Sexual Health Flashcards
Most common STI?
Chlamydia
Presentation of Chlamydia?
- Mainly asymptomatic
- Pus/White discharge
- Dysuria
What kind of organism is Trachomatis?
Obligate, intracellular Gm neg
Investigation for Chlamydia?
NAAT testing
F - vulvovaginal swab
M - first void urine
Treatment of Chlamydia?
7 days of doxycycline
Azithro/Erythro if pregnant
What organism causes Gonorrhoea?
Neisseria Gonorrhoea - gram neg diplococcus
Symptoms of Gonorrhoea?
- Pus/White discharge
- Dysuria
Risk factors for Chlamydia?
- <25
- New/Multiple sexual partners
- No condoms used
Risk factors for Gonorrhoea?
- 20-29 years old
- MSM
- Black ancestry
- Current/Prior STIs
Investigations for Gonorrhoea?
F - NAAT vulvovaginal swab
M - first void urine
Treatment for Gonorrhoea?
IM Ceftriaxone if no cultures/sensitivity
Consider using ciprofloxacin if sensitive
Complications for gonorrhoea in pregnancy?
- Premature labour
- Miscarriage
- Vertical transmission to child: Opthalmia neonatorum
Presentation of Herpes?
Multiple, painful ulcers
Symptoms of primary herpes infection?
- Fever and myalgia
- Painful blisters on genitals
- Lymphoedema
- Discharge and dysuria
Investigation for Herpes?
NAAT
Treatment for Herpes?
PO Aciclovir
Syphillis Presentation?
Single, painless papule erodes deeper into an ulcer with clear base, clear serum and rounded edges (chancre)
Investigation for Syphillis
Blood serology for virus
Organism which causes syphillis?
Treponema Pallidum
Tx for Syphillis?
IM Benzathine Benyzlpenicillin
Presentation of Thrush/Candida?
- Cottage cheese discharge
- Itchy, red inflamed vulva/glans
- Superficial dyspareunia
Risk factors for Candida?
- Diabetes
- Use of broad spec Abx
- AIDS
Tx for Candida?
Oral fluconazole is first line
If pregnant, topical clotrimazole
Presentation of Bacterial Vaginosis (Gardenerella)?
- Grey/Yellow, fishy thin discharge
Ix for BV?
- +ve Whiff test
- Microscopy: clue cells
- Increased pH > 4.5
Tx for BV?
PO Metronidazole 2g one off
Presentation of Trichomonas Vaginalis?
- Yellow/Green, frothy discharge
- Itchy
- Dysuria
- Offensive odour
- Strawberry cervix
Organism of Trichomonas?
- Flagella, protozoa parasite
Investigations for Trichomonas?
- Wet microscopy - trophozoites
Tx for Trichomonas?
PO Metronidazole 2g one off
Abx of choice for Pneumocystitis Pneumonia in HIV patient?
Co-trimoxazole
Lymphogranuloma venereum (LGV)
- MSM is risk factor
- Associated with chlamydia
- Painless ulcer which progresses to form painful buboes (groove sign)
- Fever
- Malaise
- Doxycycline Tx
What is Jarisch-Herxheimer reaction
Acute febrile reaction associated with syphillis
Tx with paracetamol and reassurance
RUQ pain in someone with PID/STI
Think Fitz-Hugh-Curtis syndrome -> treat with Abx for the underlying infection/pain relief
Which viruses cause genital herpes?
HSV-1 (most common), HSV-2
Which viruses cause genital warts?
HPV 6,11
How do genital warts present?
Hard/soft painless lesions on the genitals
How are genital warts managed?
- Can be managed conservatively
- Podophyllotoxin/Imiquimod/Cryotherapy
What malignancies can be associated with AIDS?
- Non-Hodgkins lymphoma
- Invasive cervical cancer
- HIV related Hodgkins
- HIV related anal cancer
What is molluscum contagiosum?
A skin infection caused by molluscum contagiosum - poxvirus
How does molluscum present?
- Small, smooth pearly coloured papules with central area of umbilication
- Common on genitals
How is molluscum managed?
- STI screen if indicated
- Cryotherapy/topical treatments
- Curettage
What are features of secondary syphillis?
- 6-10 weeks after primary infection
- Fever, lymphadenopathy
- Rash on trunk, palms
- Snail track ulcers in mouth
- Painless, warts on genitals
What are features of tertiary syphilis?
- Gummas (granulomatous lesions of skin and bones)
- Aortic aneurysms
- Argyll-Robertson pupil
How is syphilis investigated?
- Often a clinical diagnosis + serology
- TP-EIA test is more complex but specific for syphilis
Which organism causes BV?
Gardnerella vaginalis
How is syphilis transmitted?
Through direct contact with sores/rash during sex
How does tertiary syphilis present?
- Can be 20-40 years after the primary infection
- Can cause aortitis, arteritis, aortic regurg
- Dementia, Argyll-Robertson pupil (bilateral small pupils which do not constrict)
How does congenital syphilis present?
- Can be after birth or during infancy
- Rash of palms of soles/feet, lesions in mouth/genitals
- Anaemia, hepatosplenomegaly
- Seizures
What is the treatment for neurosyphillis?
IV benzathine benzylpenicillin
Gold standard investigation to diagnose Fitz-Hugh-Curtis?
Laparoscopy