Sexual Health Flashcards
What is a male sexual dysfunction?
Erectile dysfunction is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.
Symptoms of ED
- Erectile problems
2. Premature ejaculation
Investigations for ED
- FBC, U&E, LFT - raised in acute/chronic illnesses
- TFT - possible hypothyroidism
- Lipids - raised: consider arterial disease
- HbA1c - diabetes can cause sexual dysfunction
- PSA - raised: query UTI, prostatitis, prostate Ca
- Testosterone, FSH, LH, Prolactin: abnormal levels
Management of ED
- Admission: priapism (persistent erection)
- Referral:
- Urology – difficulty obtaining or maintain an erection
- Endo: hypogonadism
- CVS: unstable CVD that would make sexual activity unsafe
- Mental Health: psychogenic cause - PDE-5 inhibitor
- Sildenafil (Viagra) - Vacuum erection
What contraceptive is contraindicated if > 35 y/o + smoker?
COCP
Vaginal ring
Patch
What contraceptive can you use if > 35 y/o + smoker?
Progesterone only pill
What is female sexual dysfunction?
Female sexual dysfunction involves the decrease or increase of sexual responsiveness in females.
What is female sexual dysfunction broken down into?
- Sexual disinterest
- Arousal disorder
- Orgasmic disorder
- Vaginismus
- Dyspareunia
- Persistent genital arousal
Ix for infertility
- semen analysis
- serum progesterone 7 days prior to expected next period. For a typical 28 day cycle, this is done on day 21.
- Hormones between 3 rd and 5 th day of menstrual cycle. Mid luteal serum progesterone level (if this doesn’t rise indicates anovulation).
Interpret serum progesterone
< 16 nmol/l = Repeat, if consistently low refer to specialist
16 - 30 nmol/l = Repeat
> 30 nmol/l= Indicates ovulation
What advice would you give for infertility?
- folic acid
- aim for BMI 20-25
- advise regular sexual intercourse every 2 to 3 days
- smoking/drinking advice
Sx for HPV
usually asymptomatic
- benign wart – commonly seen on the hands and feet
- anal & genital infections
- many wart – cauliflower-like
- Painless, itchy, burning, local pain or bleeding - voice changes & high-pitched breath sounds
Ix for HPV
Warts are clinically diagnosed
- Infections of mucus membranes may require further interventions- epithelial cells
o Endoscopy
Definitive diagnosis = molecular testing of biopsied cells for viral DNA or RNA
Management of HPV
Usually not treated
Removal of wart & percutaneous lesions with: o Salicylic acid products o Liquid nitrogen cryotherapy o Laser removal o Surgical removal
What is BV?
Overgrowth of predominately anaerobic organisms such as Gardnerella vaginalis.
Features of BV
vaginal discharge: ‘fishy’, offensive
Management of BV
oral metronidazole for 5-7 days
What is chlamydia?
sexually transmitted infection caused by Chlamydia trachomatis
Features of chlamydia
Can be asymptomatic
- women: cervicitis (discharge, bleeding), dysuria
- men: urethral discharge, dysuria
Ix for chlamydia
Diagnostic: Nuclear acid amplification tests (NAATs)
- Women: the vulvovaginal swab (1st line)
- Men: the urine test (1st line)
Chlamydia testing should be carried out two weeks after a possible exposure
Management of chlamydia
1st line = doxycycline (7 day course)
Pregnant = azithromycin
Causative organism of gonorrhoea
Gram-negative diplococcus Neisseria gonorrhoeae
Where can gonorrhoea infection affect?
Acute infection can occur on any mucous membrane surface, typically genitourinary but also rectum and pharynx.
Features of gonorrhoea
males: urethral discharge, dysuria
females: cervicitis e.g. leading to vaginal discharge
rectal and pharyngeal infection is usually asymptomatic
Management of gonorrhoea
1st line = Single dose of IM ceftriaxone 1g
Causative organism for syphilis
spirochaete Treponema pallidum
Features of syphilis
Primary:
Painless ulcer: Chancre
Secondary (6-10 weeks after primary):
- Systemic : fevers, lymphadenopathy
- Itchy rashes developing in one area or all over the body
Tertiary:
Not an infectious stage but the bacteria has started to effect major organs: neurosyphilis
Meningitis can occur at this stage
Latent
Asymptomatic
Ix for syphilis
The diagnosis is therefore usually based on clinical features, serology and microscopic examination of infected tissue.
Management of syphilis
Medical :
- IM benzathine penicillin (1st line)
- Doxycycline
Conservative :
- Avoid UPSI and needle sharing
Surgical :
- If tertiary syphilis = surgical intervention
What is HIV?
Human Immunodeficiency Virus (HIV) - compromises the immune system & eventually makes the host vulnerable to opportunistic infections
Leads to AIDs (late stage HIV)
Features of HIV
- sore throat
- lymphadenopathy
- malaise, myalgia, arthralgia
- diarrhoea
- maculopapular rash
- mouth ulcers
- rarely meningoencephalitis
Diagnosis of HIV
Combination tests: HIV p24 antigen and HIV antibody
- If positive it should be repeated to confirm the diagnosis
- some centres may also test the viral load (HIV RNA levels) if HIV is suspected at the same time
- testing in asymptomatic patients should be done at 4 weeks after possible exposure
- after an initial negative result in an asymptomatic patient, offer a repeat test at 12 weeks
Management of HIV
Antiretrovirals (ART)
Combination of 3 drugs :
2 nucleoside reverse transcriptase inhibitors (NRTI)
and
either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI)
What is the most common opportunistic infection in AIDS
Pneumocystis carinii/ Pneumocystis jiroveci
Prophylaxis for PCP
All patients with a CD4 count < 200/mm³ should receive PCP prophylaxis
Most common complication of PCP
pneumothorax
