SEXUAL HEALTH Flashcards
women = discharge, bleeding
dysuria
men = urethral discharge and dysuria
Chlamydia - usually asymptomatic 70%
Gonorrhea
investigations for gonorrhea and chlamydia
NAATs
women = vulvovaginal swabs and
men = first void urine sample
management of chlamydia?
Doxycycline 7 days
alternative = azithromycin
partner notification
sexual abstinence for 1 week
management of gonorrhea?
1mg IM ceftriaxone
uncertainty = oral ciprofloxacin
OR
Oral ceftriaxone 400mg + oral azithromycin
fishy offensive discharge - usually thin and white
+ve whiff test
stippled epithelial cells
pH >4.5
can be asymptomatic
bacterial vaginosis
management of bacterial vaginosis
oral metronidazole 5-7 days
primary state
painless chancre
local non-tender lymphadenopathy
secondary
systemic = fevers, lymphadenopathy, rash on trunk palms/soles
buccal ‘ small track’ ulcers
condyloma lata
tertiary
gumma - granulomatous lesions
ascending aortic aneurysm
tabes dorsalis
syphilis
investigations for syphilis
darkfield microscopy
swab from chancre/ulcer site
serology / TPHA = remains positive
management for syphilis
IM penicillin
OR
oral doxycycline as alternative
infertility investigations for females
LH & FSH
progesterone - 7 days prior to next period
TVUS
hysterosalpingogram
infertility investigations for males
semen analysis
primary presentation: sore throat, lymphadenopathy, malaise and myalgia or arthralgia
diarrhoea
maculopapular rash or mouth ulcers
followed by recurrent infections - pneumonia common
HIV
investigations for HIV
serology - venous sample from either at home or at clinic
management of HIV
combination of 3 ARTs
mainly 2 NRTI such as emtricitabine, tenofovir, zidovudine and abacavir
+
protease inhibitor indinavir or nelfinavir
OR
NNRTI = nevirapine or efavirenz
what is the recommended viral load for delivery
<50 for vaginal delivery at 36weeks
usually given a zidovudine infusion 4hrs prior to C-sections
PEP HIV
combination of ARTs at least 72hrs following exposure
serologic testing at 12weeks
primary presentation = multiple painful lesions which can rupture and become crusty
vaginal/urethal discharge
local oedema
tingling/neuropathic pain in genitals, lower back, buttock & legs
herpes simplex virus (HSV-2)
investigations of HSV
swab from site - viral culture/PCR
management of HSV
primary infection = aciclovir 400mg TDS 5-10 days
supportive management includes = analgesia, lidocaine gel, bathing is warm salt water
increased fluids
painless, small flat smooth papules
may become painful on irritation
soft cauliflower like growth
Human papillomavirus / genital warts
HPV 6 & 11
genital warts
HPV 16 & 18
cervical cancer/oncogenic
management of HPV
podophyllotoxin topical - apply BD for 3/7 then review
Iriquimoid TDS nocte
treatment is 3-4weeks, immunosuppression
cryotherapy, surgical excision and specialist Tx
vulval itching, dysuria, offensive fishy discharge
frothy yellow/green discharge
vulval/lower abdo pain
trichomonas
investiagtions for trichomonas
microscopy of high vaginal swab/tip of penis swab
pH of vaginal wall
gram stain
management of trichomonas
metronidazole 400-500mg BD for 5-7 days
OR
2g as a single dose
offer further STI screening
sexual abstinence for at least 1 week
male sexual dysfunction
erectile dysfunction
premature ejaculation
management of erectile dysfunction
lifestyle advice
psychosexual therapy
PDE5 inhibitors = sildenafil
specialist Tx
management of premature ejaculation
pscyhosexual counselling, CBT
SSRIs, tramadol, terazosin and sildenafil
special Tx
female sexual dysfunction
sexual interest arousal disorder
female orgasmic disorder
genito-pelvic penetration pain disorder
management of female sexual dysfunction
psychotherapy
topical oestrogen
