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Obs & Gynae > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

Who is most at risk of contracting STIs?

A

Yougn adults, multiple partners, pregnancy before age 20, previous STI, abnormal cervical cytology, sex workers

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2
Q

What is used for asymptomatic STI screening in people with vaginas?

A
  • Vulvo-vaginal swab + NAAT-> chlamydia + gonorrhoea

- Bloods-> syphilis + HIV

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3
Q

What is used for asymptomatic STI screening in people with penises (inc het males)?

A
  • 1st void urine sample-> chlamydia + gonorrhoea

- Bloods-> syphilis + HIV

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4
Q

What is used for asymptomatic STI screening in people with penises (inc MSM)?

A
  • 1st void urine + pharyngeal swab + rectal swab (chlamydia + gonorrhoea)
  • Bloods-> syphilis, HIV + Hep B
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5
Q

What is used for symptomatic STI screening in people with vaginas?

A
  • High vaginal swab (wet and dry slides)-> BV, TV and candida
  • Cervical swab + slide-> gonorrhoea
  • Urine dip
  • Bloods-> syphilis + HIV
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6
Q

What is used for symptomatic STI screening in people with penises (inc het males)?

A
  • Urethral swab + slide-> pus cells + gonorrhoea culture
  • 1st void urine
  • Urine dip
  • Bloods-> syphilis + HIV
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7
Q

What is used for symptomatic STI screening in people with penises (inc MSM)?

A
  • Urethral, pharynx and rectal swabs-> slides + culture plates
  • 1st pass urine sample
  • Blood test-> syphilis, HIV + Hep B
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8
Q

What organism causes chlamydia?

A

Chlamydia trachomatis (gram negative cocci)

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9
Q

How can chlamydia present in people with vaginas?

A

Asymptomatic (70%), increased discharge, cervicitis, period problems

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10
Q

How can chlamydia present in people with penises?

A

Asymptomatic (50%), dysuria, discharge, tingling, pain/swelling in testicles

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11
Q

Investigations for chlamydia?

A
  • Asymptomatic screens, urine PCR

- Endocervical or urethral swabs

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12
Q

Treatment options for chlamydia?

A
  • Azithromycin-> 1g single dose PO

- Doxycycline-> 100mg BD 7 days

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13
Q

Potential complications of chlamydia?

A
  • PID, infertility, ectopic risk
  • In pregnancy-> PROM, premature, low birth weight, neonatal conjunctivitis + pneumonia
  • Reiter’s syndrome-> more in men
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14
Q

What is Reiter’s syndrome?

A
  • Complication of chlamydia
  • Arthritis + urethritis + conjunctivitis
  • More common in men
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15
Q

What organism causes gonorrhoea?

A

Neisseria gonorrhoeae (gram-negative diplococcus)

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16
Q

How can gonorrhoea present in people with vaginas?

A

Asymptomatic (50%), green discharge, intermenstrual bleeding, symptoms often few days after intercourse

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17
Q

How can gonorrhoea present in people with penises?

A

Painful urination, asymptomatic (10%)

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18
Q

Investigations for gonorrhoea?

A
  • Endocervical +/- urethral swabs

- Rectal + pharyngeal swabs if symptoms

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19
Q

Treatment options for gonorrhoea?

A
  • Ceftriaxone-> 250mg IM single dose
  • Ciprofloxacin-> 500mg orally single dose
  • Cefixime-> 400mg oral single dose
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20
Q

Complications of gonorrhoea?

A
  • PID, Bartholin’s abscess, tubal infertility
  • Disseminated-> fever, rash, septic arthritis
  • Pregnancy-> PROM, prematurity, chorioamnionitis, opthalmia neonatorum etc
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21
Q

What organism causes syphilis?

A

Treponema pallidum (spirochete)

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22
Q

How might primary syphilis present?

A

Painless genital/cervical chancre + inguinal lymphademopathy-> 10-90 days after infection

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23
Q

How might secondary syphilis present?

A
  • Generalised polymorphic rash-> on palms + soles
  • Generalised lymphadenopathy
  • Genical condyloma lata
  • Anterior uveitis
  • Present within 2 years of infection
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24
Q

How might tertiary syphilis present?

A
  • Neuro-> dementia, tabes dorsalis
  • CV-> aortic root
  • Gummata-> inflammatory plaques/nodules throughout body
  • When infected for 2+ years
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25
Q

Investigations for syphilis?

A
  • VDRL cargon antigen test
  • Rapid plasma regain test
  • Smear from rpimary lesion
  • Fluorescent treponemal antibody absorption test (FTA-abs)
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26
Q

How is syphilis treated?

A
  • Benzathine penicillin-> IM single dose)
  • Procaine penicillin G-> IM 10 days
  • Oral doxycycline or erythromycin
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27
Q

What are the complications of syphilis?

A

Tertiary, prematurity, stillbirths, congenital syphilis

28
Q

What is the pathophysiology behind herpes simplex?

A
  • HSV1 (oral) and HSV2 (genital)

- Reactivate in sacral ganglia when latent

29
Q

How can genital herpes simplex present?

A
  • Small vesicles then red open sores
  • Primary-> flu like, inguinal lymphadenopathy, vulvitis, pain, urinary retention
  • Recurrent-> usually less severe + triggered by stress, sex or menstruaton
30
Q

Investigation of herpes simplex?

A
  • Viral culture of vesicle fluid

- Antibody testing

31
Q

Treatment of herpes simplex?

A
  • Usually none + analgesia

- Aciclovir-> if within 5 days of symptom onset in primary

32
Q

Complications of herpes simplex?

A
  • Meningitis, disseminated infection, sacral radiculopathy

- Pregnancy-> vertical transmission

33
Q

How might congenital herpes simplex infection present?

A

Disseminated disease in most, sometimes just mouth + eyes, during 1st 2 weeks of life

34
Q

What is bacterial vaginosis?

A

Not an STI-> overgrowth of anaerobes that replace normal vaginal lactobacilli

35
Q

What are the risk factors for developing bacterial vaginosis?

A

TOP, IUD, PID

36
Q

How does bacterial vaginosis present?

A

Asymptomatic or profuse white/grey fishy discharge

37
Q

Investigations for bacterial vaginosis?

A
  • Whiff test-> add 10% potassium hydroxide and +ve if fishy smell
  • Microscopy-> clue cells
  • Vaginal pH-> <5.5
38
Q

Treatment for bacterial vaginosis?

A
  • Metronidazole for 5 days or single dose
  • Clindamycin cream for 7 days
  • May not need any if spontaneously resolves
39
Q

Complications of bacterial vaginosis?

A

Increased risk of infection after surgery, miscarriage, PROM, prematurity

40
Q

What is trichomonas vaginalis?

A

A flagellated protozoan causing infection via STI

41
Q

How does trichomonas vaginalis present?

A

Asymptomatic (50%), frothy/green/smelly discharge, ‘strawberry cervix’ due to haemorrhages, itchy, sore, dysuria

42
Q

Investigations for trichomonas vaginalis?

A

Wet smear + culture

43
Q

Treatment for trichomonas vaginalis?

A

Metronidazole single dose or 5-7 days

44
Q

Complications of trichomonas vaginalis?

A

Increased HIV transmission, prematurity, low birth weight

45
Q

What causes genital warts?

A

Human papillomavirus (HPV) types 6 + 11

46
Q

How do genital warts present?

A

Asymptomatic, warts on labia or clitoris, can be irritating, change to urine flow, often alongside other STIs

47
Q

Investigations for genital warts?

A

Clinical but may do biopsy to exclude neoplasia

48
Q

Treatment for genital warts?

A
  • Podophyllin pain, podophyllotoxin solution, trichloroacetic acid
  • Liquid nitrogen cryotherapy
  • Excision or diathermy
49
Q

How can genital warts be prevented?

A

HPV vaccine in all children aged 12-13

50
Q

What types of HPV can be present on the cervix?

A

HPV types 16 + 18

51
Q

Investigations for HPV?

A
  • Often incidental finding
  • Cervical cytology (smears)
  • Colposcopy-> whitening when topical acetic acid applied
52
Q

Complications of HPV infection?

A
  • High grade CIN

- Cervical neoplasia-> especially when immunosuppressed or smoker (reduce viral clearance)

53
Q

What is thrush?

A

Candidiasis from fungus (usually candida albicans)-> not an STI

54
Q

What are the risk factors for thrush?

A

Antibiotic use, pregnancy, high dose COCP, diabetes, anaemia

55
Q

Presentation of thrush?

A
  • Thick curd-like white discharge
  • Itchy + sore, dysuria, superficial dyspareunia
  • Erythema + white plaques on vaginal wall
56
Q

Investigations for thrush?

A
  • High and/or low vaginal culture

- Wet slides-> spores + pseudohyphae on microscopy

57
Q

Treatment for thrush?

A
  • Only when symptoms
  • Clotrimazole pessary +/- topical cream
  • Fluconazole oral single dose
58
Q

Who is at risk from complications due to thrush?

A

Immunocompromised patients

59
Q

Who is at risk of contracting Hepatitis B and how is it prevented?

A

Sex workers, IVDUs, MSM, high risk areas-> get screening + vaccines if non-immune

60
Q

How can HIV initially present (ie in acute HIV syndrome)?

A

Flu like illness, ulcers, swollen lymph nodes, diffuse rash-> for 1-2 weeks + 2-6 weeks after infection

61
Q

How might early symptomatic HIV present?

A
  • May be months/years after infection
  • Shingles
  • Recurrent oral/vaginal thrush
  • Oral hairky leukoplakia-> like thrush but can’t scrape off
  • Molloscum contagiosum
  • Aseptic meningitis
  • Swollen lymph nodes
62
Q

What are some of the late symptoms/complications of HIV?

A

Kaposi’s sarcoma, pneumocystis pneumonia, AIDS

63
Q

What complications can HIV cause in pregnancy?

A

Stillbirth, pre-eclampsia, IUGR, gestational diabetes

64
Q

What does treatment of HIV before delivery depend on?

A
  • Viral load
  • <50 doesn’t need
  • <400-> should consider
  • > 400-> should give
  • > 1000-> give anti-retrovirals
65
Q

What is given to babies at low risk of vertical HIV transmission?

A

Zidovudine (anti-retroviral)

66
Q

What is given to babies at high risk of vertical HIV transmission?

A

Combination post-exposure prophylaxis

67
Q

Do babies need HIV prevention treatment when mum is breastfeeding?

A

No-> formula feeds + support is fine

Obs & Gynae (5 decks)

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