Sexual Health Flashcards
What organism mainly causes candidiasis?
Candida Albicans
What are some pre disposing factors for vaginal candidiasis?
Diabetes mellitus
Pregnancy
Immunosuppression
Antibiotics
Steroids
How does vaginal candidiasis present?
Cottage cheese like discharge
Vulvitis - superficial dyspareunia, dysuria
Itching
How is vaginal candidiasis managed?
Oral - fluconazole/itraconazole
Local - clotrimazole
If pregnant, oral medications are CI
How is vaginal candidiasis managed in pregnancy?
Local clotrimazole pessary/cream only
How is recurrent vaginal candidiasis managed?
Oral fluconazole every 3 days for 3 doses
Oral fluconazole weekly for 6 months
What is bacterial vaginosis?
Overgrowth of predominantly anaerobic organisms in the vagina - Gardnerella vaginalis
Is bacterial vaginosis an STI?
No but occurs almost exclusively in sexually active women
How does bacterial vaginosis present?
Fishy offensive vaginal discharge
Asymptomatic in 50%
Which criteria is used to diagnose bacterial vaginosis?
Amsel’s criteria
What is Amsel’s criteria?
Used to diagnose BV
Thin white homogenous discharge
Microscopy shows clue cells
Vaginal pH >4.5
Positive whiff test
What is seen on microscopy in BV?
Clue cells
How is bacterial vaginosis managed?
Oral metronidazole
What are risks of BV in pregnancy?
Preterm labour/Preterm rupture of membranes
Low birth weight
Chorioamnionitis
LATE miscarriage
Can metronidazole be used in pregnancy?
Yes
What is trichomonas?
A parasite (protozoan) spread through sexual intercourse
How does trichomonas present?
Offensive yellow/green frothy discharge
Vulvovaginitis- dyspareunia, dysuria
Strawberry cervix
pH >4.5
In men - usually asymptomatic but can be balanitis
How is trichomonas diagnosed?
Charcoal swab + microscopy
What does microscopy show in trichomonas?
Motile trophozoites
How is trichomonas treated?
Oral metronidazole
Which is the most common STI in the UK?
Chlamydia
Which organism is responsible for chlamydia?
Chlamydia Trachomatis
How does chlamydia present?
Asymptomatic in majority of people
In women can present with cervicitis (discharge, bleeding) and dysuria
In men can present with urethral discharge and dysuria
What are complications of chlamydia infection?
Epididymitis
Pelvic inflammatory disease
Endometritis
Increased incidence of ectopic pregnancy
Infertility
Reactive arthritis
How is chlamydia diagnosed?
Nucleic acid amplification test
Women = vulvovaginal swab (high vaginal swab)
Men = first void urine
How is chlamydia treated?
First line = doxycycline
In pregnancy = Azithromycin/erythromycim
How is chlamydia treated in pregnancy?
Azithromycin/erythromycin
Is doxycycline safe in pregnancy?
No
Which organism is responsible for gonorrhoea?
Neisseria gonorrhoeae
Gram negative diplococcus
Where can gonorrhoea infection occur?
Any mucous membranes
Typically genitourinary but also rectum/pharynx
What is the incubation period for gonorrhoea?
2-5 days
How does gonorrhoea present?
In women - cervicitis (discharge and bleeding)
In men - urethral discharge, up dysuria
If rectal/pharynx infection - usually asymptomatic
What are complications of gonorrhoea?
Urethral strictures
Epididymo-orchitis
Salpingitis (risk of infertility)
Septic arthritis
Reactive arthritis
How is gonorrhoea treated?
IM Ceftriaxone 1g
Alternative = oral cefixime+Azithromycin
Which organism is responsible for syphilis?
Treponema pallidum
How does primary syphilis present?
Chance (painless ulcer at site of sexual contact
Local non tender lymphadenopathy (painless)
In women the chancre is usually not seen as it is on the cervix
How does secondary syphilis present?
Systemic symptoms - fever, lymphadenopathy
Widespread rash on the trunk, palms and soles
Buccal snail track ulcers
Condylomata lata (painless warty lesions on the genitalia)
What is latent syphilis?
A period after the secondary stage where the symptoms disappear and the patient is asymptomatic
How does tertiary syphilis present?
Gummas (granulomatous lesions on the skin)
Neurosyphilis - headache, altered behaviour, dementia, tabes dorsalis (degeneration of nerve cells), ocular syphilis
Argyll-Robertson pupil
How is syphilis diagnosed?
Initial screening for treponema pallidum antibodies
Cardiolipin test (VDRL/RPR) - becomes negative after treatment (Non-treponemal tests)
Treponema specific antibody test (TPHA) and EIA - remains positive after treatment
What are the syphilis test results after treatment? How do you know if the patient is now adequately treated?
VDRL = negative TPHA/EIA = positive
RPR should be less than 1:8 or have decreased four fold
How is syphilis treated?
IM Benzathine Benzylpenicillin
How does genital herpes present?
Painful genital ulceration
Dysuria
May be systemic symptoms with first episode (headache, fever, malaise)
Tender inguinal lymphadenopathy
How is genital herpes diagnosed?
Nucleic acid amplification test - swab of ulcers
How is genital herpes treated in pregnancy?
If occurs after 28 weeks - elective CS at term to avoid vertical transmission
Which two types of HPV most commonly cause genital warts?
6 and 11
How do genital warts present?
Small fleshy warts which may be slightly pigmented
These may bleed or itch
How are genital warts treated?
Cryotherapy or topical podophyllum/podophyllotoxin
How is HIV transmitted?
Unprotected sexual activity
Vertical transmission (pregnancy/birth/breastfeeding)
Needles
What are AIDS defining illnesses?
Opportunistic infections and malignancies when CD4 count falls below 200
Kaposi’s sarcoma, non-Hodgkin lymphoma, cervical cancer
TB, recurrent pneumonia
Candidiasis,cytomegalovirus
How is HIV diagnosed?
1) HIV antibodies
2) p24 antigen
Combination testing for both of the above
If positive, repeat to confirm
When should you test for HIV in an asymptomatic patient?
4 weeks post exposure
If negative, re-test at 12 weeks
How is HIV treated?
Antiretroviral therapy - Triple therapy
When should HIV treatment commence?
As soon as diagnose has been made
Different types of genital ulcers and how to differentiate?
Chancre = Painless ulcer, painless lymphadenopathy
Chancroid = Painful ulcer, painful lymphadenopathy
LGV = Painless ulcer, painful lymphadenopathy
What is the Jarisch-Herxheimer Reaction?
Classical reaction to penicillin in syphilis
Fever, rash, rigors and tahycardia
May need to admit and monitor
Just need paracetamol
What is Chancroid and how is it managed?
Painful genital ulcer + painful inguinal lymphadenopathy
High incidence in tropical areas
Management = Ciprofloxacin + Ceftriaxone
What is Lymphogranuloma vereneum? How is it managed?
Manifestation of Chlamydia trachomatis
Mainly occurs in patients with HIV
Painless ulcer + painful inguinal lymphadenopathy
Management = Doxycycline
