Sexual Health

Question 1

Indication for HIV testing

Answer 1

HIV sx:
	• Fever.
	• Chills.
	• Rash.
	• Night sweats.
	• Muscle aches.
	• Sore throat.
	• Fatigue.
Swollen lymph nodes.

Question 2

Ix for HIV

Answer 2

Blood test

1. Venous- HIV virus 
2. Finger - Antibodies against HIV 

Oral swab – Antibodies against HIV

Question 3

Sx for candida

Answer 3

1. ‘cottage cheese’, non-offensive discharge
2. vulvitis: superficial dyspareunia, dysuria
3. itch
4. vulval erythema, fissuring, satellite lesions may be seen

Question 4

Ix for candida

Answer 4

a high vaginal swab is not routinely indicated if the clinical features are consistent with candidiasis

Question 5

Types of swabs

Answer 5

1. High-vaginal charcoal – BV, trichomonas vaginalis, candida
2. NAAT swab – chlamydia and gonorrhoea
   - -> endocervical
3. Cervical smear
4. Endocervical charcoal – microscopy and sensitivities for gonorrhoea

Question 6

Types of discharge

Answer 6

1. Bacterial vaginosis: thin, profuse fishy-smelling discharge without pruritis or inflammation.
2. Candidiasis: a curd-like, non-offensive discharge with associated pruritis and inflammation.
3. Chlamydia and gonorrhoea (symptomatic): purulent vaginal discharge
4. Trichomoniasis: offensive yellow, frothy vaginal discharge with associated pruritis and inflammation.

Question 7

Ix for syphilis

Answer 7

1. Microscopy- rod like wiggly structures on microscopy (dark ground microscopy)
2. Blood test- IgG ( routine screening contact), IgM- ( acute early infection)

Question 8

Ix for chlamydia

Answer 8

Nucleic acid amplification tests (NAATs) to confirm the diagnosis.

In women:
1. An endocervical or vulvovaginal swab can be taken.

2. Alternatively, a first-catch urine (FCU) sample can be collected if the woman prefers this.
   - To collect FCU, urine should have been held in the bladder for at least 1 hour before being tested.
   - The first 20 mL of the urinary stream should be captured.

In men:
1. A FCU is the specimen of choice.

2. A urethral swab is an alternative.

Question 9

Ix for Gonorrhea

Answer 9

Swab culture: which allows abx sensitivity to be analysed as well as diagnosis

Nucleic acid amplification testing – Males: first pass urine, females: vaginal/cervical swabs

Question 10

Test of cure in Chlamydia, gonorhoea & Trichomonas vaginalis

Answer 10

Gonorrhoea

• Test of Cure – In all Cases
• 72 hours for Culture
• 2 weeks for NAAT

Chlamydia

• Test of Cure: Pregnancy, Symptoms Persist and for all rectal infections (good practice routinely)
• 3-5 weeks later

Trichomonas vaginalis

• A re-test should be conducted 1 week post treatment.
• If infection is still present, then repeat standard 7 day course of treatment.