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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
Q

Management of syphilis

A

Screening for STIs
Avoidance of sexual activity until treated
Contact tracing

Deep IM dose of benzathine benzylpenicillin (one dose)

26
Q

Syphilis in pregnancy

A

25% –> miscarriage or stillbirth
70-100% of infants of infected mothers will contract syphilis

27
Q

Features of congenital syphilis

A

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
Q

Hypospadias

A

Urethral meatus is abnormally displaced to the ventral side of the penis
Congenital condition

29
Q

Epispadias

A

Urethral meatus is displaced to the dorsal side of the penis

30
Q

Management of hypospadias

A

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
Q

Complications of hypospadias

A

Difficulty directing urination
Cosmetic and psychological concerns
Sexual dysfunction

32
Q

Predisposing factors for vaginal candidiasis

A

Diabetes mellitus
Drugs: antibiotics, steroids
Pregnancy
Immunosupression
Increased oestrogen (e.g. in pregnancy)

33
Q

Features of vaginal candidiasis

A

‘Cottage-cheese’, non-offensive discharge
Vulvitis: superficial dyspareunia, dysuria
Itch
Vulval erythema, fissuring + satellite lesions may be seen

34
Q

Vaginal pH results in different abnormal discharges

A

Bacterial vaginosis + trichomonas >4.5
Candidiasis <4.5

35
Q

Management of vaginal candidiasis

A

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
Q

How is recurrent vaginal candidiasis defined

A

> /= 4 episodes per year

37
Q

How long until an IUD is effective?

A

Instantly

38
Q

How long until POP is effective?

A

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
Q

Key features seen in trichomonas vaginalis

A

Offensive, yellow/green, frothy discharge
Vulvovaginitis
Strawberry cervix - erythematous, patches of exudate
Itching
Dysuria
Dyspareunia
Balanitis

40
Q

Causative organism of trichomonas vaginalis

A

Parasite - protozoa
Single-celled organism, with flagella (four at the front, single one at the back)

41
Q

Trichomonas can increase risk of:

A

Contracting HIV (due to damage to vaginal mucosa)
Bacterial Vaginosis
Cervical cancer
Pelvic inflammatory disease
Pregnancy-related complications

42
Q

Diagnosis of trichomonas vaginalis

A

Standard charcoal swab, with microscopy
- Posterior fornix in women, or self-taken low vaginal swab
- Urethral swab or first-catch urine

43
Q

Management of trichomonas vaginalis

A

Oral metronidazole

44
Q

What is bacterial vaginosis

A

Overgrowth of anaerobic bacteria in the vagina
Caused by a loss of lactobacilli in the vagina which maintain the low vaginal pH

45
Q

Examples of bacteria associated with bacterial vaginosis:

A

Gardnerella vaginalis
Mycoplasma hominis
Prevotella species

46
Q

Risk factors for bacterial vaginosis

A

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
Q

Presentation of bacterial vaginosis

A

Fishy-smelling, watery, grey or white vaginal discharge
>4.5 on pH scale

48
Q

Investigations of bacterial vaginosis

A

Charcoal vaginal swab - microscopy (self-taken, low swab, or high vaginal swab)
Shows ‘clue cells’ on microscopy

49
Q

Management of bacterial vaginosis

A

Asymptomatic does not usually require treatment
Oral metronidazole (or vaginal gel)
Clindamycin may also be given
Swab for concurrent STIs

50
Q

Complications of bacterial vaginalis infection

A

STIs including chlamydia, gonorrhoea, and HIV
In pregnant women:
- Miscarriage
- Pretermm delivery
- Premature rupture of membranes
- Chorioamnionitis
- Low birth weight
- Postpartum endometritis

51
Q

Causative organism for gonorrhoea

A

Neisseria gonorrhoeae
Gram-negative diplococcus bacteria

52
Q

Presentation of gonorrhoea in females

A

Odourless purulent discharge, possibly green or yellow
Dysuria
Pelvic pain

53
Q

Presentation of gonorrhoea in males

A

Odourless purulent discharge, possibly green or yellow
Dysuria
Testicular pain or swelling: epididymo-orchitis

54
Q

Management of gonorrhoea

A

Single dose IM ceftriaxone - if sensitivities are not known
Single dose oral ciprofloxacin - if sensitivities are known

55
Q

Follow-up in patients treated for gonorrhoea

A

‘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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