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LOCO SEXUAL HEALTH > Overview of different conditions > Flashcards

Overview of different conditions Flashcards

1
Q

What is the most common STI in the UK?

A

Chlamydia trachomatis

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2
Q

What % of a) women and b) men are asymptomatic when they have chlamydia?

A

a) 80%

b) 50%

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3
Q

6 symptoms of chlamydia in women?

A

1) Post coital/ intermenstural bleeding
2) Abdominal pain
3) Dysuria
4) Dysparaunia
5) Purulent vaginal discharge
6) Proctitis

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4
Q

4 symptoms of chlamydia in men?

A

1) urethral discharge
2) dysuria
3) testicular/ epididymal pain
4) can cause proctitis

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5
Q

3 signs of chlamydia in women

A

1) Cervictitis with mucopurulent discharge
2) cervical contact bleeding
3) adenexal tenderness and cervical motion tenderness

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6
Q

2 signs of chlamydia in men

A

1) Urethral discharge

2) Local complications eg epididmytis

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7
Q

3 extra-gential complications of chlamydia

A

Proctitis
Pharyngitis
Conjunctivitis

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8
Q

5 complications of chlamydia that affect women

A

1) PID
2) ectopic pregnancy
3) tubal infertility
4) sexually acquired reactive arthritis
5) peri hepatitis (fitz hugh curtis syndrome)

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9
Q

2 complications of chlamydia that affect men

A

1) epididymitis

2) SARA

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10
Q

What is the gold standard test for chlamydia

A

Nucleic acid amplification testing (NAAT)

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11
Q

How long should a swab be rotated for in the urine/ vaginal/ cervical to test for chlamydia

A

10-15 secs

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12
Q

When would microscopy be indicated in diagnosing chlamydia?

A

Non-specific urethritis/ identification of polymorphic nucleocytes

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13
Q

When should patients be tested for chlamydia

A

Any time but if they have had UPSI in last 2 weeks should be advised to test after the 2 week window

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14
Q

Recommended tx for chlamydia?

A

Azizthromycin 1g stat

Doxycycline 100mg BD for 7 days

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15
Q

What pregnancy complications is chalmydial infection associated with?

A
  • Low birth weight
  • Post-partum endometritis
  • Neonatal conjuctivitis
  • Neonatal pneumonitis
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16
Q

Who is it essential to contact after diagnosis with chlamydia

A
  • All partners in last 3 months or previous partner is longer
  • Current partner
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17
Q

Is neisseria gonorrhoea gram positive or gram negative

A

Negative

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18
Q

Can gonnorrhoea be transmitted non-sexually in adults

A

No

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19
Q

How does peri-natal transmission present in the neonate

A

Eye infection, presenting in first week of life

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20
Q

In what % of women is gonnorhoea asymptomatic?

A

50%

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21
Q

What symptoms may women with gonnorhoea present with?

A
  • Increased or altered discharge
  • Lower abdominal pain
  • Dysuria
  • Inter-menstrual bleeding
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22
Q

What is the most common presentation of gonnorhoea in men and what % of men is it seen in?

A

Mucopurulent discharge

80%

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23
Q

4 symptoms of gonnorhoea in men

A

Mucopurulent discharge
Dysuria
Anal discharge
Perianal/ anal pain

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24
Q

Signs of gonnorhea in women

A

Mucopurulent discharge

Cervical contact bleeding

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25
Q

Signs of gonnorhoea in men

A

Urethral discharge

Epididymal pain/ swelling

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26
Q

What complications of gonnorhea can be seen in women and men?

A 
Dissemination infection by haematogenous spread
Septicaemia
Arthritis
Tenosynovitis
Skin lesions
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27
Q

What complications of gonnorhoea can be seen in men?

A

Epididymitis

Prostatitis

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28
Q

What do guidelines currently suggest for testing gonnorhoea

A

NAAT

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29
Q

When should microscopy be used to test for gonnorhoea

A

Symptomatic men

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30
Q

Is microscopy definitive in diagnosing gonnorhoea

A

No- must also do NAAT and cultures

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31
Q

What is the current UK guidelines for uncomplicated gonnorhoea infection

A

Ceftriaxone 500mg IM stat

Azizthromycin 1g PO stat

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32
Q

How long should a gonnorhoea patient be advised to abstain from sexual intercourse

A

1 week after treatment and until sexual partner has been treated

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33
Q

What type of organism is implicated in trichomonas vaginalis infection

A

Flagellated protozoan

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34
Q

Transmission of what virus is enhanced by trichomonas vaginalis infection

A

HIV

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35
Q

Clinical features of TV (5)

A
  • Vaginal/ urethral discharge
  • Vulva itching
  • Dysuria
  • Offensive odour
  • Strawberry cervix (2%)
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36
Q

What 2 testing methods are there for TV?? Which is gold standard

A

Microscopy

Culture–> gold standard

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37
Q

What is drug treatment of TV?

A

Metronidazole (tinidazole)

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38
Q

How long must you abstain from sex with TV?

A

7 days/ until partners are treated

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39
Q

What is candidiasis?

A

Acute inflammatory dermatitis of the vulva and vagina due to the mucosal invasion of commensal yeast species

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40
Q

Most common species implicated in candidiasis?

A

Candida albicans

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41
Q

What 4 things are associated with candidiasis?

A
  • Vaginal douching
  • Antibiotics
  • Tight fitting, synthetic clothing
  • Perfumed soaps
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42
Q

Signs and symptoms of candidiasis?

A
  • Vulval itch and soreness
  • Vaginal discharge- white and curd like
  • Erythema and oedema
  • Superficial dyspareunia
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43
Q

Where would you swab to investigate candidiasis

A

Anterior fornix

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44
Q

What investigations would you run in a symptomatic patient with suspected candidiasis

A

Vaginal swab for microscopy and culture

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45
Q

An example of a topic cream to treat candidiasis?

A

Clotrimazole

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46
Q

An example of a tablet to treat candidiasis?

A

Fluconazole

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47
Q

What is the most common cause of abnormal vaginal discharge?

A

Bacterial vaginosis

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48
Q

Is pH higher or lower in BV

A

Higher

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49
Q

Risk factors for bacterial vaginosis

A
  • Vaginal douching
  • Receptive oral sex
  • Recent change in sex partner
  • Smoking
  • STI
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50
Q

Signs and symptoms of BV (2)

A
  • Offensive thin white discharge

- Fishy odour typically after SI

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51
Q

What investigations would you do in suspected symptomatic BV

A

Vaginal swab for microscopy

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52
Q

What cells are you looking for in swab for BV

A

Clue cells

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53
Q

What criteria is used in the swab for BV

A

Hays/ Ison

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54
Q

What would you see on a normal vaginal microscopy

A

Lactobacillus morphotypes predominate

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55
Q

What would you see on a grade 2/ intermediate vaginal swab?

A

Mixed flora
Some lactobacilli
Gardnella or Moboluncus morphotypes also present

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56
Q

What would you see on a grade 3/ BV swab?

A

Gardnerella+/ Mobiluncus morphocytes

Few or absent lactobacilli

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57
Q

What antibiotics are used to treat BV

A
  • Metronidazole or

- Clindamycin

58
Q

What characterises non-specific urethritis (NSU)

A

Dysuria +/- discharge +/- urinary frequency

59
Q

What is the most common cause of NSU in younger men

A

Ascending infection

60
Q

Common causative organisms in NSU in younger men?

A

N. Gonorrhoeae
C. Trachomatis
Mycoplasmas/ Ureaplasmas
Trochomonas vaginalis

61
Q

Most common way that NSU is aquired

A

Sexually

62
Q

What would you suspect if you saw sterile pyruria in a man with urinary symptoms

A

NSU

63
Q

Should you test asymptomatic people for NSU

A

No

64
Q

What tests should be undertaken if you suspect NSU (4)

A
  • Urethral smear for gram stain
  • Urethral culture for N. Gonnorhoea
  • NAAT for GC and CT
  • Urinalysis
65
Q

Complications of NSU in men (4)

A
  • Epididymo-orchitis
  • Sub-fertility
  • Reiter’s syndrome
  • Prostatitis
66
Q

How would treat an uncomplicated first presentation of NSU

A
  • Doxycyline, 100mg BD for 7 days
  • Azithromyicine 1g STAT PO
  • Ofloxacin 200mg BD/ 400mg OD for 7 days
67
Q

How would you treat recurrent/ complicated NSU

A
  • Doxycycline 100mg BD for 7 days PLUS metronidazole 400mg BD for 5 days
  • Azithromycin 500mg STAT then 250mg OD for 4 days PLUS metronidazole 400mg BD for 5 days
68
Q

Which virus is the usual cause of oro-labial herpes

A

HSV-1

69
Q

What is now the most common cause of genital herpes in the UK

A

HSV-1

70
Q

Which virus type mainly causes recurrent anogenital symptoms

A

HSV-2

71
Q

How is HSV transmitted

A

Close physical contact: sexual or oro-genital

72
Q

When can HSV be transmitted

A

When an already infected individual is shedding

73
Q

When is an HSV virus shedding?

A
  • Sporadic

- Not necessary in association with symptoms flare

74
Q

What % of patients develop symptoms of HSV upon first transmission?

A

1/3

75
Q

How long does an untreated episode of genital last

A

3 weeks

76
Q

5 symptoms of herpes virus?

A
  • Febrile illness
  • Dysuria/ frequency
  • Painful inguinal lymphadenopathy
  • Tingling/ neuropathic pain in genital area/ buttocks/legs
  • Genital blisters, ulcers, fissures
77
Q

How long does a febrile illness associated with HSV last?

A

5-7 days

78
Q

3 complications of HSV?

A
  • Acute urinary retention
  • Constipation
  • Aseptic meningitis
79
Q

If complications of HSV occur when are they mos tlikely to

A

In first episode

80
Q

Are recurrent episodes of HSV usually mild or severe

A

Mild

81
Q

How long does it normally take for a recurrent episode of HSV to resolve

A

3-4 days

82
Q

Symptoms of a recurrent episode of HSV

A
  • Neuropathic prodome in genital area/ buttocks

- Erythema/ blisters

83
Q

What 5 things increase the risk of symptomatic recurrences of herpes

A
  • Young (<20)
  • Have a severe first episode
  • If recurrence is within 3 months of first episode
  • Who have a genital type 2 infection
  • HIV/ immunosuppresant
84
Q

Where do you take swabs in HSV

A

From the lesions if symptomatic

85
Q

What is the gold standard for identifying herpes

A

PCR culture

86
Q

Pros and cons of culture in HSV diagnosis

A

Slow but very specific

87
Q

What is the purpose of serology in herpes

A

Detects type specific antibodies

88
Q

When should you commence treatment for first episode of herpes?

A

Within 5 days of lesions develop// new lesions still forming// systemic symptoms still present

89
Q

What is the recommended 5 day regimens for herpes?

A

Aciclovir- 400mg TDS

Valaciclovir 500mg BD

90
Q

Do anti-virals alter the natural history of herpes

A

No

91
Q

True or false: recurrent episodes are usually self limiting

A

True

92
Q

When would you suggest suppresive therapy to prevent herpes recurrences

A
  • Patients with 6 or more episodes per year

- Patients with prolonged episodes (>4 days)

93
Q

What group of viruses calls genital warts

A

Human papillomavius (HPV)

94
Q

90% of genital warts are called by strains;

A

6 and 11

95
Q

Do women with genital warts need more frequent cervical smears

A

No

96
Q

How is HPV passed

A

Close physical contact, almost always genital- genital

97
Q

Can you transmit HPV when you don’t have warts

A

Yes

98
Q

5 symptoms of signs of genital warts?

A
  • Genital lumps
  • Irritation/ discomfort
  • Bleeding
  • Itching
  • Hyper-pigmentation
99
Q

What is the aim of treating HPV

A

Eradicate visible warts

100
Q

How would you treat simple external genital warts

A
  • Podophyllotoxin cream/ solution

- Weekly cryotherapy if available

101
Q

How would you treat cervical warts

A

Colposcopy

102
Q

How would you treat oral warts

A

Cryotherapy

103
Q

Is contact tracing necessary in genital warts

A

No

104
Q

What organism causes syphilis

A

Treponema Pallidum subspecies pallidum

105
Q

2 ways that syphilis can be transmitted

A
  • Direct contact with an infectious lesion (SI)

- Vertical transmission during pregnancy (via placenta)

106
Q

In which group is syphilis most common

A

White MSM aged 25-34

107
Q

What % of white MSM with syphilis also have HIV

A

40%

108
Q

Incubation period of primary syphilis

A

21 days

109
Q

What is the main thing you will see in primary syphilis

A

Chancre: a single ano-genital ulceration. Painless, indurated with clean base.

110
Q

How long does it take for a chancre to resolve

A

3-8 weeks

111
Q

What % of untreated syphilis will develop into secondary syphilis

A

25%

112
Q

How long after an intial chancre does seconary syphilis typically occur

A

4-10 weeks

113
Q

What rash may be seen in secondary syphilis

A

Widespread mucocutaneus, itchy, palms and soles, mucous patches

114
Q

How long does it take for secondary syphilis to resolve

A

3-12 weeks

115
Q

What % of patients will develop a recurrence of secondary syphilis in early latent stage

A

25%

116
Q

When does latent syphilis occur

A

20-40 years after intiial infection

117
Q

In what proportion of syphilis patients does latent/ teritiary disease occur

A

1/3

118
Q

Diagnosis of syphilis is based on which 2 investigations`

A

1) Dark-field microscopy of swab from lesion to identify T. Pallidum
2) Serology (anti-treponemal IgM and IgG)

119
Q

What is PID

A

Inflammation caused by an infection ascending from the endocervix

120
Q

5 organisms commonly causing PID

A
  • Chalmydia
  • Gonnorhoea
  • Anaerobes
  • Mycoplasma
  • Streptococci
121
Q

What is the difference between acute and chronic PID

A

Acute <1 month

Chronic >1 month

122
Q

Risk factors of PID

A 
<25
Recent partner change
Use of non-barrer contraception only
TOP
Recent IUD change
Recent miscarriage
123
Q

Symptoms of PID

A
  • Pelvic pain
  • Deep dyspareunia
  • Irregular periods
  • Intermensutral/ post-coital bleeding
  • Vaginal discharge
124
Q

Signs of PID

A
  • Cervical motion tenderness

- Adnexal discomfort

125
Q

Common long term consequences of PID

A

Chronic pelvic pain
Ectopic pregnancy
Infertility

126
Q

Investigations for PID (3)

A
  • Endocervical NAAT for GC and CT. Swab inserted inside cervical os and firmly rotated
  • Endocervical swab for microscopy
  • Urinalysis/ MSU/ pregnancy test
127
Q

When would you do a pelvic us/ laparoscopy

A

Reserved for patients failin to respond to therapy

128
Q

Outpatient tx for mild PID

A

Ceftriaxone 500mg IM STAT PLUS Doxycycline 100mg BD 14 days PLUS Metronidazole 400mg BD 14 days

Ofloxacin 400mg BD 14 days PLUS Metronidazole 400mg BD 14 days

129
Q

When would you admit someone with suspected PID

A
  • Diagnostic uncertainty
  • Severe symptoms
  • Presence of a tubo-ovarian abscess
  • Immunodeficiency
  • Inability to tolerate oral regimen
130
Q

Is contact tracing necessary with PID

A

Current male partners/ recent sexual partners within 6 months of symptom onset can be traced even if no organism identified

131
Q

What is epididymo-orchitis defined as

A

Pain, swelling and inflammation of epididymides +/- testicular inflammation triggered by an infectious agent

132
Q

4 infectious agents related to epididymo-orchitis

A
  • N.gonorrhoea
  • C.Trachomatis
  • E.coli
  • M.Tuberculosis
133
Q

When is chlaymidia most seen inrelation to epididymo-orchitis

A

<35

134
Q

When is e.coli most seen in relation to epididymo-orchitis

A

structural urinary tract abnormality

135
Q

Is epididymo-orchitis usually uni or bilateral?

A

Uni

136
Q

Clinical features of epididymo-orchitis

A
  • Scrotal pain
  • Testicular pain
  • Torsion
137
Q

Complications of epididymo-orchitis?

A

Reactive hydrocele
Abscess formation
Infertility

138
Q

Investigations for epididymo-orchitis

A
  • First pass urine – CT/GC
  • Midstream urinalysis – UTI, TB
  • Serology – HIV, syphilis, mumps
  • Doppler USS – Torsion
  • Refer to urology - structural abnormalities
139
Q

General advice for epididymo-orchitis

A
  • Rest/ analgesia
  • Abstain from SI
  • If severe treat as inpatient with fluid/ electrolyte management
140
Q

What is the recommended regimen for epididymo-orchitis if UTI likely cause

A

Ofloxacin 200mg PO BD 14 days

Ciprofloxacin 500mg PO BD 10 days

LOCO SEXUAL HEALTH (2 decks)

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