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Phase 3a > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

Contacts of which conditions are treated for chlamydia?

A

PID
epididymo-orchitis

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2
Q

Pharmacological management of chlamydia?

A

doxycycline 100mg BD 7 days
= CI in pregnancy

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3
Q

Counselling for chlamydia diagnosis?

A

no sex for 1 week + after partner treated
see health advisor for treatment and contact tracing
warning: oesophageal irritation and avoid direct sunlight
advise re-test in 3mo if <25yrs (document)
ToC in 6wks if pregnant or if rectal infection

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4
Q

After what positive tests is gonorrhoea treated?

A

not after +ve GC NAAT alone
always obtain cultures

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5
Q

Pharmacological management of gonorrhoea?

A

ceftriaxone 1g/3.5mls 1% lidocaine IM stat
OR
if cultures available: ciprofloxacin 500mg stat, if sensitive

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6
Q

Counselling for gonorrhoea diagnosis?

A

no sex for 1 week + after partner treated
see health advisor for contact tracing
ToC in 2 wks

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7
Q

Which contacts of gonorrhoea are treated?

A

empirical tx if sexual contact was in last 2wks

if >2wks ago: screen all 3 sites (incl cultures) + wait to treat

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8
Q

Management of BV? When is BV treated?

A

if symptomatic or grade II/III
metronidazole 2g stat
OR 400mg BD for 7 days if pregnant/risk of pregnancy
no alcohol for 48hrs after metronidazole (N&V, flushing)

aqeuous cream - mix with water for washing if desired
prevention advice: wash only with water, avoid soap/shower gell etc, avoid washing hair in bath

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9
Q

Counselling for TV diagnosis?

A

ToC if pregnant
see health advisor for contact tracing

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10
Q

Pharmacological management of thrush?

A

clotrimazole pessary 500mg stat
+/- clotrimazole 1% cream BD if vulval irritation

fluconazole 150mg PO stat if requested but NOT if pregnant/at risk of pregnancy

see GP if recurrent thrush

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11
Q

Management of 1st herpes outbreak?

A

Aciclovir 400mg TDS 5/7 with Instillagel topical PRN

if severe, f/u in 1wk
“task” yourself to chase result
if HSV -ve, write clinical note about further action - what was the sore?
write to gp if +ve in case of recurrences

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12
Q

Pharmacological management of recurrence of herpes?

A

aciclovir 800mg TDS 2/7

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13
Q

Counselling for HSV diagnosis?

A

obtain GC/CT blind swab if possible + HIV/STS bloods
advise saline baths/urinate in bath
attend a&e if can’t urinate
if pregnant, discuss with senior dr
if >6 outbreaks a yr, consider suppression and discuss with senior dr

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14
Q

What are the tx options and their SEs for genital warts?

A

creams = 1st line
- MUST be on reliable contraception
- SE: soreness, blisters, dermatitis

warticon (podophyllotoxin) topic 3 consecutive days BD

imiquimod topical nocte
- every other night across 6 days, need to wash off in morning

cyrotherapy - 3 freeze thaw cycles weekly
- SE: painful, hypopigmentation, scarring

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15
Q

Essential mx in women with abdo pain?

A

concerned about PID
check urine dip/pregnancy test + do PV
ie exclude UTI and pregnancy

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16
Q

Pharmacological management of PID?

A

take mycoplasma swab if treating
ceftriaxone 1g IM stat /3.5ml 1% lidocaine
AND
doxycycline 100mg BD 14/7
AND
metronidazole 400mg BD 14/7
regular ibuprofen

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17
Q

Counselling for PID diagnosis?

A

no sex for 2wks/1wk after partner treated
document given contact slips to give to partners + to abstain until treated
f/u in 2wks for results and review

at review:
give results
check abstained and compliant with abx
partner treated
sx improved?
repeat PV
mycoplasma +ve required further tx

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18
Q

Who should be tested for mycoplasma genitalium?

A

men with microscopically confirmed NGU (split initial urine into 2 - 1 for CT/GC, 1 for myco)
all women with PID - VVS
all current sexual contacts of +ve mycoplasma - only tx contacts if +ve

mycoplasma ToC in 5wks

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19
Q

How is NGU microscopically confirmed?

A

> 5 PC’s on microscopy (normally men have none)

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20
Q

Pharmacological management of epididymo-orchitis?

A

if likely gonorrhoea:
Ceftriaxone 1g IM stat / 3.5ml 1% lidocaine
AND
Doxycycline 100mg BD for 14 days

if likely chlamydia/other non-gonococcal organism (ie if microscopy was -ve for GC + no RFs):
Doxycycline 100mg PO daily for 14 days

regular analgesia

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21
Q

Counselling for epididymo-orchitis diagnosis?

A

no sex for 2 weeks/1 wk after partner tx
document given contact slips
f/u in 2 wks

at review:
give results
check abstained and compliant with abx
partner treated
sx improved?
repeat examination

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22
Q

Who is NGU tested for in?

A

men with dysuria, discharge or testicular pain

test for mycoplasma

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23
Q

Pharmacological management of NGU?

A

Doxycycline 100mg BD for 7 days

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24
Q

Counselling for NGU?

A

no sex for 1 wk and after partner treated
warn oesophageal irritation and avoid direct sunlight
document given contact slips

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25
Q

Tests done for asymptomatic woman?

A

self taken VVS (for GC/CT NAAT)
+ rectal if receive anal
bloods for HIV + STS

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26
Q

Tests done for symptomatic woman or contact of infection?

A

HSV swab if ulcers
VVS (for GC/CT NAAT + red topped one for mycoplasma)
+ rectal swab and culture if receive anal

bloods for HIV + STS

wet slide (use loop) of posterior fornix
dry slide (use cotton bud) of lateral walls
MOP CERVIX
slide + culture of cervix (use cotton bud) for GC

bimanual exam
if abdo pain/deep dyspareunia: urine dip/pregnancy test

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27
Q

When are pharyngeal swabs taken in women?

A

contact of gonorrhoea
CSW
patient request

= swab for GC/CT NAAT + culture for GC

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28
Q

Tests done for asymptomatic heterosexual men?

A

1st void urine for CT/GC NAAT
- should not have passed urine in last hr

bloods for HIV + STS

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29
Q

Tests done for symptomatic or contact of infection heterosexual men or ?

A

HSV swab if ulcers

urethral swab for slide and GC culture (small cotton bud)

bloods for HIV + STS

1st void urine
- if NGU - split urine and do M.gen PCR and resistance test

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30
Q

Tests done for asymptomatic MSM?

A

1st void urine for CT/GC NAAT
+ rectal and pharyngeal swabs
+ rectal and pharyngeal culture if sx/contact of GC

bloods for HIV, STS, Hep B Sag, Hep C ab
-doc should be vaccinated for hep b if -ve

offer hep a and b vaccine
offer hpv vaccine if <45
inform about PeP and PreP

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31
Q

Tests done for symptomatic MSM?

A

1st void urine for CT/GC NAAT
+ rectal and pharyngeal swabs
- if NGU - split urine and do M.gen PCR and resistance test

bloods for HIV, STS, Hep B Sag, Hep C ab

HSV swab if ulcers

urethral swab for slide and cultures (small cotton bud)

offer hep a and b vaccine
offer hpv vaccine if <45
inform about PeP and PreP

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32
Q

What is chlamydia caused by?

A

chlamydia trachomatis
(obligate IC bacteria)

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33
Q

How is chlamydia ad gonorrhoea transmitted?

A

sexual contact
vertical

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34
Q

RFs of chlamydia?

A

<25
new sexual partner
>1 sexual partner/yr
not using condoms

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35
Q

Clinical features of chlamydia in women and men?

A
  • asymptomatic in 70%
  • increased vaginal discharge
  • dysuria
  • pelvic pain
  • post coital/intermenstrual bleeding
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36
Q

Complications of chlamydia?

A

epididymo-orchitis
PID (1-30%)
infertility
ectopic pregnancy
reactive arthritis

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37
Q

What organism must be tested for in MSM with rectal chlamydia?

A

LGV
type of chlamydia bacteria that attacks the lymph node

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38
Q

What is gonorrhoea caused by?

A

neisseria gonorrhoeae
gram -ve diplococcus

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39
Q

Clinical features of gonorrhoea in women?

A
  • 50% asymptomatic
  • mucopurulent discharge (50%)
  • pelvic pain (25%)
  • dysuria (12%)
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40
Q

Clinical features of gonorrhoea in men?

A
  • <10% asymptomatic
  • mucopurulent discharge (80%)
  • dysuria (50%)
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41
Q

Clinical features of chlamydia in men?

A
  • asymptomatic in 50%
  • urethral discharge
  • dysuria
  • testicular pain
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42
Q

Complications of gonorrhoea?

A

epididymo-orchitis
PID

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43
Q

How is gonorrhoea diagnosed?

A

microscopy
NAAT
cultures prior to tx (due to increasing abx resistance)

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44
Q

How is chlamydia diagnosed?

A

NAAT

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45
Q

What is PID caused by?

A

ascending infection of chlamydia + gonorrhoea (25%), gardnerella vaginalis (BV), anaerobes, other vaginal commensals

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46
Q

Clinical features of PID?

A

bilateral lower abdominal pain
deep dyspareunia
abnormal vaginal bleeding
purulent discharge
fever
adnexal and cervical motion tenderness on bimanual

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47
Q

Differentials for PID?

A

ectopic - exclude pregnancy
appendicitis - vomiting
endometriosis - cyclical
ovarian cyst torsion/rupture - sudden onset
UTI - urinary sx
functional pain - longstanding

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48
Q

Inx for PID

A

full STI screen
pregnancy test
urinalysis
bimanual
mycoplasma PCR/resistance test

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49
Q

What additional abx are needed if PID is mycoplasma +ve?

A

moxifloxacin

50
Q

Complications of PID?

A

infertility
ectopic
chronic pelvic pain
pelvic abscess

51
Q

What is epididymo-orchitis caused by?

A

young pt: local extension of infection from STI (CT/GC)

older pt: UTI - gram -ve enteric organisms

rarely extrapulmonary TB

52
Q

Clinical features of epididymo-orchitis?

A

unilateral pain, swelling and inflammation of epididymis/testes

possibly urethral discharge, pyrexia, secondary hydrocele, symptoms of UTI

53
Q

Complications of epididymo-orchitis?

A

reactive hydrocele
abscess
tesicular infarction
infertility

54
Q

Differentials of epididymo-orchitis?

A

EXCLUDE testicular torsion - sudden onset pain = surgical emergency - needs testicle salvage in 6hrs
mumps - headache, fever, parotid swelling, serology

55
Q

Ivx for epididymo-orchitis?

A
  • gram stained urethral smear and culture
  • 1st void urine STI screen
  • urinalysis
  • MSU
  • mycoplasma if >5PCs on microscopy
56
Q

What organisms cause NGU?

A

no cause found in 50%

chlamydia trachomatis (45%)
mycoplasma genitalium
trichomonas vaginalis
ureaplasma urealyticum
UTI
adenoviruses
HSV
candida
trauma
irritation
urethral structure
lichen sclerosus
urinary calculi

57
Q

RFs for NGU?

A

sexually active
unprotected sex
homo/biseuxal
aged <35
multiple partners

58
Q

Complications of NGU?

A

epididymo-orchitis
sexually acquired RA

59
Q

Clinical features of NGU?

A

asymptomatic
urethral discharge
dysuria

60
Q

Inx of NGU?

A

gram stained urethral smear (>5PCs per field) + culture
1st pass urine
urinalysis
MSU
urine sample into two for GC/CT and mycoplasma PCR/resistance

61
Q

What organism is TV caused by?

A

flagellated prozoon

62
Q

Clinical features of TV in women?

A

asymptomatic (10-50%)
yellow frothy discharge
itching
dysuria
pelvic pain

63
Q

Clinical features of TV in men?

A

asymptomatic (15-50%)
urethral discharge
dysuria
frequency

64
Q

How is TV diagnosed?

A

wet slide from posterior fornix in females

urethral/urine culture in males

65
Q

What is BV caused by?

A

if vaginal pH >4.5, normal vaginal flora (lactobacilli) dominated by anaerobes cause the sx
eg gardnereall vaginalis

66
Q

How is TV transmitted?

A

sexual contact

67
Q

How is BV transmitted?

A

not sexually

68
Q

Clinical features of BV?

A

asymptomatic (50%)
thin white offensive smelling vaginal discharge
NO soreness, itching, irritation

69
Q

Complications of BV?

A

a/w miscarriage, preterm birth/PROM, postpartum endometritis in pregnancy

70
Q

How is BV diagnosed?

A

gram stained vaginal microscopy
- grade I - normal - only lactobacilli seen
grade II - intermediate - mixed flora, some lactobacilli
grade III - BC - few/no lactobacilli seen

71
Q

What organism causes thrush?

A

candida albicans
sometimes other non-albican species

72
Q

How is thrush transmitted?

A

not sexually

73
Q

RFs for thrush?

A

uncontrolled DM
immunosuppression
hyperoestrogenaemia eg HRT< COCP
broad-spec abx

74
Q

Clinical features of thrush in women?

A

vulval itch and soreness
vaginal discharge - curdy non-offensive
superficial dyspareunia
external dysuria
erythema
fissuring
excoriation

75
Q

Clinical features of thrush in men?

A

red skin
swelling
irritation
soreness
itchiness
phimosis
dysuria
dyspareunia

76
Q

Complications of thrush?

A

chronic/recurrent infection in men > phimosis

77
Q

How is thrush diagnosed?

A

routine microscopy

78
Q

What is the differences between HSV type 1 and 2?

A

type 1 - usual cause of oral herpes
type 2 - a/w sexual transmission

both can cause oral or genital herpes

79
Q

How does herpes develop following primary infection?

A

primary infection > becomes latent in sensory ganglia > periodically reactivates to cause symptomatic lesions/asymptomatic viral shedding

80
Q

Clinical features of herpes

A

asymptomatic (80%)
painful blisters and ulcers
dysuria
tender inguinal lymphadenitis
discharge
fever
myalgia
occasionally non-specific erythema, fissures or erosions

81
Q

Complications of herpes?

A

urinary retention
aseptic meningitis

82
Q

How is herpes diagnosed?

A

HSV DNA detection by PCR after swab at base of ulcer

83
Q

How are genital warts transmitted?

A

skin to skin

84
Q

Clinical features of genital warts?

A

most asymptomatic
more common in pregnancy due to immunosuppression

small fleshy lumps
itching
distorted flow of urine if present in urethra

85
Q

Clinical features of M.gen in men?

A

asymptomatic majority
urethral discharge
dysuria
penile irritation
urethral discomfort
urethritis - acute, persistent, recurrent
balanoposthitis

86
Q

Clinical features of M.gen in women?

A

asymptomatic
dysuria
post-coital bleeding
painful inter-menstrual bleeding
cervicitis
lower abdo pain

87
Q

Complications of M.gen?

A

sexually acquired RA
epididymitis
PID
infertility in females
pre-term delivery

88
Q

How is M.gen diagnosed?

A

NAAT and resistance testing
males - 1st void urine
females - vaginal swab

89
Q

Who is tested for M.gen?

A
  • men with confirmed NGU
  • women with PID
  • S&S of mucopurulent cervicitis (esp post-coital bleeding)
  • men with epididymo-orchitis
    people with sexually-acquired proctitis
  • sexual partners of people infected with M.gen
90
Q

Treatment for an uncomplicated urogenital infection of M.gen eg urethritis, cervictis?

A

if macrolide sensitive/resistance status unknown:
doxycycline 100mg BF for 1wk
THEN immediately after:
azithromycin 1g PO STAT then orally once daily for 2 days

macrolide-resistant/azithromycin failed:
- moxifloxacin 400mg orally once daily for 10 days

91
Q

Treatment for complication urogenital infection of M.gen eg PID, epididymo-orchitis?

A

moxifloxacin 400mg orally once daily for 14 days

92
Q

Counselling for M.gen infection?

A

abstain until 14 days after start of tx/until sx resolve
only current partners should be tested + if +ve given same abx tx
TOC 5 weeks after start of tx

93
Q

How is Hep B transmitted?

A

sexually
parenteral
vertical

94
Q

Incubation period of Hep B?

A

40-160 days

95
Q

Clinical features of hep B?

A

asymptomatic in 10-50% in acute phase (esp if HIV+ve)
chronic carrier usually asymptomatic - may have fatigue, loss of appetite
prodromal/icteric phase > similar to hep A, may be more severe/prolonged

96
Q

Complications of Hep B

A

fulminant hepatitis
chronic infection
risk of miscarriage/premature labour in acute infection + vertical transmission

97
Q

Ivx for Hep B?

A

serology - Hep B sAg, cAb
LFTs - only grossly abnormal in late stage

98
Q

Mx for Hep B?

A

acute phase - rest, hydration, admit if unwell
refer to hepatologist
refer to health advisor for contact tracing
avoid unprotected sex until partners are vaccinated (any sexual contact/needle sharer 2 weeks before onset of jaundice > sAg -ve)
Hep B = notifiable disease

99
Q

What vaccine is given for Hep B?

A

engerix B 1ml

0,1 ,6 months for most groups
accelerated course for assault/recent high risk exposure
check sAb 8 weeks after, if <10 = need repeat course/booster + recheck

100
Q

How is hep C transmitted?

A

parenteral
vertical
rarely sexually transmitted

101
Q

Complications of hep C?

A

50-85% become chronic carriers
severe liver disease (30%)
hepatocellular carcinoma
acute fulminant hepatitis
pregnancy complications

102
Q

How is screened for hep c?

A

CSW
IVDU
sexual assault
HIV+ve MSM and partners
cocaine use
born outside of W europe/australia/N america
contact
blood transfusions/tattoos/piercings/acupuncture/dental procedures done abroad

103
Q

Inv for Hep C?

A

screen for Hep C Ab

if ab +ve but RNA -ve > second RNA test
if still -ve > past infection

104
Q

When is early and late STS defined?

A

> 2yrs

105
Q

What organism causes STS?

A

treponema pallidum (gram -ve spirochete)

106
Q

How is STS transmitted?

A

sexual
vertical

107
Q

What are the sx of primary, secondary, early/late latent and tertiary STS?

A

primary:
- chancre - painless ulcer at site of invasion, 10-90 days after exposure, anywhere on body

2ndary:
- maculopapular rash on trunk, palms and soles
- headache
- hepatitis
- generalised adenopathy
- condylomata lata
- snail track ulcers
- moth-eaten alopecia

early/later latent:
- asymptomatic infection for >2yrx

tertiary
- CVS - aortic incompetence, aneurysms
- gummatous - chronic painless nodules that break down into ulcers and heal slowly

108
Q

When can neurosyphilis develop? What are the sx?

A

any time

meningitis
optic neuritis
sensorineural hearing loss

109
Q

Inv for STS?

A

dark ground microscopy from primary chancre

serology:
- treponemal EIA - may be +ve for life
- TPPA - may be +ve for life
- RPR - non-specific, used to measure response to tx, want it to decrease with tx

110
Q

Tx for early + late STS?

A

early - benzathine pencillin G 2.4mu IM stat
late - benzathine pencillin G 2.4mu weekly for 3 doses

111
Q

Follow up for STS?

A

blood tests on day of tx, then 3, 6 an 12 mo
then 6 monthly until RPR -ve or serofast
sustained 4-fold+ increase in RPR suggests re-finection of tx failure

112
Q

How is HIV transmitted?

A

sexual
needle sharing/needlestick injury
vertical
blood transfusion

113
Q

What are the 4 stages of HIV and their sx?

A
  1. acute infection - often asymptomatic
  2. seroconversion (2-6 weeks post exposure) - myalgia, fever, rash, severe sore throat
  3. asymptomatic phase (loss of CD4 cells) - generalised lymphadenopathy
  4. AIDS (CD4 count <200*10^6/L) - fatal if untreated
114
Q

How is HIV diagnosed?

A

venous blood sample = GS
window period > repeat test 7 wks after last unprotected sex
if +ve need repeat to confirm

can see HA for same day result if anxious
PoCT is for HIV Ab only + STS

115
Q

How is HIV monitored?

A

CD4 count
viral load - aim is undetectable

116
Q

How is HIV treated?

A

anti-retroviral therapy combo
aim is U=U

integrase inhibitors eg bictergravir, raltegravir
NRTIs (nucleoside analogue reverse transcriptase inhibitors) ag abacavir, tenofovir
PI (protease inhibitor) eg darunavir
NNRTIs (non-NRTI) eg efavirenz

CCR5 inhibitors, entry inhibitors
lots of drug interactions
SEs - nausea, diarrhoea, tiredness, cholesterol changes, weight gain

117
Q

What are signs of AIDS?

A

pneumocystis jiroveci
oesophageal candidiasis
AIDS related dementia
CMV encephalitis
toxoplasma gondii
Hodgkin’s lymphoma
Kaposi’s sarcoma
CMV retinitis
TB

118
Q

What is PEP?

A

post exposure prophylaxis

28 day course of ART
start as soon as possible after exposure - within 72hrs

inform all MSM about PEP and PrEP
+ sexual assault in last 72hours

119
Q

When is AIDS diagnosed?

A

CD4 count <200

120
Q

Whats is PrEP?

A

pre-exposure prophylaxis

ART (tenofovir/emtricitabine tablet) for people at high risk of HIV acquisition
reduces risk by 86% if taken properly
document if discussed
MSM who have condomless anal sex, Black african heterosexuals

121
Q

Incubation period ofr GC/CT?

A

2 wks

122
Q

Incubation period of STS?

A

12 wks

Phase 3a (11 decks)

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