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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
Tests done for asymptomatic woman?
self taken VVS (for GC/CT NAAT) + rectal if receive anal bloods for HIV + STS
26
Tests done for symptomatic woman or contact of infection?
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
27
When are pharyngeal swabs taken in women?
contact of gonorrhoea CSW patient request = swab for GC/CT NAAT + culture for GC
28
Tests done for asymptomatic heterosexual men?
1st void urine for CT/GC NAAT - should not have passed urine in last hr bloods for HIV + STS
29
Tests done for symptomatic or contact of infection heterosexual men or ?
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
30
Tests done for asymptomatic MSM?
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
31
Tests done for symptomatic MSM?
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
32
What is chlamydia caused by?
chlamydia trachomatis (obligate IC bacteria)
33
How is chlamydia ad gonorrhoea transmitted?
sexual contact vertical
34
RFs of chlamydia?
<25 new sexual partner >1 sexual partner/yr not using condoms
35
Clinical features of chlamydia in women and men?
- asymptomatic in 70% - increased vaginal discharge - dysuria - pelvic pain - post coital/intermenstrual bleeding
36
Complications of chlamydia?
epididymo-orchitis PID (1-30%) infertility ectopic pregnancy reactive arthritis
37
What organism must be tested for in MSM with rectal chlamydia?
LGV type of chlamydia bacteria that attacks the lymph node
38
What is gonorrhoea caused by?
neisseria gonorrhoeae gram -ve diplococcus
39
Clinical features of gonorrhoea in women?
- 50% asymptomatic - mucopurulent discharge (50%) - pelvic pain (25%) - dysuria (12%)
40
Clinical features of gonorrhoea in men?
- <10% asymptomatic - mucopurulent discharge (80%) - dysuria (50%)
41
Clinical features of chlamydia in men?
- asymptomatic in 50% - urethral discharge - dysuria - testicular pain
42
Complications of gonorrhoea?
epididymo-orchitis PID
43
How is gonorrhoea diagnosed?
microscopy NAAT cultures prior to tx (due to increasing abx resistance)
44
How is chlamydia diagnosed?
NAAT
45
What is PID caused by?
ascending infection of chlamydia + gonorrhoea (25%), gardnerella vaginalis (BV), anaerobes, other vaginal commensals
46
Clinical features of PID?
bilateral lower abdominal pain deep dyspareunia abnormal vaginal bleeding purulent discharge fever adnexal and cervical motion tenderness on bimanual
47
Differentials for PID?
ectopic - exclude pregnancy appendicitis - vomiting endometriosis - cyclical ovarian cyst torsion/rupture - sudden onset UTI - urinary sx functional pain - longstanding
48
Inx for PID
full STI screen pregnancy test urinalysis bimanual mycoplasma PCR/resistance test
49
What additional abx are needed if PID is mycoplasma +ve?
moxifloxacin
50
Complications of PID?
infertility ectopic chronic pelvic pain pelvic abscess
51
What is epididymo-orchitis caused by?
young pt: local extension of infection from STI (CT/GC) older pt: UTI - gram -ve enteric organisms rarely extrapulmonary TB
52
Clinical features of epididymo-orchitis?
unilateral pain, swelling and inflammation of epididymis/testes possibly urethral discharge, pyrexia, secondary hydrocele, symptoms of UTI
53
Complications of epididymo-orchitis?
reactive hydrocele abscess tesicular infarction infertility
54
Differentials of epididymo-orchitis?
EXCLUDE testicular torsion - sudden onset pain = surgical emergency - needs testicle salvage in 6hrs mumps - headache, fever, parotid swelling, serology
55
Ivx for epididymo-orchitis?
- gram stained urethral smear and culture - 1st void urine STI screen - urinalysis - MSU - mycoplasma if >5PCs on microscopy
56
What organisms cause NGU?
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
RFs for NGU?
sexually active unprotected sex homo/biseuxal aged <35 multiple partners
58
Complications of NGU?
epididymo-orchitis sexually acquired RA
59
Clinical features of NGU?
asymptomatic urethral discharge dysuria
60
Inx of NGU?
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
What organism is TV caused by?
flagellated prozoon
62
Clinical features of TV in women?
asymptomatic (10-50%) yellow frothy discharge itching dysuria pelvic pain
63
Clinical features of TV in men?
asymptomatic (15-50%) urethral discharge dysuria frequency
64
How is TV diagnosed?
wet slide from posterior fornix in females urethral/urine culture in males
65
What is BV caused by?
if vaginal pH >4.5, normal vaginal flora (lactobacilli) dominated by anaerobes cause the sx eg gardnereall vaginalis
66
How is TV transmitted?
sexual contact
67
How is BV transmitted?
not sexually
68
Clinical features of BV?
asymptomatic (50%) thin white offensive smelling vaginal discharge NO soreness, itching, irritation
69
Complications of BV?
a/w miscarriage, preterm birth/PROM, postpartum endometritis in pregnancy
70
How is BV diagnosed?
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
What organism causes thrush?
candida albicans sometimes other non-albican species
72
How is thrush transmitted?
not sexually
73
RFs for thrush?
uncontrolled DM immunosuppression hyperoestrogenaemia eg HRT< COCP broad-spec abx
74
Clinical features of thrush in women?
vulval itch and soreness vaginal discharge - curdy non-offensive superficial dyspareunia external dysuria erythema fissuring excoriation
75
Clinical features of thrush in men?
red skin swelling irritation soreness itchiness phimosis dysuria dyspareunia
76
Complications of thrush?
chronic/recurrent infection in men > phimosis
77
How is thrush diagnosed?
routine microscopy
78
What is the differences between HSV type 1 and 2?
type 1 - usual cause of oral herpes type 2 - a/w sexual transmission both can cause oral or genital herpes
79
How does herpes develop following primary infection?
primary infection > becomes latent in sensory ganglia > periodically reactivates to cause symptomatic lesions/asymptomatic viral shedding
80
Clinical features of herpes
asymptomatic (80%) painful blisters and ulcers dysuria tender inguinal lymphadenitis discharge fever myalgia occasionally non-specific erythema, fissures or erosions
81
Complications of herpes?
urinary retention aseptic meningitis
82
How is herpes diagnosed?
HSV DNA detection by PCR after swab at base of ulcer
83
How are genital warts transmitted?
skin to skin
84
Clinical features of genital warts?
most asymptomatic more common in pregnancy due to immunosuppression small fleshy lumps itching distorted flow of urine if present in urethra
85
Clinical features of M.gen in men?
asymptomatic majority urethral discharge dysuria penile irritation urethral discomfort urethritis - acute, persistent, recurrent balanoposthitis
86
Clinical features of M.gen in women?
asymptomatic dysuria post-coital bleeding painful inter-menstrual bleeding cervicitis lower abdo pain
87
Complications of M.gen?
sexually acquired RA epididymitis PID infertility in females pre-term delivery
88
How is M.gen diagnosed?
NAAT and resistance testing males - 1st void urine females - vaginal swab
89
Who is tested for M.gen?
- 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
Treatment for an uncomplicated urogenital infection of M.gen eg urethritis, cervictis?
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
Treatment for complication urogenital infection of M.gen eg PID, epididymo-orchitis?
moxifloxacin 400mg orally once daily for 14 days
92
Counselling for M.gen infection?
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
How is Hep B transmitted?
sexually parenteral vertical
94
Incubation period of Hep B?
40-160 days
95
Clinical features of hep B?
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
Complications of Hep B
fulminant hepatitis chronic infection risk of miscarriage/premature labour in acute infection + vertical transmission
97
Ivx for Hep B?
serology - Hep B sAg, cAb LFTs - only grossly abnormal in late stage
98
Mx for Hep B?
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
What vaccine is given for Hep B?
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
How is hep C transmitted?
parenteral vertical rarely sexually transmitted
101
Complications of hep C?
50-85% become chronic carriers severe liver disease (30%) hepatocellular carcinoma acute fulminant hepatitis pregnancy complications
102
How is screened for hep c?
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
Inv for Hep C?
screen for Hep C Ab if ab +ve but RNA -ve > second RNA test if still -ve > past infection
104
When is early and late STS defined?
>2yrs
105
What organism causes STS?
treponema pallidum (gram -ve spirochete)
106
How is STS transmitted?
sexual vertical
107
What are the sx of primary, secondary, early/late latent and tertiary STS?
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
When can neurosyphilis develop? What are the sx?
any time meningitis optic neuritis sensorineural hearing loss
109
Inv for STS?
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
Tx for early + late STS?
early - benzathine pencillin G 2.4mu IM stat late - benzathine pencillin G 2.4mu weekly for 3 doses
111
Follow up for STS?
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
How is HIV transmitted?
sexual needle sharing/needlestick injury vertical blood transfusion
113
What are the 4 stages of HIV and their sx?
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
How is HIV diagnosed?
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
How is HIV monitored?
CD4 count viral load - aim is undetectable
116
How is HIV treated?
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
What are signs of AIDS?
pneumocystis jiroveci oesophageal candidiasis AIDS related dementia CMV encephalitis toxoplasma gondii Hodgkin's lymphoma Kaposi's sarcoma CMV retinitis TB
118
What is PEP?
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
When is AIDS diagnosed?
CD4 count <200
120
Whats is PrEP?
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
Incubation period ofr GC/CT?
2 wks
122
Incubation period of STS?
12 wks

Phase 3a (11 decks)

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