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Phase 3A Revision > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

Causative organism of chlamydia

A

Chlamydia trachomatic - gra-negative bacteria
Intracellular organism

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2
Q

Investigations for chlamydia

A

Nucleic acid amplification tests - used for chlamydia and gonorrhoea
- Women: vulvovaginal swab, endocervical swab or first-catch urine
- Men: first-catch urine sample or urethral swab
- Rectal and pharyngeal swabs if required

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3
Q

Presentation of chlamydia in women

A

Mostly asymptomatic
Sexually active
Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding: intermenstrual or postcoital
Painful sex (dyspareunia)
Painful urination (dysuria)

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4
Q

Risk factors for STIs

A

Multiple partners
Young adults (15-24 years old)
Pregnancy <20 years old
Previous termination of pregnancy
History of previous STI
Abnormal cervical cytology
involvement in commercial sex industry

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5
Q

Presentation of chlamydia in men

A

Sexually active
Urethral discharge or discomfort
Painful urination
Epididymo-orchitis
Reactive arthritis

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6
Q

Other presentations of chlamydia

A

Consider rectal chlamydia or lymphogranuloma venereum with anorectal symptoms e.g. discomfort, discharge, bleeding + change in bowel habits

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7
Q

Examination findings of chlamydia

A

Pelvic or abdominal tenderness
Cervical excitation
Cervicitis
Purulent discharge

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8
Q

Management of chlamydia

A

1st line, uncomplicated: doxycyline 100mg BD for 7 days
2nd line: 1g azithromycin oral (removed as 1st line due to concerns of resistance, especially from mycoplasma genitalium, and less effective in rectal chlamydia)

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9
Q

Management of chlamydia in pregnant/breastfeeding women

A

Azithromycin: 1g stat, 500mg od for 2 days
Erythromycin: 500mg qds for 7 days, or BD for 14 days
Amoxicillin: 500mg tds for 7 days

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10
Q

Other elements of management of chlamydia

A

Abstain from sex for seven day of treatment
Contact tracing
Test and treat for other STIs
Consider safeguarding

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11
Q

Complications of chlamydia

A

PID
Chronic pevlic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Lymphogranuloma venereum
Reactive arthritis

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12
Q

Pregnancy-related complications of chlamydia

A

Preterm delivery
P-PROM
LBW
Postpartum endometritis
Neonatal infection: conjunctivitis + pneumonia
Chorioamnionitis

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13
Q

Lymphogranuloma venereum

A

Affects lymphoid tissue around site of infection with chlamydia
Most common in MSM

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14
Q

Stages of LGV

A

Primary = painless ulcer (primary lesion), on penis, vaginal wall, or rectum
Secondary = lymphadenitis. Swelling, inflammation and pain in inguinal or femoral lymph nodes
Tertiary = proctitis and inflamation of anus. –> anal pain, change in bowel habit, tenesmus, discharge

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15
Q

Management of LGV

A

Doxycycline 100mg Bd for 21 days

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16
Q

Investigations for gonorrhoea

A

NAAT swabs/first-catch urine sample
When demonstrated on NAAT, endocervical charcoal swab required for MC+S

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17
Q

Causative organism of syphylis

A

Treponema pallidum - spirochete

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18
Q

Transmission of syphilis

A

Oral, vaginal or anal sex
Vertical transmission during pregancy
IVDU
Blood transfusions + other transplants

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19
Q

Primary syphilis

A

Painless ulcer (chancre) at original site of infection
3 weeks post infection
Inguinal lymphadenopathy
Resolves over 3-8 weeks

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20
Q

Secondary syphilis

A

Involves systemic symptoms (skin + mucous membranes): polymorphic rash affecting palms + soles (maculopapular)
Lymhpadenopathy
Genital condylomata lata (wart-like lesions)
Anterior uveitis
Low grade fever
Alopecia
Oral lesions
Within first 2 years of infection (usually after 6-8 weeks)
Resolve after 3-12 weeks

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21
Q

Tertiary syphilis

A

Presents in up to 40% people infected for >2 years
Neurosyphilis - tabes dorsalis, and dementia
Cardiovascular syphilis - commonly affects aortic root e.g. aortic aneurysms
Gummata - inflammatory plaques or nodules

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22
Q

Latent syphilis

A

Occurs after secondary stage
Symptoms disappear -> asymptomatic
Early latent = within 2 years
Late latent = from 2 years after initial infection onwards

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23
Q

Neurosyphilis

A

Headache
Altered behaviour
Dementia
Tabes dorsalis = demyelination affectign spinal cord posterior columns
Ocular syphilis
Paralysis
Sensory impairment

Argyll-Robertson pupil = constricted pupil that accomodates when focussing on a near object, but does not react to light. Often irregularly shaped. ‘prostitute’s pupil’

24
Q

Diagnosis of syphilis

A

Antibody testing for T. pallidum (TPHA) used as screening, also remains after treatment
COnfirm presence using samples from site of infection:
- Dark field microscopy
- PCR
Rapid plasma reagin (RRR) + venereal disease research lab tests (VDRL) = non-specific, but sensitive
VDRL negative after treatment

25
Management of syphilis
Screening for STIs Avoidance of sexual activity until treated Contact tracing Deep IM dose of benzathine benzylpenicillin (one dose)
26
Syphilis in pregnancy
25% --> miscarriage or stillbirth 70-100% of infants of infected mothers will contract syphilis
27
Features of congenital syphilis
Generalised lymphadenopathy Infectious rhinitis (purulent or blood-stained) Hepatosplenomegaly Rash Glomerulonephritis + nephrotic syndrome Skeletal malformations e.g. osteochondritis CNS involvement e.g. CSF abnormalities and syphilitic meningitis
28
Hypospadias
Urethral meatus is abnormally displaced to the ventral side of the penis Congenital condition
29
Epispadias
Urethral meatus is displaced to the dorsal side of the penis
30
Management of hypospadias
Referral to paediatric specialist urologist Do not circumcise until urologist says this is okay Mild cases may be left Surgery usually performed after 3-4 months of age: aims to correct position of meatus and straighten penis (if have chordee)
31
Complications of hypospadias
Difficulty directing urination Cosmetic and psychological concerns Sexual dysfunction
32
Predisposing factors for vaginal candidiasis
Diabetes mellitus Drugs: antibiotics, steroids Pregnancy Immunosupression Increased oestrogen (e.g. in pregnancy)
33
Features of vaginal candidiasis
'Cottage-cheese', non-offensive discharge Vulvitis: superficial dyspareunia, dysuria Itch Vulval erythema, fissuring + satellite lesions may be seen
34
Vaginal pH results in different abnormal discharges
Bacterial vaginosis + trichomonas >4.5 Candidiasis <4.5
35
Management of vaginal candidiasis
Oral fluconazole 150mg sinle dose Clotrimazole 500mg intravaginal pessary single dose (if oral therapy contraindicated) Vulval symptoms --> topical imidazole as well as oral or intravaginal antifungal Pregnant --> only local treatments
36
How is recurrent vaginal candidiasis defined
>/= 4 episodes per year
37
How long until an IUD is effective?
Instantly
38
How long until POP is effective?
If commenced up to and including day 5 of the cycle, protection is immediate If not, additional contraception required for 2 days Immediate protection if continued directly from COCP
39
Key features seen in trichomonas vaginalis
Offensive, yellow/green, frothy discharge Vulvovaginitis Strawberry cervix - erythematous, patches of exudate Itching Dysuria Dyspareunia Balanitis
40
Causative organism of trichomonas vaginalis
Parasite - protozoa Single-celled organism, with flagella (four at the front, single one at the back)
41
Trichomonas can increase risk of:
Contracting HIV (due to damage to vaginal mucosa) Bacterial Vaginosis Cervical cancer Pelvic inflammatory disease Pregnancy-related complications
42
Diagnosis of trichomonas vaginalis
Standard charcoal swab, with microscopy - Posterior fornix in women, or self-taken low vaginal swab - Urethral swab or first-catch urine
43
Management of trichomonas vaginalis
Oral metronidazole
44
What is bacterial vaginosis
Overgrowth of anaerobic bacteria in the vagina Caused by a loss of lactobacilli in the vagina which maintain the low vaginal pH
45
Examples of bacteria associated with bacterial vaginosis:
Gardnerella vaginalis Mycoplasma hominis Prevotella species
46
Risk factors for bacterial vaginosis
Multiple sexual partners (although not an STI) Excessive vaginal cleaning Recent antibiotics Smoking Copper coil Less common if using COCP, or using condoms effectively
47
Presentation of bacterial vaginosis
Fishy-smelling, watery, grey or white vaginal discharge >4.5 on pH scale
48
Investigations of bacterial vaginosis
Charcoal vaginal swab - microscopy (self-taken, low swab, or high vaginal swab) Shows 'clue cells' on microscopy
49
Management of bacterial vaginosis
Asymptomatic does not usually require treatment Oral metronidazole (or vaginal gel) Clindamycin may also be given Swab for concurrent STIs
50
Complications of bacterial vaginalis infection
STIs including chlamydia, gonorrhoea, and HIV In pregnant women: - Miscarriage - Pretermm delivery - Premature rupture of membranes - Chorioamnionitis - Low birth weight - Postpartum endometritis
51
Causative organism for gonorrhoea
Neisseria gonorrhoeae Gram-negative diplococcus bacteria
52
Presentation of gonorrhoea in females
Odourless purulent discharge, possibly green or yellow Dysuria Pelvic pain
53
Presentation of gonorrhoea in males
Odourless purulent discharge, possibly green or yellow Dysuria Testicular pain or swelling: epididymo-orchitis
54
Management of gonorrhoea
Single dose IM ceftriaxone - if sensitivities are not known Single dose oral ciprofloxacin - if sensitivities are known
55
Follow-up in patients treated for gonorrhoea
'Test of cure' given high antibiotic resistance NAAT testing if asymptomatic, cultures if symptomatic. Should be negative after: - 72 hours after treatment for culture - 7 days after treatment for RNA NAAT - 14 days after treatment for DNA NAAT

Phase 3A Revision (12 decks)

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