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FCM Matrix > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

What is a male sexual dysfunction?

A

Erectile dysfunction is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance.

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2
Q

Symptoms of ED

A
  1. Erectile problems

2. Premature ejaculation

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3
Q

Investigations for ED

A
  1. FBC, U&E, LFT - raised in acute/chronic illnesses
  2. TFT - possible hypothyroidism
  3. Lipids - raised: consider arterial disease
  4. HbA1c - diabetes can cause sexual dysfunction
  5. PSA - raised: query UTI, prostatitis, prostate Ca
  6. Testosterone, FSH, LH, Prolactin: abnormal levels
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4
Q

Management of ED

A
  1. Admission: priapism (persistent erection)
  2. Referral:
    - Urology – difficulty obtaining or maintain an erection
    - Endo: hypogonadism
    - CVS: unstable CVD that would make sexual activity unsafe
    - Mental Health: psychogenic cause
  3. PDE-5 inhibitor
    - Sildenafil (Viagra)
  4. Vacuum erection
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5
Q

What contraceptive is contraindicated if > 35 y/o + smoker?

A

COCP
Vaginal ring
Patch

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6
Q

What contraceptive can you use if > 35 y/o + smoker?

A

Progesterone only pill

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7
Q

What is female sexual dysfunction?

A

Female sexual dysfunction involves the decrease or increase of sexual responsiveness in females.

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8
Q

What is female sexual dysfunction broken down into?

A
  • Sexual disinterest
  • Arousal disorder
  • Orgasmic disorder
  • Vaginismus
  • Dyspareunia
  • Persistent genital arousal
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9
Q

Ix for infertility

A
  1. semen analysis
  2. serum progesterone 7 days prior to expected next period. For a typical 28 day cycle, this is done on day 21.
  3. Hormones between 3 rd and 5 th day of menstrual cycle. Mid luteal serum progesterone level (if this doesn’t rise indicates anovulation).
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10
Q

Interpret serum progesterone

A

< 16 nmol/l = Repeat, if consistently low refer to specialist
16 - 30 nmol/l = Repeat
> 30 nmol/l= Indicates ovulation

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11
Q

What advice would you give for infertility?

A
  • folic acid
  • aim for BMI 20-25
  • advise regular sexual intercourse every 2 to 3 days
  • smoking/drinking advice
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12
Q

Sx for HPV

A

usually asymptomatic

  1. benign wart – commonly seen on the hands and feet
  2. anal & genital infections
    - many wart – cauliflower-like
    - Painless, itchy, burning, local pain or bleeding
  3. voice changes & high-pitched breath sounds
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13
Q

Ix for HPV

A

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

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14
Q

Management of HPV

A

Usually not treated

Removal of wart & percutaneous lesions with:
o	Salicylic acid products
o	Liquid nitrogen cryotherapy
o	Laser removal
o	Surgical removal
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15
Q

What is BV?

A

Overgrowth of predominately anaerobic organisms such as Gardnerella vaginalis.

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16
Q

Features of BV

A

vaginal discharge: ‘fishy’, offensive

17
Q

Management of BV

A

oral metronidazole for 5-7 days

18
Q

What is chlamydia?

A

sexually transmitted infection caused by Chlamydia trachomatis

19
Q

Features of chlamydia

A

Can be asymptomatic

  1. women: cervicitis (discharge, bleeding), dysuria
  2. men: urethral discharge, dysuria
20
Q

Ix for chlamydia

A

Diagnostic: Nuclear acid amplification tests (NAATs)

  1. Women: the vulvovaginal swab (1st line)
  2. Men: the urine test (1st line)

Chlamydia testing should be carried out two weeks after a possible exposure

21
Q

Management of chlamydia

A

1st line = doxycycline (7 day course)

Pregnant = azithromycin

22
Q

Causative organism of gonorrhoea

A

Gram-negative diplococcus Neisseria gonorrhoeae

23
Q

Where can gonorrhoea infection affect?

A

Acute infection can occur on any mucous membrane surface, typically genitourinary but also rectum and pharynx.

24
Q

Features of gonorrhoea

A

males: urethral discharge, dysuria
females: cervicitis e.g. leading to vaginal discharge

rectal and pharyngeal infection is usually asymptomatic

25
Q

Management of gonorrhoea

A

1st line = Single dose of IM ceftriaxone 1g

26
Q

Causative organism for syphilis

A

spirochaete Treponema pallidum

27
Q

Features of syphilis

A

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

28
Q

Ix for syphilis

A

The diagnosis is therefore usually based on clinical features, serology and microscopic examination of infected tissue.

29
Q

Management of syphilis

A

Medical :

  • IM benzathine penicillin (1st line)
  • Doxycycline

Conservative :
- Avoid UPSI and needle sharing

Surgical :
- If tertiary syphilis = surgical intervention

30
Q

What is HIV?

A

Human Immunodeficiency Virus (HIV) - compromises the immune system & eventually makes the host vulnerable to opportunistic infections

Leads to AIDs (late stage HIV)

31
Q

Features of HIV

A
  • sore throat
  • lymphadenopathy
  • malaise, myalgia, arthralgia
  • diarrhoea
  • maculopapular rash
  • mouth ulcers
  • rarely meningoencephalitis
32
Q

Diagnosis of HIV

A

Combination tests: HIV p24 antigen and HIV antibody

  1. If positive it should be repeated to confirm the diagnosis
  2. some centres may also test the viral load (HIV RNA levels) if HIV is suspected at the same time
  3. testing in asymptomatic patients should be done at 4 weeks after possible exposure
  4. after an initial negative result in an asymptomatic patient, offer a repeat test at 12 weeks
33
Q

Management of HIV

A

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)

34
Q

What is the most common opportunistic infection in AIDS

A

Pneumocystis carinii/ Pneumocystis jiroveci

35
Q

Prophylaxis for PCP

A

All patients with a CD4 count < 200/mm³ should receive PCP prophylaxis

36
Q

Most common complication of PCP

A

pneumothorax

FCM Matrix (17 decks)

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