misuse services

  • Need to get verbal consent to test tho

The lab test checks for HIV antibodies AND the p24 antigen

  • window period of 45 days = can take up to 45 days for test to turn positive

POC test - only checks Ab
- 90 day window period

Can get home kits if think at risk
- Self-sample (lab)
- PoC test

84
Q

AIDS-defining illnesses

A

Only occur in end-stage HIV infection when CD4 count has dropped (usually < 200)

  • Kaposi’s sarcoma
  • PNEUMOCYSTIS JIROVECII PENUMONIA (PCP)
  • CYTOMEGALOVIRUS
  • OESOPHAGEAL / BRONCHIAL Candidiasis
  • Lymphomas
  • TUBERCULOSIS
85
Q

How is HIV monitored

A
  • CD4 count
    - norm = 500 - 1200 cells/mm3
    - < 200 cells/mm3 = high risk of opportunistic infection
  • HIV RNA -> VIRAL LOAD
    - undetectable if well treated
86
Q

HIV Mx

A

Managed at specialist centres

Antiretroviral therapy (ART)

  • can do Genotypical resistance testing to establish how resistant the HIV strain is to the diff antiretrovirals to guide Tx

Diff classes:

  • Protease Inhib
  • Integrase Inhib
  • Nucleoside reverse transcriptase Inhib
  • Non-nucleoside reverse transcriptase inhib
  • Entry inhib

Usually starting regime = 2 NRTIs (e.g. Tenofovir + Emtricitabine) + a 3rd agent (e.g. Bictegravir)

  • Prophylactic Co-trimoxazole if CD4 count < 200
  • close CVD risk monitoring (as higher risk because of the HIV)
  • YEARLY PAP smear
  • Vaccinate (including PCP) but avoide live vaccines
87
Q

How to prevent HIV transmission during birth

A
  • Viral load < 50 copies/ml = normal delivery is fine
  • > 50 = CONSIDER Pre-labour C-section
  • > 400 = PRE- LABOUR C-SECTION
  • If unknown OR >1000 = IV ZIDOVUDINE during labour

Consider prophyl for babies:

  • Low risk (mum’s viral load <50) = ZIDOVUDINE for 2-4 wks
  • High risk = ZIDOVUDINE, LAMIVUDINE and NEVIRAPINE for 4 WEEKS

Avoid breastfeeding afterwards!

88
Q

Post-exposure prophylaxis (PEP) for HIV

A
  • must be started within LESS thhan 72 HOURS after exposure (sooner the better)
    - not 100% effective
  • ART combination = Emticitabine/tenofovir (Truvada) + raltegravir (for 28 DAYS)

NB can also take Emitricitabine/tenofovir before potential exposure

89
Q

Risk factors for urinary incontinence

A
  • Increasing age
  • Previous preg / child birth
  • High BMI
  • Hysterectomy
  • FHx
90
Q

Classification of urinary incontinence

A
  • Urge incontinence / overactive bladder
    • caused by detrusor overactivity
    • urge is quickly followed by uncontrollabe leakage
  • stress incontinence
    • leaking small amounts when coughing / laughing
  • mixed incontinence
  • overflow incontinence
    • due to bledder outlet obstruction (e.g. enlarged prostate)
  • Functional incontinence
    • Patient can’t get to bathroom in time due to co-morbs
      • e.g. dementia, sedation, injury/illness -> decreased ambulation
91
Q

Initial Ix for urinary incontinence

A
  • MINIMUM 3 DAYS of bladder diary
  • Vaginal exam to exclude pelvic organ prolapse + check ability to initiate colutary contraction of pelvic floor muscles
  • Urine dipstick + cultures (to exclude infection)
  • Urodynamic studies
92
Q

Urge incontinence Mx

A
  1. Bladder retraining (for at least 6 weeks)
  2. Bladder stabilising drugs
    • 1st line = antimuscarinics
      • Oxybutynin (immediate release) (avoid immediate release in frail older women)
      • Tolterodine (immediate release)
      • Darifenacin (OD)
    • Mirabegron (beta-3 agonist) - if worried about anti-muscarinic SE esp in frail older patients
  3. Surgical/invasive
    • botulinum toxin (risk of subsequent overflow incontinence)
    • Sacral nerve stimulation
93
Q

Stress incontinence Mx

A
  1. PELVIC FLOOR MUSCLE TRAINING
    • 8 contractions TDS, for minimum 3 months
    • consider electrical stimulation
    • Vaginal cones
  2. Duloxetine - the SNRI (can increase muscle tone of striated muscle in external urethral sphincter by increasing the synaptic concentration of noradrenaline and serotonin in the PUDENDAL NERVE)
  3. Surgical
    • Colposuspension (lifting and fixing neck of bladder)
    • Sling surgery (placed around neck of bladder) - usually autologous tissue
    • Urethral bulking agenst
    • Artificial urinary sphincter

Phase 3a (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions