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sexual health Flashcards

1
Q

neisseria gonorrhoeae

A

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

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2
Q

neisseria gonorrhoeae presentation

A

more symptomatic than chlamydia

  • odourless purulent discharge, possibly green/yellow
  • dysuria
  • pelvic pain(F), testicular pain (M)

urethritis, PID, pharyngitis, proctitis

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3
Q

neisseria gonorrhoeae investigation

A

screen by PCR, NAAT
requires chocolate agar to grow

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4
Q

neisseria gonorrhoea management

A

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

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5
Q

chlamydia trachomatis

A

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

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6
Q

incubation period of chlamydia trachomatis

A

7-21days

lots are asymtpmatic - 70% W, 50%M

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7
Q

incubation period of gonotthoea

A

2-5days

(chlamydia 7-21days)

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8
Q

chlamydia presentation

A

increased vaginal discharge - milky
irregular bleeding
abdo pain
dyuria
dyspareunia

urethritis, epididymo-orchitis, proctitis

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9
Q

chlamydia trachomatis

A

NAAT - nucleic acid amplification test

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10
Q

management of chlamydia

A

doxycycline for 7 days

or azithromycin 1g stat followed by 500mg for 2days

contact tracing

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11
Q

chlamydia complication

A

PID
salpingitis, endometritis
tubal infertility
ectopic pregnancy
reactive arthritis

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12
Q

mycoplasma genitalium + Mx

A

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

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13
Q

investigation of mycoplasma genitalium

A

NAAT
men = first urine sample in morning
women = vaginal swabs

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14
Q

what does treponema pallidum cause

A

syphillis
spirochaete - moves by rapid rotation, sprial shaped

found in 1-11% of pregnant women during screening
similar in MSM

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15
Q

how is syphilis spread? incubation period?

A

sexually transmitted
via blood transfusion
during pregnancy

incubations = 9-90days

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16
Q

syphilis investigations

A

Samples from sites of infection to confirm presence of T. pallidum
o Dark field microscopy
o Polymerase chain reaction (PCR)

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17
Q

syphilis management

A

IM benzathine benzylpenicillin

  • alternative = doxycycline
  • Contact tracing

tertiary, neurosphylisi, pregnancy -> specialist management

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18
Q

transmission of syphilis

A

sexually - oral, vaginal, anal
vertically -mother to baby
IV drug use
blood transfusions/transplants

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19
Q

stages of syphilis

A

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

20
Q

secondary stage of syphilis

A

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

21
Q

tertiary stage of syphilis

A

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
22
Q

differentials for vaginal discharge

A

Candida –> cottage cheese discharge, vulvitis, itch

Trichomonas vaginalis –> offensive, yellow/green, frothy discharge, vulvovaginitis, strawberry cervix

Bacterial vaginosis –> offensive, thin, white/grey, “fishy” discharge

23
Q

risk factors for candida

A

antibiotics
poorly controlled diabetes
high oestrgen levels - high in pregnancy
immunocompromised

24
Q

candida presentation

A

thick, white cottage cheese discharge - NOT SMELLY
vulvitis - superfical dysparenunia, dysuria

itch

25
Q

candida diagnosis

A

clinical

vaginal pH
candidiasis -> pH <4.5
bacterial vaginosis + trichomonis -> pH >4.5

26
Q

management of candida

A

oral fluconazole
clotrimazole pessary if contraindicated (pregnancy)

27
Q

bacterial vaginosis

A

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

28
Q

commonest bacteria in bacterial vaginosis

A

gardnerella vaginalis (anaerobic obvs)

29
Q

key risk factor for bacterial vaginosis

A

excessive vaginal cleaning

30
Q

bacterial vaginosis presentation

A

smelly, thin, white/grey, “fishy” discharge

pH >4.5

31
Q

bacterial vaginosis investigations

A

vaginal pH >4.5 (alkaline)

swab for microscopy -> clue cells (epithelial cells from cervix that have bacteria stuck inside them [gardnerella vaginalis])

32
Q

management of bacterial vaginosis

A

oral metronidazole for 5-7days
- avoid alcohol

33
Q

trichomonas vaginalis

A

single celled protozoal, highly motile (4 flagella at front, 1 at back)

sexually transmitted !!

34
Q

what can trichomonas vaginalis increase ur risk of?

A

contracting HIV - by damaging vaginal mucosa
bacterial vaginosis
cervical cancer
PID
pregnancy complications - preterm delivery

35
Q

trichomonas vaginalis presentation

A

smelly YELLOW/GREEN frothy discharge
vulvulovaginitis
strawberry cervix (colpitis macularis)
pH >4.5

usually asymptomatic in men - balantitis

36
Q

trichomonas vaginalis investigations

A

charcoal swab with microscopy -> motile trophozoites (flagellaaaa)

  • first catch urine in men for NAAT
37
Q

management of trichomonas vaginalis

A

oral metronidazole 5-7days

38
Q

genital warts

A

HPV 6 + 11
spread by skin to skin contact

diagnosis = clinical - white, rough raised NOT painful

management = topical podphyllum, cryotherapy or imiquimod topical cream

39
Q

HSV responsible for cold sores + genital herpes respectively?

A

HSV-1 -> cold sores, oro-genital sex

HSV-2 -> genital herpes, sexually transmitted

40
Q

latent stage of genital herpes

A

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

41
Q

presentation of genital herpes

A

painful genital ulceration
tender inguinal lymphadenopathy
flu like symptoms
neuropathic type pain - tingling, burning or shooting

primary infection usually more severe than recurrent episodes

42
Q

investigation + Mx of genital herpes

A

investigation = NAAT, viral PCR

management = oral aciclovir

43
Q

which strains of HPV cause cervical cancers vs genital warts

A

HPV 16 + 18

(HPV 6 + 11 = genital warts)

44
Q

complications of primary herpes simplex

A

radiculopathies causing urinary retention

45
Q

complication of genital warts

A

intra-epithelial neoplasia

46
Q

diagnosing urethritis on microscopy

A

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

repro (33 decks)

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