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Finals > Sexual health > Flashcards

Sexual health Flashcards

1
Q

How would you investigate for primary herpes simplex

A

Swab ulcers - send for HSV PCR
Syphilis serology
Vulvovaginal swabs for chlamydia and gonorrhoea NAAT

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2
Q

What is the treatment for primary herpes simple

A 
Aciclovir 400mg tds for 5 days 
Saline baths
Antibiotics - flucloxacillin for any infection
Loose clothing
Avoid intercourse with symptoms 
Topical Vaseline 
Topical 2% lidocaine gel
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3
Q

What tests are done for gonorrhoea

A

Light microscopy - gram negative intracellular diplococci inside the neutrophils

GC culture and chlamydia/gonorrhoea NAAT from 3 sites in MSM rectum, pharynx and urethra
Syphilis and HIV serology Hep B and c s

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4
Q

How is gonorrhoea treated?

A

1g IM ceftriaxone

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5
Q

What are the causes of non-gonococcal urethritis (NGU)

A

Chlamydia trachomatis
Mycoplasma genitalium
HSV
Adenovirus

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6
Q

What tests would you do for someone with NGU

A

Chlamydia/gonorrhoea NAAT urine

HIV/syphilis serology

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7
Q

How do you treat epididymo-orchitis caused by chlamydia

A

Doxycycline 100mg

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8
Q

What are the symptoms of reactive arthritis

A

Cant see - conjunctivitis
Cant pee - urethritis
Cant climb a tree - immune inflammation of joint

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9
Q

How do you treat reactive arthritis

A

Doxycycline 100mg bd 7 days

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10
Q

List some causes of vaginal discharge

A

Non sexually transmitted - candida albicans, bacterial vaginosis

Sexually transmitted - chlamydia, gonorrhoea, trichomonas vaginalis

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11
Q

What would you find on examination in PID

A

Pain on superficial and/or deep palpation of pelvis
Mucopurulent discharge at cervix
Contact bleeding at cervix
Bimanual examination - cervical motion tenderness, uterine tenderness and adnexal tenderness
Pyrexia

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12
Q

What tests would you do to look for candida

A

Microscopy vaginal specimen lunking for fungal spores and candida culture

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13
Q

Which organisms cause PID

A 
Chlamydia
Gonorrhoea 
BV - gardnerella vaginalis 
Mycoplasma genitalium
E.coli
H.influenzae
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14
Q

Describe the treatment of PID

A

Ceftriaxone 1g IM stat, doxycycline 100mg bd 2weeks, metronidazole bd 5 days

Or Moxifloxacin 400mg od 2 weeks

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15
Q

Describe the secondary syphilis rash

A

Hands and soles of feet

6 weeks to 6 months post inoculation

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16
Q

Describe the primary syphilis rash

A

9-90 days after

Chancre - ulcer - usually not painful - tend to be solitary

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17
Q

How do you investigate for syphilis

A

Dark field microscopy - corkscrew moving

Serology - 3 different tests and at least 2 should be positive

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18
Q

How is syphilis treated

A

IM benzathine penicillin 2.4mega units

IM procaine penicillin for HIV positive individuals

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19
Q

Describe how HIV is tested

A

Point of care test - HIV Ag/Ab

Blood for 4th generation test - can test for earlier disease (3-4 weeks)

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20
Q

How long is the window period for chlamydia and gonorrhoea

A

2 weeks

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21
Q

What is the window period for syphilis

A

6 weeks

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22
Q

How long is the window period for HIV

A

45 days

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23
Q

Describe cerebral toxoplasmosis

A

Multiple abscesses in the brain

Caused by immunosuppression for a long time

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24
Q

How is pneumocystis jivoreci pneumonia (PCP) treated

A

IV septrin 3 weeks

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25
Q

How is some antiviral therapy metabolised

A

CY450 - watch out for interactions

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26
Q

Describe the drug reaction in HIV and asthma

A

Cushing’s syndrome from the flixonase in Seretide inhaler with the ART

TB interactions

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27
Q

When should HIV be considered

A

In non specific illness

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28
Q

Describe what happens in bacterial vaginosis to vaginal flora and pH

A

Lactobacilli (friendly bacteria - produce lactic acid to keep pH <4.5) are lost
The pH rises, the more alkaline the vagina, the more able other bacteria are to multiply

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29
Q

Give some examples of bacteria associated with BV

A

Gardnerella vaginalis
Mycoplasma hominis
Prevotella species

Chlamydia, gonorrhoea and candidiasis

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30
Q

List some risk factors for bacterial vaginosis

A 
Multiple sexual partners
Excessive vaginal cleaning
Recent antibiotics
Smoking
Copper coil
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31
Q

Describe the presentation of bacterial vaginosis

A

Fishy smelling watery grey or white vaginal discharge

Itching and pain are not typically associated with BV but may present with co-occuring infection

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32
Q

Describe the Investigations in bacterial vaginosis

A

Vaginal pH - 3.5-4.5

Charcoal vaginal swab taken for microscopy - high vaginal swab taken during speculum examination or self taken low vaginal swab

Clue cells on microscopy

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33
Q

What are clue cells

A

Epithelial cells from the cervix that have bacteria (Gardnerella vaginalis) stuck inside them

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34
Q

Describe the management of bacterial vaginosis

A

Metronidazole - targets anaerobic bacteria - 400mg bd PO, vaginally

Clindamycin - alternative but less optimal antibiotic choice

Assess the risk of additional pelvic infections with chlamydia and gonorrhoea swabs

Provide advice and information about measures to reduce risk of further episodes of BV

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35
Q

Why should alcohol be avoided when taking metronidazole

A

Causes a disulfiram like reaction with nausea and vomiting, flushing and sometimes shock and angioedema

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36
Q

List the complications of BV

A

Associated with and increases the risk of STIs
Complications in pregnancy - miscarriage, preterm delivery, premature rupture of membranes, Chorioamniotis, low birth weight, post partum endometritis

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37
Q

What causes thrush

A

Candida albicans - colonise the vagina causing symptoms

Progress to infection when in right environments

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38
Q

List some risk factors for candidiasis

A

Increased oestrogen
Poorly controlled diabetes
Immunosuppression - corticosteroids
Broad spectrum antibiotics

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39
Q

Describe the presentation of candidiasis

A

Thick, white discharge - does not smell
Vulval and vaginal itching, irritation and discomfort
Erythema, fissures, oedema, pain during sex, dysuria and excoriations

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40
Q

Describe the treatment of thrush

A

Single dose intravaginal clotrimazole cream (5g 10%) or pessary at night (500mg ON)

Three doses of clotrimazole pessaries 200mg over 3 nights

Single dose of fluconazole 150mg

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41
Q

How does antifungal medication affect condoms

A

Destroys the latex - women need to use alternative contraception or abstain for 5 days

42
Q

Describe chlamydia trachomatis

A

Gram negative bacteria

Intracellular organism - enters and replicates within cells before rupturing the cell and spreading to others

43
Q

Describe charcoal swabs

A

Microscopy, culture and sensitivities

Gram staining and light microscopy of endocervical and high vaginal swabs

44
Q

Describe nucleic acid amplification tests (NAAT)

A

Check directly for the DNA/RNA of the organism
Chlamydia and gonorrhoea
Vulvovaginal, endocervical, rectal, pharyngeal and first catch urine

45
Q

What swabs are required in gonorrhoea

A

NAAT

Endocervical charcoal swab for MC&S

46
Q

Describe the presentation of chlamydia in women

A 
Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding
Painful sex
Painful urination
47
Q

Describe the presentation of chlamydia in men

A

Urethral discharge/discomfort
Painful urination
Epididymo-orchitis
Reactive arthritis

48
Q

Describe the examination findings in chlamydia

A

Pelvic/abdo tenderness
Cervical motion tenderness
Inflamed cervix
Purulent discharge

49
Q

Describe the treatment of chlamydia

A

Doxycycline 100mg bd for 7 days

Azithromycin 1g stat then 500mg OD for 2 days/ erythromycin 500mg for 7 days in pregnant and breast feeding

50
Q

List the complications of chlamydia

A 
PID
Chronic pelvic pain
Infertility 
Ectopic pregnancy
Epididymoorchitis
Conjunctivitis
Lymphogranuloma venereum
Reactive arthritis
51
Q

List some complications of chlamydia in pregnancy

A 
Preterm delivery
Premature rupture of membranes
Low birth weight
Postpartum endometritis
Neonatal infection - conjunctivitis and pneumonia
52
Q

Describe Fitz-hugh-curtis syndrome

A

PID complication - liver capsule becomes inflamed causing right upper quadrant pain, scar tissue formation and peri-hepatic adhesions

53
Q

What swabs are required in chlamydia

A

Vulvovaginal NAAT

54
Q

Describe Neisseria gonorrhoea

A

Gram negative diplococcus bacteria
Infects mucous membranes with columnar epithelium - endocervix in women, urethra, rectum and conjunctiva
Spread via contact with mucus secretions from infected areas
High level of antibiotic resistance

55
Q

How does gonorrhoea present in women

A

Odourless purulent discharge - yellow or green
Dysuria
Pelvic pain

56
Q

How does gonorrhoea present in men

A

Odourless purulent discharge - yellow or green
Dysuria
Testicular pain and swelling

57
Q

How is gonorrhoea diagnosed

A

NAAT - RNA/DNA

Charcoal endocervical swab for MC&S - high rate of antibiotic resistance

58
Q

Describe the management of gonorrhoea

A 
Testing
Treatment - IM ceftriaxone 1g or oral ciprofloxacin 500mg 
Contact tracing 
Abstain from sex for 7 days 
Test of cure
59
Q

List some complications of gonorrhoea

A 
PID
Chronic pelvic pain
Infertility 
Epididymoorchitis
Prostatitis 
DIC
Urethral strictures
Septic arthritis
Endocarditis 
Gonococcal gonorrhoea
60
Q

Describe disseminated gonococcal infection

A 
Complication of untreated gonococcal infection - bacteria spreads to the skin and joints 
Various non-specific skin lesions
Polyarthralgia
Migratory polyarthritis
Tenosynovitis
Systemic symptoms
61
Q

What is mycoplasma genitalium a cause of

A

Non-gonococcal urethritis

STI

62
Q

List the symptoms of mycoplasma genitalium

A 
Urethritis 
Epididymitis
Cervicitis 
Endometritis
PID
RA
Preterm delivery in pregnancy 
Tubal infertility
63
Q

Describe the investigations of mycoplasma genitalium

A

NAAT - DNA and RNA as it is slow growing bacteria so culture not possible

First urine sample in the morning - men
Vaginal swab - women

Check for macrolide resistance and test of cure after treatment

64
Q

Describe the treatment of mycoplasma genitalium

A

Doxycycline 100mg bd 7days then azithromycin 1g stat then 500mg od for 2 days

Moxifloxacin is alternative for complicated infection

Azithromycin used alone in pregnancy

65
Q

List some symptoms of PID

A 
Pelvic/abdo pain
Abnormal vaginal discharge/bleeding
Pain during sex
Fever
Dysuria
66
Q

Describe trichomonas vaginalis

A

Parasite spread via sex and lives in the urethra and vagina

Protozoan and is a singled celled organism with 4 flagella (appendages stretching from the body) on the front and one on the back. Use the flagella for movement, attaching to tissues and causing damage

67
Q

What can trichomonas increase the risk of

A

Contracting HIV - damages the vaginal mucosa
BV
Cervical Ca
PID
Pregnancy related complication - preterm delivery

68
Q

Describe the presentation of trichomonas vaginalis

A

Up to 50% asymptomatic

Vaginal discharge(frothy/yellow/green with a fishy smell), itching, dysuria, dyspareunia, balanitis

Strawberry cervix (colpitis macularis) - inflammation relating to the infection with tiny haemorrhages seen across the cervix

Vaginal pH >4.5

69
Q

How is trichomonas vaginalis diagnosed

A

Charcoal swabs from the posterior fornix with microscopy or self taken low vaginal swab or urethral swab or first catch urine

70
Q

What is the treatment of trichomonas

A

Metronidazole

71
Q

What are the two types of herpes simplex virus

A

1 (cold sore)
2 (genital)

HSV 1 may occur on genitals via orogenital sex

72
Q

Where does oral herpes simplex lay dormant

A

Trigeminal nerve ganglion

73
Q

Where does genital herpes lay dormant

A

Sacral nerve ganglion

74
Q

How is herpes simplex spread

A

Direct contact with mucous membranes or viral shedding in mucous secretions

75
Q

When is asymptomatic viral shedding most common

A

First 12 months of infection

76
Q

Describe the presentation of genital herpes

A 
Ulcers or blistering lesions
Neuropathic pain - tingling, burning, shooting
Flu like symptoms 
Dysuria
Inguinal lymphadenopathy

Symptoms can last 3 weeks in primary infection

Recurrent symptoms usually milder and resolve more quickly

77
Q

How is genital herpes diagnosed

A

Clinical diagnosis but viral PCR swab from lesion can confirm the organism

78
Q

How is primary genital herpes contracted before 28 weeks gestation treated

A

Aciclovir during inital infection followed by regular prophylatic aciclovir from 36weeks onwards to reduce risk of genital lesions during labour and delivery
Women with symptoms recommend C-section

79
Q

How is primary genital herpes contracted after 28weeks gestation managed

A

Treat with aciclovir during initial infection followed by immediate regular prophylactic Aciclovir.
C-section in all cases

80
Q

How is recurrent genital herpes managed in a woman known to have genital herpes before pregnancy

A

Prophylatic acidlovir from 26 weeks although risk of neonatal infection is low even if lesions present during delivery

81
Q

List some AIDs (immunodeficient/late stage HIV) defining illnesses

A 
Kaposi's sarcoma 
Pneumocystis jivoreci pneumonia 
CMV
Candidiasis - oesophageal/bronchial
Lymphoma
TB
82
Q

Describe HIV

A

RNA retrovirus
HIV1 (common) and 2 (rare outside of africa)
Virus enters and destroys CD4 T helper cells
Transmitted via unprotected anal, vaginal or oral sexual activity, mother to child at any stage of pregnancy birth or breastfeeding, mucous membrane, blood or open wound exposure to infected blood or bodily fluids

83
Q

Describe the initial seroconversion of HIV

A

Flu like illness within few weeks of infection

84
Q

Which antigen is tested for in HIV antigen testing

A

p24

85
Q

Describe monitoring in HIV

A

CD4 count 500-1200 (normal range), <200 is end stage HIV

Viral load - HIV RNA, undetectable <50 copies

86
Q

What are some HIV management

A

2 NRTIs (Nucleoside reverse transcriptase inhibitors - tenofovir and emtricitabine) plus a third agent

Prophylactic co-trimoxazole (septrin) - protect against PCP if CD4 <200

Statins for cardiovascular disease

Yearly cervical smears

Vaccinations - influenza, pneumococcal, hep A and B, tetanus diphtheria and polio

87
Q

What drug can be given during delivery or to the baby in a HIV mother

A

Zidovudine

88
Q

Is breastfeeding safe in HIV

A

No

89
Q

How long can post exposure prophylaxis be commenced after HIV exposure

A

72hrs

90
Q

Describe PEP

A

ART therapy - Truvada (emtricitabine and tenofovir) and raltegravir for 28 days
HIV test immediately and 3 months after

91
Q

What class of drugs are HIV drugs ending in -navir

A

Protease inhibitors

92
Q

Describe toxoplasmosis

A

HIV
Neuro symptoms
Multiple brain lesions with ring
enhancement

93
Q

What is the most common cause of diarrhoea in HIV patients

A

Cryptosporidium

94
Q

Describe Kaposi’s sarcoma

A

Caused by HHV8
Purple papules or plaques on the skin or mucosa
Skin lesions may ulcerate
Respiratory involvement may cause haemoptysis or pleural effusion

95
Q

How is Kaposi’s sarcoma managed

A

Radiotherapy and resection

96
Q

Describe Cryptococcus neoformans on LP

A

Stains with india ink

97
Q

Name and describe the bacteria which causes syphilis

A

Treponema pallidum - spirochete - spiral shaped bacteria

98
Q

How is syphilis spread

A

Oral, vaginal, anal sex
Vertical transmission
IVDU
Blood transfusions and other transplants

99
Q

Describe the stages of syphilis

A

Primary - painless ulcer (chancre) and lymphadenopathy 3-8 weeks

Secondary syphilis - systemic symptoms - maculopapular rash, condylomata lata (grey wart like lesion around genitals and anus), low grade fever, lymphadenopathy, alopecia, oral lesions, these resolve after 3-12 weeks

Latent syphilis - early latent <2yrs and late latent >2yrs

Tertiary syphilis - development of gummas (granulomatous lesions), cardiovascular (aortic aneurysms) and neurosyphilis (headache, altered behaviour, dementia, ocular syphilis, argyll-robertson pupil (constricted pupil that accommodates but does not react to light), paralysis, sensory impairment. tabes dorsalis (demyelination affecting the spinal cord posterior columns)

100
Q

How is syphilis diagnosed

A

Antibody testing to the T.pallidum bacteria

Samples tested for T.pallidum with dark field microscopy and PCR

101
Q

What is the treatment for syphilis

A

Deep IM injection of benzathine benzylpenicillin

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