Sexual Health Flashcards
1
Q
Uncomplicated chlamydia
A
Infection has not ascended to the upper genital tract
- Chlamydia is AS in 70% women, 50% men
2
Q
women S+S chlamydia
A
- Post coital, IM bleeding
- Increased or purulent discharge
- Mucopurulent cervical discharge
- Deep dyspareunia
- Dysuria
- Pelvic pain and tenderness
- Inflamed cervix
3
Q
Men S+S chlamydia
A
- Dysuria
- Urethral discharge
- Urethral discomfort
- Epididymo-orchitis or reactive arthritis
4
Q
Ix chlamydia
A
- Vaginal swab women
- Men = 1st void urine
- NAAT
5
Q
Chlamydia Tx
A
- Doxycycline 100mg 2x day for 7 days
- Women pregnant, breastfeeding = azithromycin, amox or erythro
6
Q
Other S+S chlamydia
A
- Rectal = discharge and discomfort
- Conjunctivitis
- Oropharyngeal = pharyngitis and sore throat
7
Q
Definition uncomplicated gonorrhoea
A
- localised and primarily affects the mucous membranes or urethra, endocervix, rectum, pharynx and conjunctiva
8
Q
Disseminated gonorrhoea
A
- Uncommon
- Petechial or pustular aral skin lesions
- asymetrical arthralgia
- Tenosynovitis
- Septic arthritis
9
Q
S+S gonorrhoea penis
A
- Urethral discharge
- Dysuria
- 2-5 days after exposure
- Mucopurulent or purulent urethral discharge
- Sometimes epididymal tenderness or swelling
10
Q
S+S gonorrhoea vagina
A
- Asymptomatic
- Develop within 10 days
- Abdo pain
- IM bleeding
- Dyspareunia
- Dysuria
- Altered discharge
11
Q
Ix gonorrhoea
A
- NAAT showing neisseria gonorrhoeae by swab or urine
- Uncomplicated anogenital or pharyngeal = IM ceftriaxone
12
Q
Mx gonorrhoea
A
Cef and azith
13
Q
1st episode genital herpes
A
- blisters burst to leave erosions and ulcers on external geintaliea
- 4-7 days after exposure
- Dysuria
- Discharge
- Systemic
14
Q
Recurrent herpes
A
- reactivation
- Blisters or ulcers unilaterally in single site
- prodromal tingling and burning
15
Q
Tx initial episode herpes
A
- 200mg acyclovir 5X daily
16
Q
BV definitoin
A
- overgrowth of anaerobic organisms and a loss of lactobacilli
- Vagina loses normal acidity and pH increases over 4.5
17
Q
RF for BV
A
- Sexually active
- Douches, deoderant, vaginal washes, menstruation and semen in vagina
- copper IUD
- smoking
18
Q
BV symptoms
A
- Fishy smelling discharge
- Examination may reveal thin white homogeneous discharge on walls
19
Q
BV Tx
A
- Oral metronidazole
- intravaginal metronidazole or clindamycin gel
20
Q
What bacterium causes syphilis
A
- Spirochete bacterium treponema pallidum
21
Q
Complications syphilis
A
- Neurosyphilis
- Cardiovascular
- Gummatous syphilis
22
Q
S+S syphilis
A
- Genital lesions = solitary, painles, indurated, genital ulcer (chancre)
- Non pruritic maculopapular rash
- Moist wart like lesion (condylomata lata)
- Patchy lesions on oral mucosa
- Generalised lymphadenopathy
- Unexplained neuro or opthalmological Sx
23
Q
Tx syphilis
A
- 1st line = parenteral benzathine and procaine penicillin
24
Q
Ix syphilis
A
- Swabs from lesions
- Dark field microscopy
- PCR
25
Mycoplasma fenitalium
- No cell wall = not visible by gram stain
- Found in genital tract and rectum
- Oropharynx rare
26
MF S+S penis
- Asymtpomatic
- Urethral discharge
- Dysuria
- Penile irritation
- Urethral discomfort
- SARA
- Epididymo orchitis
27
MF S+S Vagina
- Asymptomatic
- Dysuria
- PC/IM bleeding
- Cervicitis
- PID
- SARA
- Pre term delivery
28
MF testing
- Penis = 1st void
- Vagina = viral swab
- Test partners patient wants to have sex with again
29
MF Tx
Non complicated
- 1st line doxy 100mg BD 7 days followed by azith 1g on day 1, 500mg day 2 and 3
- 2nd line = moxifloxacin
Complicated
- Moxifloxacin 400mg OD 14 days
- Test of ure at 5 weeks
30
Complicated gonorrhoea
- Proctitis
- Conjunctivitis
- PID
- Tenosynovitis
- Arthritis
- SARA
- DGI
31
Causes SARA
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Mycoplasma genitalium
32
Shigella
- Causes bloody diarrhoea, fever, cramps
- Mistaken for food poisoning
- Bi and gay men at risk
TX if severe (fever, blood, sepsis)
- If tx needed discuss with microbiology
33
Primary syphilis
- Primary chancre = 95% genital skin
- Incubation 9-90 days
- Dusky macule - papule
- Regional nodes 1-2 weeks after chancre
34
Secondary syphillis
- 4-10 weeks after infection
- Untreated 25% of people will develop signs of secondary syphilis
- Primary chancre may be present concurrently (30%)
- May have no hx primary chancre
35
S+S Secondary syphilis
- Rash
- Mucous membrane lesions
- Lymphadenopathy
- Optic sx
36
Prep
- Tenofovir DF/emtricitabine licensed and comissioned in UK
- Daily dosing or event based
>99% effective
37
1st line pep regimen
- Tenofovir disoproxil 245mg/emtricitabine 200mg with raltegravir 1200mg OD for 28 days
38
What causes trichomoniasis
- Flagellated protozoan trichomonas vaginalis
39
S+S trichomoniasis vagina
- Dysuria
- Offensive odour
- Discharge
- Itching
- Asymptomatic
40
S+S trichomoniasis penis
- Asymptomatic
- Urethral discharge
- Dysuria
41
trichomoniasis Ix
- High vaginal swab
- Urethral swab +/- 1st void for penis
42
Trich Tx
- oral metronidazole 400 - 500mg 2x day for 7 days
- Or single 2g dose
- Abstinence for 1 week until treatment and follow up
43
S+S genital warts
- Lesions may be single or multiple and tend to occur in areas of high friction.
- Warts on dry, hairy skin tend to be firm and keratinized (horny).
- Those on warm, moist, non–hair-bearing skin tend to be soft and non-keratinized.
- Lesions may be broad-based or pedunculated (attached by a stalk), and some are pigmented
44
Genital warts treatment
- No treatment — one-third of visible warts disappear spontaneously within 6 months.
- Self-applied treatments (podophyllotoxin 0.5% solution, or 0.15% cream, imiquimod 5% cream, sinecatechins 10% ointment).
- Ablative methods (such as cryotherapy, excision, and electrocautery)
45
How HIV transmitted
- Sexual activity
- Vertically from mother to child
- By inoculation
46
Presentation of primary HIV infection
- Flu like illness in first few weeks
- Asymptomatic stage once symptoms PHI resolve
- Advanced = <200 CD4
47
When to consider HIV
- Common sx or infections unusually severe, prolonged, recurrent or unexplained
- Conditions related to immunosuppression = shingles, candidiasis
- Glandular fever like illness
- Lymphadenopathy of unknown origin
- Pyrexia of unknown origin
- Weight loss >10kg
- Lifestyle and social RF
48
Infants HIV S+S
- Fail to thrive
- Pneumocystis pneumonia
- CMV
- HIV encephalopathy
49
Most common tumour in those with HIV
Kaposi's sarcoma
- Dark purple or brown intradermal skin lesions
50
Resp conditions associated with HIV
- Pneumocystis pneumonia = fever, dry cough, crackles, SOB
- TB
51
Neuro conditions associated with HIV
- Cryptococcal meningitis
- Cerebral toxoplasmosis
- Cerebral lymphoma
- CMV retinitis
52
Oral conditions and HIV
- Oral candidiasis
- Aphthous ulcers
- Oral hairy leukoplakia
- Gingivitis
- Abscess
53
complications maternal chlamydia
- Chorioamnionitis
- Neonatal conjunctivitis
- Neonatal pneumonia
- Prelabour rupture of membranes
54
features maternal syphilis
- Generalised lymphadenopathy
- Hepatosplenomegaly
- Rash
- Skeletal malformations
