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Sexual Health Flashcards

1
Q

What organism mainly causes candidiasis?

A

Candida Albicans

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2
Q

What are some pre disposing factors for vaginal candidiasis?

A

Diabetes mellitus

Pregnancy

Immunosuppression

Antibiotics

Steroids

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3
Q

How does vaginal candidiasis present?

A

Cottage cheese like discharge

Vulvitis - superficial dyspareunia, dysuria

Itching

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4
Q

How is vaginal candidiasis managed?

A

Oral - fluconazole/itraconazole

Local - clotrimazole

If pregnant, oral medications are CI

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5
Q

How is vaginal candidiasis managed in pregnancy?

A

Local clotrimazole pessary/cream only

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6
Q

How is recurrent vaginal candidiasis managed?

A

Oral fluconazole every 3 days for 3 doses

Oral fluconazole weekly for 6 months

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7
Q

What is bacterial vaginosis?

A

Overgrowth of predominantly anaerobic organisms in the vagina - Gardnerella vaginalis

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8
Q

Is bacterial vaginosis an STI?

A

No but occurs almost exclusively in sexually active women

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9
Q

How does bacterial vaginosis present?

A

Fishy offensive vaginal discharge

Asymptomatic in 50%

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10
Q

Which criteria is used to diagnose bacterial vaginosis?

A

Amsel’s criteria

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11
Q

What is Amsel’s criteria?

A

Used to diagnose BV

Thin white homogenous discharge

Microscopy shows clue cells

Vaginal pH >4.5

Positive whiff test

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12
Q

What is seen on microscopy in BV?

A

Clue cells

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13
Q

How is bacterial vaginosis managed?

A

Oral metronidazole

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14
Q

What are risks of BV in pregnancy?

A

Preterm labour/Preterm rupture of membranes

Low birth weight

Chorioamnionitis

LATE miscarriage

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15
Q

Can metronidazole be used in pregnancy?

A

Yes

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16
Q

What is trichomonas?

A

A parasite (protozoan) spread through sexual intercourse

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17
Q

How does trichomonas present?

A

Offensive yellow/green frothy discharge

Vulvovaginitis- dyspareunia, dysuria

Strawberry cervix

pH >4.5

In men - usually asymptomatic but can be balanitis

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18
Q

How is trichomonas diagnosed?

A

Charcoal swab + microscopy

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19
Q

What does microscopy show in trichomonas?

A

Motile trophozoites

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20
Q

How is trichomonas treated?

A

Oral metronidazole

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21
Q

Which is the most common STI in the UK?

A

Chlamydia

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22
Q

Which organism is responsible for chlamydia?

A

Chlamydia Trachomatis

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23
Q

How does chlamydia present?

A

Asymptomatic in majority of people

In women can present with cervicitis (discharge, bleeding) and dysuria

In men can present with urethral discharge and dysuria

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24
Q

What are complications of chlamydia infection?

A

Epididymitis

Pelvic inflammatory disease

Endometritis

Increased incidence of ectopic pregnancy

Infertility

Reactive arthritis

25
How is chlamydia diagnosed?
Nucleic acid amplification test Women = vulvovaginal swab (high vaginal swab) Men = first void urine
26
How is chlamydia treated?
First line = doxycycline In pregnancy = Azithromycin/erythromycim
27
How is chlamydia treated in pregnancy?
Azithromycin/erythromycin
28
Is doxycycline safe in pregnancy?
No
29
Which organism is responsible for gonorrhoea?
Neisseria gonorrhoeae Gram negative diplococcus
30
Where can gonorrhoea infection occur?
Any mucous membranes Typically genitourinary but also rectum/pharynx
31
What is the incubation period for gonorrhoea?
2-5 days
32
How does gonorrhoea present?
In women - cervicitis (discharge and bleeding) In men - urethral discharge, up dysuria If rectal/pharynx infection - usually asymptomatic
33
What are complications of gonorrhoea?
Urethral strictures Epididymo-orchitis Salpingitis (risk of infertility) Septic arthritis Reactive arthritis
34
How is gonorrhoea treated?
IM Ceftriaxone 1g Alternative = oral cefixime+Azithromycin
35
Which organism is responsible for syphilis?
Treponema pallidum
36
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
37
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)
38
What is latent syphilis?
A period after the secondary stage where the symptoms disappear and the patient is asymptomatic
39
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
40
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
41
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
42
How is syphilis treated?
IM Benzathine Benzylpenicillin
43
How does genital herpes present?
Painful genital ulceration Dysuria May be systemic symptoms with first episode (headache, fever, malaise) Tender inguinal lymphadenopathy
44
How is genital herpes diagnosed?
Nucleic acid amplification test - swab of ulcers
45
How is genital herpes treated in pregnancy?
If occurs after 28 weeks - elective CS at term to avoid vertical transmission
46
Which two types of HPV most commonly cause genital warts?
6 and 11
47
How do genital warts present?
Small fleshy warts which may be slightly pigmented These may bleed or itch
48
How are genital warts treated?
Cryotherapy or topical podophyllum/podophyllotoxin
49
How is HIV transmitted?
Unprotected sexual activity Vertical transmission (pregnancy/birth/breastfeeding) Needles
50
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
51
How is HIV diagnosed?
1) HIV antibodies 2) p24 antigen Combination testing for both of the above If positive, repeat to confirm
52
When should you test for HIV in an asymptomatic patient?
4 weeks post exposure If negative, re-test at 12 weeks
53
How is HIV treated?
Antiretroviral therapy - Triple therapy
54
When should HIV treatment commence?
As soon as diagnose has been made
55
Different types of genital ulcers and how to differentiate?
Chancre = Painless ulcer, painless lymphadenopathy Chancroid = Painful ulcer, painful lymphadenopathy LGV = Painless ulcer, painful lymphadenopathy
56
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
57
What is Chancroid and how is it managed?
Painful genital ulcer + painful inguinal lymphadenopathy High incidence in tropical areas Management = Ciprofloxacin + Ceftriaxone
58
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

Medicine Finals (32 decks)

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