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CCFP 3 > Rape, Sex, STIs > Flashcards

Rape, Sex, STIs Flashcards

1
Q

What to include in hx of rape

A

medical history, identifying info about assailant, circumstances, details of sexual contact, physical restraints/weapons/drugs, activities of victim after assault, gynae hx (LMP, contraception, pregnancy hx, last voluntary sexual encounter, gynae sx)

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2
Q

What evidence to collect after rape

A

Pt’s clothing
Fingernail scrapings
Hair strands
Oropharyngeal swabs
Pubic hair
Vaginal swabs
Vaginal washing
Pap
Rectal swab
Blood samples

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3
Q

Ix after rape + when to perform

A

Pregnancy test
VDRL (syphilis): initial visit, repeat at 12 + 24 wks
Hepatitis (if not immune, repeat at 1 + 6mo
HIV: initial visit, 6, 12 + 24wks)

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4
Q

Pregnancy prophylaxis after rape

A

Ulipristal 30mg up to 5 days
Levonorgestrel 1.5mg up to 72hrs
Copper IUD up to 7 days

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5
Q

STI prevention after rape

A

If unsure of FU, assailant has known STI, pt has sx of STI, pt requests it
Cefixime 400mg x1, azithromycin 1g x1

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6
Q

Complications + management after rape

A

Depression
Sexual dysfunction
Offer counselling to victim, family, friends, partners

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7
Q

Posthitis

A

Inflammation of foreskin

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8
Q

Phimosis

A

Narrowing of foreskin preventing retraction over glans

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9
Q

Paraphimosis

A

Narrowing of foreskin below glans preventing return to normal

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10
Q

Management congenital phimosis

A

Reassurance (a good majority can resolve spontaneously with time)
Corticosteroids (betamethasone 0.05-0.1% applied bid x 6-8 weeks with gradual retractions)
Consider Circumcision (if failure of medical treatment or concerning physical exam findings)

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11
Q

When to consider surgery in phimosis

A

Recurrent Infections
Foreskin Scarring (fibrous ring formation)
Meatal Stenosis
Excessive Ballooning with Urination
Painful Erections

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12
Q

Sx of andropause

A

Low Libido
Erectile Dysfunction
Decreased Morning Erections
Increased Body Fat
Low Muscle Mass
Decreased Physical Strength
Hair Loss
Fatigue
Low Energy
Low/Depressed Mood
Irritability
Decreased Concentration
Insomnia
Low Bone Mass
Anemia
Flushing

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13
Q

Ix for andropause

A

2x morning total testosterone serum level
FSH
LH
PRL
TSH
sHBG (sex-hormone binding globulin)
Free Testosterone
Bioavailable Testosterone

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14
Q

Meds/ substances that lower testosterone

A

Opiods
Marijuana
Ethanol
Corticosteroids
Spironolactone
Ketoconazole
Cimetidine
Neuroleptics (increases PRL)
Metoclopramide (increases PRL)
Chemotherapy

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15
Q

When to ask about sexual health and function

A

In conditions that are high risk for sexual dysfunction (post MI, diabetes)
Through life cycle transitions (adolescent, pregnant, menopause)

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16
Q

RF for ED

A

CVD: obesity, DM, dyslipidemia, metabolic syndrome, smoking
Age
OSA
Liver dz
Vit D deficiency

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17
Q

Causes of ED

A

Psychogenic: sudden acute onset, normal nocturnal + AM erections, situational
Organic: gradual onset
Vascular:
5 yrs after stroke or MI
Atherosclerosis, PVD
Substances:
Antihypertensives (BB, CCB, spironolactone)
Opiates
Antidepressants
Ranitidine
Hormones (steroids, anti-androgens)
Methotrexate
Cannabis
Cocaine
Alcohol
Psychologic: MDD, GAD, stress
Neuro:
Spinal cord injury
Polyneuropathy (DM, alcohol)
MS
Parkinsons
Alzheimers
Hormonal
Hypogonadism
Hyperprolactinemia
Thyroid
Cushings
Addisons

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18
Q

What to do on physical exam for ED

A

Peripheral pulses, BP, HR, BMI
Thyroid exam
Penis: Peyronie’s, micropenis, plaques, phimosis, frenula tether, meatal stenosis, femoral pulses
Penis sensation

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19
Q

Ix for ED

A

Lipids, a1c, TSH, ECG

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20
Q

Rx for ED

A

Counsel r.e. risk marker for CVD
Weight loss
Diet + exercise
Reduce alcohol, smoking + drugs
Meds:
PDE5i (sildenafil, tadalafil)
CI: unstable angina, uncontrolled HTN, HF, recent MI, arrhythmias, HOCM, nitrate use
SE: sudden, severe vision loss. HA, flushing, dyspepsia, congestion, visual disturbance, hypotension
Vacuum constriction device
Intracavernosal injection (alprostadil)
Surgical prosthesis

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21
Q

CI to viagra

A

Recent Myocardial Infarction
Recent Stroke
Recent Arrhythmias
Uncontrolled Hypertension/Hypotension

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22
Q

SE of viagra

A

Headaches
Flushing/Rhinitis
Abnormal Vision (blue dots)
Dizziness
Myalgia
Nausea/Dyspepsia
Priapism

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23
Q

Sx of testicular torsion

A

sudden onset, severe, unrelenting unilateral scrotal pain, N/V

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24
Q

What score to assess testicular torsion, and what Ix?

A

TWIST score
Testicular swelling (2), hard testicle (2), high riding testes (1), absent cremasteric reflex (1), N/V (1)
5/7 = positive predictive value of 100%
Doppler US

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25
Management of testicular torsion
manual detorsion if surgery not available. Golden window is 4-8 hrs from sx onset
26
Sx fourniers gangrene
Groin pain Bilateral testicular pain Erythematous skin SC emphysema
27
Ix fourniers gangrene
CT abdo
28
General prevention of STIs
HPV Hep A + B Condom use Male circumcision PrEP Reduce partners
29
Screening for STIs
<30 + sexually active = screen annually
30
Sx acute HIV + Sx chronic HIV
Sx acute HIV: flu like illness, fever, fatigue, malaise, arthralgias, HA, anorexia, rash, nightsweats, oral ulcers, pharyngitis Sx chronic HIV: fever, fatigue, wt loss, anemia, candidiasis, SOB, cough, dysphagia, Kaposi sarcoma, HSV
31
AIDs-defining conditions
CMV, encephalopathy, dementia HSV Candidiasis, recurrent PNA, TB Cervical cancer Kaposi sarcoma Lymphoma PJP Salmonella sepsis (recurrent)
32
Screening for HIV
exposure, high risk, preg, once for all 15-65
33
Pre test counselling hiv
Consent Confidentiality Counselling Correct test results Connect to prevention/ care/ treatment
34
Post test counselling HIV
Supports HIV vs AIDs Education re transmission Partner notification + protection Treatment + goals
35
Ix for HIV testing
3w for ELISA test If positive: HIV resistance testing, viral load, CD4
36
Management of HIV: what imms to recommend, what ART regime 1st line, when to give prophylaxis against PJP + mycobacterium based on CD4 count
Immunisations: Hep A, B, Tdap, pneumococcal, HPV4, influenza, MMR + varicella ART: 2 NRTI (tenofovir, entracitabine (Truvada)) + integrase inhibitor (dolutegravir) Prophylaxis: CD4<0.2 = Septra DS d/t risk of PJP CD4 <0.05 = Azithromycin d/t risk of mycobacterium
37
Pre-exposure prophylaxis for HIV - who and what
Who: MSM + condomless sex + 1) syphilis or 2) HIV positive partner not on ART OR VL >200 or 3) HIV RF >10 Tenofovir + emtricitabine
38
Meds for post-exposure prophylaxis for HIV
Truvada + Dolutegravir x28d
39
Sx of GC + CT
Asymptomatic - could present after exposure or partner testing positive Sx - dysuria, urethral/ vaginal/ rectal discharge, itchy, lower abdo/ testest/ rectal pain, conjunctivitis
40
Ix for CT + GC
first catch urine or urethral/ cervical swab NAAT - nucleic acid amplification test. Urine microscopy good for post pubertal males. Must be at least 2 days post exposure. Send for gonoccal culture to help with tracking resistance patterns
41
Management of CT
Tx: if tests are positive or if sx are suggestive of STI or if partner was diagnosed Treatment also for pregnant women, victims of sexual assault and those with inadequate FU Chlamydia: doxycycline 100mg PO BID x 7 days or 1g azithromycin PO single dose if 7 day course is difficult Lab will notify public health if result is positive Wait 7 days after start of meds before having sex
42
Management of GC
Tx: if tests are positive or if sx are suggestive of STI or if partner was diagnosed Treatment also for pregnant women, victims of sexual assault and those with inadequate FU Gonorrhea: ceftriaxone 250mg IM single dose + 1g azithromycin PO single dose, or cefixime 800mg PO single dose + 1g azithromycin PO single dose Lab will notify public health if result is positive Notify public health if cefixime, ceftriaxone or azithromycin FAILURE for gonoccocal infection Wait 7 days after start of meds before having sex
43
Sx of urethritis
Sx: 2-6d after exposure, urethral d/c/itch, dysuria, urinary freq Abstain for 7d
44
Bacterial vaginosis sx + rx
Sx: fishy odor, white/ grey thin d/c Rx: metronidazole 500mg BID x 10/7
45
Candidiasis sx
Sx: itchy, dysuria, dyspareunia, white clumpy d/c
46
Trichomoniasis sx + rx
Sx: itchy, white/ yellow dc, strawberry cervix Rx: metronidazole 2g x 1 dose for men, 500mg BID x7/7 for women
47
Lymphogranuloma venereum sx + rx
Sx: painless papule, ulcers, tender inguinal nodes Rx: doxycycline 100mg BID x 3w Test of cure
48
HSV sx + rx
Painful vesiculoulcerative genital lesions, systemic sx of fever, myalgias, tender lymphadenopathy Confirm with lab testing Partner notification not required Rx: acyclovir 400mg TID x 10 days
49
HPV sx + rx
Sx: cauliflower like growth Rx: imiquimod 3.75% QHS up to 8w or cryotherapy q1-2 wks
50
Chancroid sx, ix + rx
Sx: papules -> pustules -> painful ulcers Ix: swab Rx: ciprofloxacin 500mg BID x3/7 Treat partners empirically
51
Pubic lice sx + rx
24hr life span off host Sx: itching, erythema, small blue spots Rx: permethrin 1% cream
52
Sx + rx of scabies
Sx: nocturnal itching, burrows/ tracking Rx: permethrin 5% cream + ivermectin 200ug/kg PO x1 dose Wash clothing + bedding in hot water, vacuum mattress
53
Sx of primary, secondary, latent + tertiary syphilis
Primary: chancre, painless ulcer with raised border, lymphadenopathy Secondary: fever, flu like illness, rash (pink macules on palms + soles), oral lesions, genito-inguinal rash, diffuse alopecia Latent: asymptomatic Tertiary: aortic aneurysm, AR, HA, vertigo, dementia, ataxia
54
Rx for syphilis
Penicillin G FU w/ serology at 6 + 12mo
55
Causes, RF + sx of epididymitis
Causes: CT, GC, E coli RF: UTI, unprotected sex, catheter, reflux Sx: testicular pain + swelling, urethritis, Phren’s sign (pain relief w/ elevation of testicle)
56
Complications, dx, rx and Phren sign in epididymitis
Complications: testicular atrophy + infertility Dx: STI testing, midstream urine culture Management: Suspected STI: doxy 100mg BID + ceftriaxone 250mg IM Suspected enteric organism (MSM): levofloxacin 500mg x 14d Phren sign: Scrotal elevation relieves pain in epididymitis but not in testicular torsion.
57
Most common bacteria causing epidydimitis
E.Coli Gram Negative Bacilli
58
Sx + rx for PID
Sx: bilateral lower abdo pain, cervical motion tenderness Dx: R/O ectopic Rx: cefixime 800mg x1 + doxycycline 100mg BID x14d Add metronidazole if adnexal mass, abscess, peritonitis or BV
59
Genetic causes of infertility in males
Klinefelter’s, Kallmann, CF, Kartageners
60
Causes of gynaecomastia
familial, obesity, hyperthyroidism, Klinefelter’s, Kallmann, secondary hypogonadism, hyperprolactinemia, testicular tumor, chronic renal dz
61
Genetic causes of infertility in males
Klinefelter’s, Kallmann, CF, Kartageners
62
When to urgently refer gynaecomastia
bloody nipple discharge, unilateral sub-areolar mass
63
Causes of genital itching
yeast, eczema, psoriasis, lichen sclerosis, vulvar cancer, herpes, BV
64
Complication of fertility treatment
ovarian hyperstimulation syndrome
65
Non pharmacological methods of treating ED
penile implants, sexual counselling, vacuum devices
66
Sudden penis pain after using viagra
priapism, penile fracture/ trauma
67
How and when to test for ovarian reserves
anti-mullerian hormone in women >35, or <35 w/ RF: single ovary, ovarian surgery, chemo or RT
68
PID rx, 1st line and if penicillin allergic
ceftriaxone + doxy OR clindamycin + gentamicin
69
Counselling for PID
partner treatment, contact tracing, abstinence x1 wk
70
What are the ABCs of sex?
Abuse, babies, cancer, STIs
71
Age of consent
18 if exploitative, 16 if non-exploitative, age 12-13 up to 2 yrs older, age 14-15 up to 5 years older
72
Priapism Ix
doppler US, cavernosal blood gas
73
Zika virus - transmission + sx
spread by mosquitos or sexual, fever, HA, arthralgia, myalgia
74
Types of priapism and management of each
non-ischemic: watch + wait, finasteride, lupron (GnRH agonist) Ischemic: needle drainage, intracavernosal phenylephrine, surgical shunt if >48hrs
75
undescended testes can increase risk of what?
torsion, trauma, tumors, inguinal hernias + infertility
76
TWIST >6 - what to do
call peds uro
77
Cisgender definition
gender identity congruent with sex assigned at birth
78
Trans definition
individual who does not identify as cisgender
79
Transgender definition
gender identity different to gender assigned at birth
80
HIV PrEP med name
Truvada
81
RF for ED
smoking, HTN, PVD, depression
82
Meds that cause ED
H2 blockers, diuretics, BB
83
Sexual minorities are at higher risk for….
obesity, smoking, SU, MH issues, intimate partner violence, STIs, cancer

CCFP 3 (67 decks)

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