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Medicine Finals > Sexual Health > Flashcards

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
Q

How is chlamydia diagnosed?

A

Nucleic acid amplification test

Women = vulvovaginal swab (high vaginal swab)

Men = first void urine

26
Q

How is chlamydia treated?

A

First line = doxycycline

In pregnancy = Azithromycin/erythromycim

27
Q

How is chlamydia treated in pregnancy?

A

Azithromycin/erythromycin

28
Q

Is doxycycline safe in pregnancy?

A

No

29
Q

Which organism is responsible for gonorrhoea?

A

Neisseria gonorrhoeae

Gram negative diplococcus

30
Q

Where can gonorrhoea infection occur?

A

Any mucous membranes

Typically genitourinary but also rectum/pharynx

31
Q

What is the incubation period for gonorrhoea?

A

2-5 days

32
Q

How does gonorrhoea present?

A

In women - cervicitis (discharge and bleeding)

In men - urethral discharge, up dysuria

If rectal/pharynx infection - usually asymptomatic

33
Q

What are complications of gonorrhoea?

A

Urethral strictures

Epididymo-orchitis

Salpingitis (risk of infertility)

Septic arthritis

Reactive arthritis

34
Q

How is gonorrhoea treated?

A

IM Ceftriaxone 1g

Alternative = oral cefixime+Azithromycin

35
Q

Which organism is responsible for syphilis?

A

Treponema pallidum

36
Q

How does primary syphilis present?

A

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
Q

How does secondary syphilis present?

A

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
Q

What is latent syphilis?

A

A period after the secondary stage where the symptoms disappear and the patient is asymptomatic

39
Q

How does tertiary syphilis present?

A

Gummas (granulomatous lesions on the skin)

Neurosyphilis - headache, altered behaviour, dementia, tabes dorsalis (degeneration of nerve cells), ocular syphilis

Argyll-Robertson pupil

40
Q

How is syphilis diagnosed?

A

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
Q

What are the syphilis test results after treatment? How do you know if the patient is now adequately treated?

A 
VDRL = negative
TPHA/EIA = positive

RPR should be less than 1:8 or have decreased four fold

42
Q

How is syphilis treated?

A

IM Benzathine Benzylpenicillin

43
Q

How does genital herpes present?

A

Painful genital ulceration

Dysuria

May be systemic symptoms with first episode (headache, fever, malaise)

Tender inguinal lymphadenopathy

44
Q

How is genital herpes diagnosed?

A

Nucleic acid amplification test - swab of ulcers

45
Q

How is genital herpes treated in pregnancy?

A

If occurs after 28 weeks - elective CS at term to avoid vertical transmission

46
Q

Which two types of HPV most commonly cause genital warts?

A

6 and 11

47
Q

How do genital warts present?

A

Small fleshy warts which may be slightly pigmented

These may bleed or itch

48
Q

How are genital warts treated?

A

Cryotherapy or topical podophyllum/podophyllotoxin

49
Q

How is HIV transmitted?

A

Unprotected sexual activity

Vertical transmission (pregnancy/birth/breastfeeding)

Needles

50
Q

What are AIDS defining illnesses?

A

Opportunistic infections and malignancies when CD4 count falls below 200

Kaposi’s sarcoma, non-Hodgkin lymphoma, cervical cancer

TB, recurrent pneumonia

Candidiasis,cytomegalovirus

51
Q

How is HIV diagnosed?

A

1) HIV antibodies
2) p24 antigen

Combination testing for both of the above

If positive, repeat to confirm

52
Q

When should you test for HIV in an asymptomatic patient?

A

4 weeks post exposure

If negative, re-test at 12 weeks

53
Q

How is HIV treated?

A

Antiretroviral therapy - Triple therapy

54
Q

When should HIV treatment commence?

A

As soon as diagnose has been made

55
Q

Different types of genital ulcers and how to differentiate?

A

Chancre = Painless ulcer, painless lymphadenopathy

Chancroid = Painful ulcer, painful lymphadenopathy

LGV = Painless ulcer, painful lymphadenopathy

56
Q

What is the Jarisch-Herxheimer Reaction?

A

Classical reaction to penicillin in syphilis
Fever, rash, rigors and tahycardia

May need to admit and monitor
Just need paracetamol

57
Q

What is Chancroid and how is it managed?

A

Painful genital ulcer + painful inguinal lymphadenopathy
High incidence in tropical areas

Management = Ciprofloxacin + Ceftriaxone

58
Q

What is Lymphogranuloma vereneum? How is it managed?

A

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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