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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
What are some of the complications of an untreated chlamydia infection?
``` 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 ```
26
Name two ways to help prevent the spread of chlamydia?
Promotion of safe sexual behaviour Encouragement of early healthcare-seeking behaviour Primary care involvement in prevention and sexual healthcare
27
Aetiology of gonorrhoea?
Neisseria gonorrhoeae | Gram negative diplococcus
28
What are the symptoms of a symptomatic man with a gonorrhoea infection
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%)
29
What are the potential signs of a symptomatic man with a gonorrhoea infection?
Mucopurulent or purulent urethral discharge | Epididymal tenderness/swelling
30
What are the symptoms of a women with a gonorrhoea infection?
Increased or altered vaginal discharge Lower abdominal pain May have IMB or menorrhagia Dysuria
31
What are the potential signs in a woman with a gonorrhoea infection?
Mucopurulent endocervical discharge Easily induced contact bleeding of the cervix Pelvic/lower abdominal tenderness Normal examination is very common
32
What investigations would you do if you suspected that your patient had gonorrhoea?
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
33
What is the management for gonorrhoea?
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
What antibiotic regime would you suggest for an uncomplicated gonococcal anogenital infection?
500mg IM ceftriaxone stat + 1g orally azithromycin stat
35
What complications can arise in males only from an untreated gonococcal infection?
Gonococcal urethritis may cause urethral scarring and stricture, resulting in bladder-outflow obstruction Local spread causing acute epididymitis, prostatitis, seminal vesiculitis, penile lymphangitis
36
What complications can arise in women only from an untreated gonococcal infection?
PID - infertility, chronic pelvic pain and ectopic pregnancy Peri-hepatitis
37
What complications can occur in both men and women from an untreated gonococcal infection?
Haematogenous dissemination (less than 1%) Increased risk of acquiring and transmitting HIV infection.
38
When is haematogenous dissemination of gonorrhoea more likely to occur?
This is more likely to occur when the infection is asymptomatic, as it is left undiagnosed and untreated.
39
What are the features of haematogenous dissemination of gonococcal infection?
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
Where does gonococcal infection tend to spread to in disseminated disease
Joints and skin
41
Name three causes for Non-Gonococcal Urethritis
Most common organisms : Chlamydia trachomatis and Mycoplasma genitalium UTI may account for a few cases but not solidly confirmed Idiopathic
42
What is the presentation of non-gonococcal urethritis
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
What investigations would you do in a man with urethritis to determine if it was caused by gonorrhoea or another cause (non-gonococcal urethritis)
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
What is the management for NGU
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
What are 2 complications of untreated NGU?
``` Epididymitis and/or orchitis Prostatitis Systemic dissemination of gonorrhoea Reactive arthritis PID HIV transmission is increased ```
46
What is another name for genital warts?
condylomata acuminata
47
What is the aetiology of genital warts?
Caused by infection with HPV (types 6 and 11) Sexually transmitted 60% transmission rate between partners
48
Name 5 risk factors that increase your chance of developing genital warts?
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
What are the symptoms of genital warts?
Painless lesion(s) May cause itching, bleeding or dyspareunia Urethral lesions may cause distortion of the urinary stream
50
what are the potential signs of genital warts
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
What investigations would you do in someone who presented with suspected genital warts?
Screen for co-existing STIs Vaginal speculum examination in women Proctoscopy if there is a history of anal receptive sex
52
What are the treatment options for gential warts
No treatment - 30% disappear spontaneously in 6 months Self applied Specialist application - trichloroacetic acid Ablative methods
53
What are the options for self applied treatments?
Podophyllotoxin solution/cream - soft, non-keratinized external lesions Imiquimod - not internal use Sinecatechins - external warts for people who are immunocompromised
54
When would you consider ablative methods to treat genital warts?
If there is a small number of low volume warts
55
Alongside treatment, what other advice would you offer patients?
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
What are two preventative measures used to reduce the incidence of genital warts?
Condoms | Vaccination - Gardasil protects against four strains of HPV (6, 11, 16 and 18)
57
What strains of HPV virus cause the majority of genital warts?
6 and 11
58
What is the aetiology of genital herpes simplex?
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
How is HSV transmitted
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
What are the symptoms of a primary infection of HSV?
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
What are the symptoms of a recurrent infection of HSV
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
What investigations would you do in a patient you suspect has HSV?
Viral culture | DNA detection using polymerase chain reaction of a swab from the base of an ulcer
63
What is the management plan of a primary HSV infection?
``` No cure Refer to a GUM clinic Full STI screen Supportive management Antivirals ```
64
What supportive management advice would you give to patients with an HSV infection of the genitals?
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
What is the antiviral treatment to treat a primary infection of HSV?
Oral aciclovir 400mg three times a day for 5-10 days
66
What suppressive treatment would you offer patients with recurrent HSV infection?
May need if getting more than 6 attacks a year Aciclovir 400mg twice daily Discontinue after 12 months to reassess attack frequency
67
What antiviral therapy would you offer someone suffering with a recurrent infection of HSV?
aciclovir 800mg 3 times a day for 2 days
68
Name three complications of genital HSV?
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
What type of organism causes Trichomonas vaginalis?
flagellated protozoan. A member of the Parabasalia, a group of single-celled eukaryotes which includes parasites.
70
How is trichomonas vaginalis caught?
Adults transmission is almost exclusively through sexual intercourse
71
What are the symptoms of trichomonas vaginalis in women?
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
Presence of frothy yellow/greenish urine indicates what infection?
Trichomonas vaginalis
73
What is "strawberry cervix" and what infection may it suggest?
cervix has an erythematous, punctate, and papilliform appearance. It is named because of the superficial similar appearance to a strawberry.
74
What investigations would you do for a woman with suspected trichomonas vaginalis?
Vaginal swab - NAAT Wet microscopy Contact tracing Screening for other STIs
75
What is the management for trichomonas vaginalis?
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
What investigations would you do for a man with suspected trichomonas vaginalis?
Contact tracing Screening for other STIs Men - urethral culture or first void urine culture
77
What are the complications of trichomonas vaginalis?
Preterm delivery and low birth weight Infection at delivery may predispose to maternal postpartum sepsis May enhance HIV transmission
78
What is the aetiology of syphilis?
Treponema pallidum | Spirochete (spiral shaped bacteria)
79
How does syphilis infect a host
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
How is syphilis transmitted?
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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