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Phase 3A > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

What are the components of a sexual health history

A
  • HPC
  • Past GU history
  • Past general medical/surgical history
  • Drugs (any antibiotics in the last month)

Sexual History from the last 3-12 months

  • When was last sexual intercourse
  • Are they a regular/casual partner
  • Who having sex with - type of parter (male/female)
  • What type of sexual intercourse - oral, vaginal, anal
  • Condom use

Females

  • Menstrual history - when last had period etc
  • Pregnancy history - outcomes, terminations, deliveries etc.
  • Contraception
  • Cervical cytology history - are they up to date with smears, any abnormal results, any outcomes

Males
Last time they voided urine

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2
Q

Why is it important to ask patients if they have been on any antibiotics in the past 2 weeks?

A

If patients have been on similar antibiotics that are used to treat STIs, it may mask the results the clinic gets when they test the patient for the STI. Would ask them to come back again after two weeks to ensure a proper sample.

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3
Q

Why do you ask men when the last time they voided urine was?

A

If they have passed urine in the last hour, the urine will have got rid of the abnormal cells on the tip of the penis so will interfere with swab results

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4
Q

What tests would you do if an asymptomatic female presented to the GUM clinic?

A

Self-taken vulvo-vaginal swab for gonorrhoea + chlamydia (NAAT)
Bloods for STS + HIV

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5
Q

What screening tests would you do if an asymptomatic heterosexual man presented to the GUM clinic?

A

First void urine for chlamydia and gonorrhoea NAAT

Bloods for STS + HIV

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6
Q

What screening tests would you do if an asymptomatic homosexual man presented to the GUM clinic?

A

First void urine for chlamydia/gonorrhoea NAAT
Pharyngeal swab for chlamydia/gonorrhoea NAAT
Rectal swab for chlamydia/gonorrhoea NAAT
Bloods for STS, HIV, Hep B (potentially Hep C if indicated)

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7
Q

What tests would you do if a symptomatic female presented to the GUM clinic?

A

Vulvo-vaginal swab for gonorrhoea + chlamydia NAAT

High vaginal swab (wet and dry slides) for:
Bacterial vaginosis
Trichomonas vaginalis
Candida

Cervical swab for slide + gonorrhoea culture
Dipstick urinalysis (if dysuria)
Bloods for STS and HIV

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8
Q

What screening tests would you go if a symptomatic heterosexual male presented to the GUM clinic

A

Urethral swab for slide + gonorrhoea culture
First void urine for gonorrhoea + chlamydia NAAT
Dipstick urinalysis (if dysuria)
Bloods for STS + HIV

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9
Q

What screening tests would you do if a symptomatic homosexual man presented to the GUM clinic?

A

Urethral swab for slide + gonorrhoea culture
First void urine for gonorrhoea + chlamydia NAAT
Dipstick urinalysis (if dysuria)
Bloods for STS + HIV
Urethral + rectal slides
Urethral, rectal, pharyngeal culture plates
Bloods for HIV, Hep B and Hep C

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10
Q

What patients would you screen for hepatitis B?

A

MSM
Commercial Sex Workers and their sexual partners
IVDUs (current/past) and their sexual partners
People from high risk areas and their sexual partners (Africa, Asia, Eastern Europe)

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11
Q

Why is partner notification/contact tracing necessary?

A

Necessary to prevent re-infection of the index patient
To identify and treat asymptomatic infected individuals as a public health measure
Invite partners for screening and offer them for treatment

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12
Q

You can diagnose urethritis in men if any of the following are present:

A

Mucopurulent or purulent discharge from urethral meatus

Gram stain of urethral smear showing > 5 polymorphonuclear cells per high power field

First pass urine positive for > 10 PMN per high power field

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13
Q

How do you classify urethritis in men?

A

Gonococcal urethritis Non-gonococcal urethritis (or non-specific urethritis)

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14
Q

What is the most common STI in the UK

A

Chlamydia

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15
Q

What pathogen causes chlamydia

A

Chlamydia trachomatis (types D-K are most responsible for GU infection)

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16
Q

Name 3 risk factors that increase your chances of developing a STI

A
  • Young age (under 20 years)
  • Number of partners (2+ partners in the last 6 months, new partner in the last 3 months or concurrent partners)
  • Non-use of condoms
  • Other STIs
  • Sexual preference (MSM)
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17
Q

What are the potential symptoms of a chlamydia infection (female)

A 
Majority are asymptomatic 
Altered vaginal discharge
IMB, PCB 
Dysuria without frequency 
Vague lower abdominal pain
Fever
Deep dyspareunia
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18
Q

What are the potential signs of a chlamydia infection (female)

A

Friable, inflamed cervix sometimes with a cobblestone appearance with contact bleeding
Mucopurulent endocervical discharge
Abdominal tenderness
Pelvic adnexal tenderness of bimanual palpation
Cervical excitation

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19
Q

What are the potential symptoms of a chlamydia infection (male)

A

Urethral discharge and/or dysuria in ~50%
May have epididymo-orchitis presenting as unilateral testicular pain and swelling
Remainder are asymptomatic

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20
Q

What are the potential signs of a chlamydia infection (male)

A

Epididymal tenderness
Mucoid or mucopurulent discharge
Perineal fullness due to prostatitis

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21
Q

What investigations would you do in a person with a suspected chlamydia infection

A 
NAAT samples (vulvo-vaginal swab/first catch urine) 
Urethral swabs may be needed
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22
Q

What is the management of a person with a chlamydia infection?

A

Antibiotics
- Doxycycline 100mg twice daily for 7 days OR 1g single dose of azithromycin

Screening of other STIs
Partner notification
Advise against sex including with condoms until the patient and partner(s) have completed treatment
Repeat test 3 months later for those under the age of 25

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23
Q

In a symptomatic male with a chlamydia infection, as part of contact tracing what partners would you need to notify?

A

4 weeks prior to developing symptoms for symptomatic males and all contacts since

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24
Q

In a female/asymptomatic male with a chlamydia infection, as part of contact tracing what partners would you need to notify?

A

4 weeks prior to developing symptoms for symptomatic males and all contacts since

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25
Q

What are some of the complications of an untreated chlamydia infection?

A 
PID if untreated 
Infertility 
Ectopic pregnancy
Epididymo-orchitis 
Perihepatitis 
Reactive arthritis 
In pregnancy 
- Increased risk of preterm delivery and low birth weight 
- Postpartum endometritis 
- Neonatal ophthalmic infection
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26
Q

Name two ways to help prevent the spread of chlamydia?

A

Promotion of safe sexual behaviour
Encouragement of early healthcare-seeking behaviour
Primary care involvement in prevention and sexual healthcare

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27
Q

Aetiology of gonorrhoea?

A

Neisseria gonorrhoeae

Gram negative diplococcus

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28
Q

What are the symptoms of a symptomatic man with a gonorrhoea infection

A

Urethral infection - discharge and/or dysuria
Rectal - usually asymptomatic, may cause anal discharge or perianal/anal pain, pruritis or bleeding

Symptomatic in the majority (90-95%)

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29
Q

What are the potential signs of a symptomatic man with a gonorrhoea infection?

A

Mucopurulent or purulent urethral discharge

Epididymal tenderness/swelling

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30
Q

What are the symptoms of a women with a gonorrhoea infection?

A

Increased or altered vaginal discharge
Lower abdominal pain
May have IMB or menorrhagia
Dysuria

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31
Q

What are the potential signs in a woman with a gonorrhoea infection?

A

Mucopurulent endocervical discharge
Easily induced contact bleeding of the cervix
Pelvic/lower abdominal tenderness
Normal examination is very common

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32
Q

What investigations would you do if you suspected that your patient had gonorrhoea?

A

Women - vulvo-vaginal swab for NAAT
Men - first pass urine specimen for NAAT

A culture should be taken in all people who are NAAT positive for gonorrhea before prescribing antibiotics to test for susceptibility and identify resistant strains

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33
Q

What is the management for gonorrhoea?

A

Antibiotics based on sensitivities from culture
- Recommended treatment for uncomplicated gonococcal anogenital infection : 500mg IM ceftriaxone stat + 1g orally azithromycin stat

Avoid sexual intercourse

Partner notification

Follow up 1 week after treatment

Test of cure
NAAT at two weeks post completion of treatment

34
Q

What antibiotic regime would you suggest for an uncomplicated gonococcal anogenital infection?

A

500mg IM ceftriaxone stat + 1g orally azithromycin stat

35
Q

What complications can arise in males only from an untreated gonococcal infection?

A

Gonococcal urethritis may cause urethral scarring and stricture, resulting in bladder-outflow obstruction

Local spread causing acute epididymitis, prostatitis, seminal vesiculitis, penile lymphangitis

36
Q

What complications can arise in women only from an untreated gonococcal infection?

A

PID - infertility, chronic pelvic pain and ectopic pregnancy
Peri-hepatitis

37
Q

What complications can occur in both men and women from an untreated gonococcal infection?

A

Haematogenous dissemination (less than 1%)

Increased risk of acquiring and transmitting HIV infection.

38
Q

When is haematogenous dissemination of gonorrhoea more likely to occur?

A

This is more likely to occur when the infection is asymptomatic, as it is left undiagnosed and untreated.

39
Q

What are the features of haematogenous dissemination of gonococcal infection?

A

Skin lesions (papules, bullae, petechiae and necrotic skin lesions)

Arthralgia, arthritis and tenosynovitis of the ankles, wrists, hands and feet (reactive arthritis)

Fever, chills and malaise

Meningitis, endocarditis or myocarditis (extremely rare)

40
Q

Where does gonococcal infection tend to spread to in disseminated disease

A

Joints and skin

41
Q

Name three causes for Non-Gonococcal Urethritis

A

Most common organisms : Chlamydia trachomatis and Mycoplasma genitalium
UTI may account for a few cases but not solidly confirmed
Idiopathic

42
Q

What is the presentation of non-gonococcal urethritis

A

May be asymptomatic
Urethral discharge (with or without blood)
Urethral pruritus, dysuria or penile discomfort
Systemic symptoms if there is involvement of other organs

43
Q

What investigations would you do in a man with urethritis to determine if it was caused by gonorrhoea or another cause (non-gonococcal urethritis)

A

Chlamydia tests and gonorrhoea tests NAAT (asymptomatic)
May need a urethral smear if necessary
Urine dipstick to exclude a UTI
Screen for other STIs

44
Q

What is the management for NGU

A

Doxycycline 100mg twice daily for 7 days OR azithromycin 1g stat

Avoid sexual intercourse until the infection has cleared up

Follow up for review in 2 weeks

45
Q

What are 2 complications of untreated NGU?

A 
Epididymitis and/or orchitis 
Prostatitis 
Systemic dissemination of gonorrhoea 
Reactive arthritis 
PID 
HIV transmission is increased
46
Q

What is another name for genital warts?

A

condylomata acuminata

47
Q

What is the aetiology of genital warts?

A

Caused by infection with HPV (types 6 and 11)
Sexually transmitted
60% transmission rate between partners

48
Q

Name 5 risk factors that increase your chance of developing genital warts?

A

Smoking
Multiple sexual partners
Early age of onset of sexual intercourse
History of other STIs
Anoreceptive intercourse
Manual sexual practices (fisting and fingering) can increase the risk of anal warts
Immunosuppression

49
Q

What are the symptoms of genital warts?

A

Painless lesion(s)
May cause itching, bleeding or dyspareunia
Urethral lesions may cause distortion of the urinary stream

50
Q

what are the potential signs of genital warts

A

Warts on moist, non-hairy skin are soft and non-keratinised, whereas those on dry hairy skin are more likely to be firm and keratinised
May be pigmented
Found usually on areas subject to trauma during sexual intercourse

51
Q

What investigations would you do in someone who presented with suspected genital warts?

A

Screen for co-existing STIs
Vaginal speculum examination in women
Proctoscopy if there is a history of anal receptive sex

52
Q

What are the treatment options for gential warts

A

No treatment - 30% disappear spontaneously in 6 months
Self applied
Specialist application - trichloroacetic acid
Ablative methods

53
Q

What are the options for self applied treatments?

A

Podophyllotoxin solution/cream - soft, non-keratinized external lesions

Imiquimod - not internal use

Sinecatechins - external warts for people who are immunocompromised

54
Q

When would you consider ablative methods to treat genital warts?

A

If there is a small number of low volume warts

55
Q

Alongside treatment, what other advice would you offer patients?

A

Give patients a detailed explanation of the condition with emphasis on long-term health implications for themselves and their partners. Explain the long latent period with HPV
Use condoms until resolution of lesions
Screen for other STIs
Smoking cessation

56
Q

What are two preventative measures used to reduce the incidence of genital warts?

A

Condoms

Vaccination - Gardasil protects against four strains of HPV (6, 11, 16 and 18)

57
Q

What strains of HPV virus cause the majority of genital warts?

A

6 and 11

58
Q

What is the aetiology of genital herpes simplex?

A

Infection with HSV
Type 1 : oral region and causes cold sores. Most common cause of genital herpes.
Type 2: anogenital infection (penis, anus, vagina).

59
Q

How is HSV transmitted

A

Infectious secretions on oral, genital or anal mucosal surfaces
Contact with lesions from other anatomical sites e.g eyes, skin or herpetic whitlow (infection of the finger with HSV)
Transmitted through vaginal, anal and oral sex, close genital contact and contact with other sites such as the eye and finger.

60
Q

What are the symptoms of a primary infection of HSV?

A

Febrile flu-like prodrome. Myalgia and fever
Tingling neuropathic pain in the genital area/buttocks/legs
Extensive painful crops of blisters/ulcers in the genital area
Bilateral lesions
Tender lymph nodes (usually bilateral)
Local oedema
Dysuria
Vaginal or urethral discharge

61
Q

What are the symptoms of a recurrent infection of HSV

A

Following primary infection, the virus becomes latent in local sensory ganglia near to the skin
Lesions tend to be unilateral
Symptoms may be mild and self-limiting

62
Q

What investigations would you do in a patient you suspect has HSV?

A

Viral culture

DNA detection using polymerase chain reaction of a swab from the base of an ulcer

63
Q

What is the management plan of a primary HSV infection?

A 
No cure 
Refer to a GUM clinic 
Full STI screen 
Supportive management 
Antivirals
64
Q

What supportive management advice would you give to patients with an HSV infection of the genitals?

A

Saline bathing
Oral painkillers
Topical lidocaine
Vaseline to prevent pain during micturition
Increase fluid intake
Urinate in a bath to prevent urinary retention
Abstain from sexual intercourse

65
Q

What is the antiviral treatment to treat a primary infection of HSV?

A

Oral aciclovir 400mg three times a day for 5-10 days

66
Q

What suppressive treatment would you offer patients with recurrent HSV infection?

A

May need if getting more than 6 attacks a year
Aciclovir 400mg twice daily
Discontinue after 12 months to reassess attack frequency

67
Q

What antiviral therapy would you offer someone suffering with a recurrent infection of HSV?

A

aciclovir 800mg 3 times a day for 2 days

68
Q

Name three complications of genital HSV?

A

Autonomic neuropathy resulting in urinary retention
Aseptic meningitis
Spread to extra-genital areas
Secondary infection with candida or streptococci
Perinatal transmission if the woman is pregnant
Psychological and psychosexual problems
In people with HIV with primary infection and no HIV therapy there may be development of severe prolonged mucocutaneous lesions

69
Q

What type of organism causes Trichomonas vaginalis?

A

flagellated protozoan. A member of the Parabasalia, a group of single-celled eukaryotes which includes parasites.

70
Q

How is trichomonas vaginalis caught?

A

Adults transmission is almost exclusively through sexual intercourse

71
Q

What are the symptoms of trichomonas vaginalis in women?

A

Vaginal discharge, usually frothy yellowish/greenish that can vary in thickness
Vulval itching
Dysuria
Offensive odour of urine
Lower abdominal discomfort can occur
May be signs of local inflammation with vulvitis and vaginitis
Cervicitis may be present which leads to the cervix having the appearance of the surface of a strawberry (strawberry cervix)

72
Q

Presence of frothy yellow/greenish urine indicates what infection?

A

Trichomonas vaginalis

73
Q

What is “strawberry cervix” and what infection may it suggest?

A

cervix has an erythematous, punctate, and papilliform appearance. It is named because of the superficial similar appearance to a strawberry.

74
Q

What investigations would you do for a woman with suspected trichomonas vaginalis?

A

Vaginal swab - NAAT
Wet microscopy
Contact tracing
Screening for other STIs

75
Q

What is the management for trichomonas vaginalis?

A

Oral metronidazole 2g as a single dose OR Oral metronidazole 400-500mg twice a day for 5-7 days

Avoid sex for at least one week following recieving treatment

Treatment of partners

76
Q

What investigations would you do for a man with suspected trichomonas vaginalis?

A

Contact tracing
Screening for other STIs
Men - urethral culture or first void urine culture

77
Q

What are the complications of trichomonas vaginalis?

A

Preterm delivery and low birth weight
Infection at delivery may predispose to maternal postpartum sepsis
May enhance HIV transmission

78
Q

What is the aetiology of syphilis?

A

Treponema pallidum

Spirochete (spiral shaped bacteria)

79
Q

How does syphilis infect a host

A

Enters via abraded skin or intact mucous membrane, replicates and distributes via the bloodstream and lymphatics after an incubation period of three weeks throughout the body

80
Q

How is syphilis transmitted?

A

Oral, vaginal or anal sex : direct contact with an infected area (mainly sexual)
Vertical transmission from mother to baby during pregnancy
IVDU
Blood transfusions (rare due to screening of blood products)

Phase 3A (4 decks)

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