sexual health Flashcards
neisseria gonorrhoeae
gram neg diplococcus bacteria
spread via mucous secretions from infected area
infects mucous membranes with a columnar epithelium - endocervix, urethra, rectum, conjuntiva, pharynx
high levels of antibiotic resistance to gonorrhoea
neisseria gonorrhoeae presentation
more symptomatic than chlamydia
- odourless purulent discharge, possibly green/yellow
- dysuria
- pelvic pain(F), testicular pain (M)
urethritis, PID, pharyngitis, proctitis
neisseria gonorrhoeae investigation
screen by PCR, NAAT
requires chocolate agar to grow
neisseria gonorrhoea management
1st = ceftriaxone IM or ciprofloxacin
2nd = cefixme plus azithromycin - only if IM contraindicated or refused (needle phobic)
test of cure in all patiennts after 2-3weeks
partner notification
chlamydia trachomatis
gram neg
intracellular bacterium - enters + replicates before rupturing the cell + spreading to others
commonest ST in uk, significant cause of infertility
up to 50% resolve untreated after 12months
incubation period of chlamydia trachomatis
7-21days
lots are asymtpmatic - 70% W, 50%M
incubation period of gonotthoea
2-5days
(chlamydia 7-21days)
chlamydia presentation
increased vaginal discharge - milky
irregular bleeding
abdo pain
dyuria
dyspareunia
urethritis, epididymo-orchitis, proctitis
chlamydia trachomatis
NAAT - nucleic acid amplification test
management of chlamydia
doxycycline for 7 days
or azithromycin 1g stat followed by 500mg for 2days
contact tracing
chlamydia complication
PID
salpingitis, endometritis
tubal infertility
ectopic pregnancy
reactive arthritis
mycoplasma genitalium + Mx
not sustainable ass lacking cell walls
assoc with non-gonococcal urethritis + PID
Ix = NAAT
doxycycline then azithromycin
-> azithromycin used alone in pregnancy/breast feeding
test of cure
investigation of mycoplasma genitalium
NAAT
men = first urine sample in morning
women = vaginal swabs
what does treponema pallidum cause
syphillis
spirochaete - moves by rapid rotation, sprial shaped
found in 1-11% of pregnant women during screening
similar in MSM
how is syphilis spread? incubation period?
sexually transmitted
via blood transfusion
during pregnancy
incubations = 9-90days
syphilis investigations
Samples from sites of infection to confirm presence of T. pallidum
o Dark field microscopy
o Polymerase chain reaction (PCR)
syphilis management
IM benzathine benzylpenicillin
- alternative = doxycycline
- Contact tracing
tertiary, neurosphylisi, pregnancy -> specialist management
transmission of syphilis
sexually - oral, vaginal, anal
vertically -mother to baby
IV drug use
blood transfusions/transplants
stages of syphilis
primary = painless ulcer (chancre) at orignial site of infection, local lymphadenopathy
secondary = systemic symptoms (see other)
latent = symptoms disappear for >=2yrs
tertiary = many organs affected, gummas, neurosyphilis
secondary stage of syphilis
systemic symptoms
o maculopapular copper palmar/plantar/trunk rash
o snail trail mouth ulcers
o patchy alopecia
o flu like illness
o condylomata lata – painless, warty lesions on genitalia
o generalised lymphadenopathy
can resolve after 3-12wks when enter latent stage
tertiary stage of syphilis
many years after initial infection, affect many organs
- gummas – granulomatous lesions of the skin + bones
- ascending aortic aneuryms
- neurosyphilis
o argyll-robertson pupil
———> (bilateral small pupils that reduce in size for near object but NOT when exposed to light)
———> Often irregularly shaped
differentials for vaginal discharge
Candida –> cottage cheese discharge, vulvitis, itch
Trichomonas vaginalis –> offensive, yellow/green, frothy discharge, vulvovaginitis, strawberry cervix
Bacterial vaginosis –> offensive, thin, white/grey, “fishy” discharge
risk factors for candida
antibiotics
poorly controlled diabetes
high oestrgen levels - high in pregnancy
immunocompromised
candida presentation
thick, white cottage cheese discharge - NOT SMELLY
vulvitis - superfical dysparenunia, dysuria
itch
candida diagnosis
clinical
vaginal pH
candidiasis -> pH <4.5
bacterial vaginosis + trichomonis -> pH >4.5
management of candida
oral fluconazole
clotrimazole pessary if contraindicated (pregnancy)
bacterial vaginosis
overgrowth of anaerobic bacteria, loss of lactobilli (frindly bacteria)
NOT sexually transmitted - can increase risk of STI
reduced no of lactobacilli increases cagina pH - alkaline environment enable anaerobic bacteria to multiply
can occur alongside other infections
commonest bacteria in bacterial vaginosis
gardnerella vaginalis (anaerobic obvs)
key risk factor for bacterial vaginosis
excessive vaginal cleaning
bacterial vaginosis presentation
smelly, thin, white/grey, “fishy” discharge
pH >4.5
bacterial vaginosis investigations
vaginal pH >4.5 (alkaline)
swab for microscopy -> clue cells (epithelial cells from cervix that have bacteria stuck inside them [gardnerella vaginalis])
management of bacterial vaginosis
oral metronidazole for 5-7days
- avoid alcohol
trichomonas vaginalis
single celled protozoal, highly motile (4 flagella at front, 1 at back)
sexually transmitted !!
what can trichomonas vaginalis increase ur risk of?
contracting HIV - by damaging vaginal mucosa
bacterial vaginosis
cervical cancer
PID
pregnancy complications - preterm delivery
trichomonas vaginalis presentation
smelly YELLOW/GREEN frothy discharge
vulvulovaginitis
strawberry cervix (colpitis macularis)
pH >4.5
usually asymptomatic in men - balantitis
trichomonas vaginalis investigations
charcoal swab with microscopy -> motile trophozoites (flagellaaaa)
- first catch urine in men for NAAT
management of trichomonas vaginalis
oral metronidazole 5-7days
genital warts
HPV 6 + 11
spread by skin to skin contact
diagnosis = clinical - white, rough raised NOT painful
management = topical podphyllum, cryotherapy or imiquimod topical cream
HSV responsible for cold sores + genital herpes respectively?
HSV-1 -> cold sores, oro-genital sex
HSV-2 -> genital herpes, sexually transmitted
latent stage of genital herpes
After initial infection, virus becomes latent in assoc sensory nerve ganglia
Typically this is the –
- trigeminal nerve ganglion for cold sores
- sacral nerve ganglia for genital herpes
presentation of genital herpes
painful genital ulceration
tender inguinal lymphadenopathy
flu like symptoms
neuropathic type pain - tingling, burning or shooting
primary infection usually more severe than recurrent episodes
investigation + Mx of genital herpes
investigation = NAAT, viral PCR
management = oral aciclovir
which strains of HPV cause cervical cancers vs genital warts
HPV 16 + 18
(HPV 6 + 11 = genital warts)
complications of primary herpes simplex
radiculopathies causing urinary retention
complication of genital warts
intra-epithelial neoplasia
diagnosing urethritis on microscopy
gram stain of urethral smear
- <5 polymorphs = normal, recently passed urine, poor swabbing technique
> =5 polymorphs = urethritis
- gram neg intracellular diplococci = gonococcal urethritis
- no gram neg = non-gonoccocal/specific urethritis
