Sexual Health Flashcards
Definition of recurrent candidiasis
4 or more symptomatic episodes- x2 lab- confirmed, in 12 months
Treatment of recurrent candidiasis
Fluconazole 150mg stat q72h for 3 doses + maintenance 150mg weekly for 6 months
Or
Clotrimazole 2% nocte for 3 days, repeat monthly for 6 months
Apart from gonorrhoea and chlamydia, what other organisms can cause PID
Mycoplasma
Gardnerella
Bacteroides
Trichimonas
GBS
Chronic PID- actinomyces, TB
No organism isolated in 20% of cases
Syphilis classification
Early (<2 years):
- primary
- secondary
- early latent
Late (>2 years):
- late latent
- tertiary
Primary syphilis
Presents 9- 90 days following exposure.
Solitary painless purple papule. Inflammatory changes lead to necrosis, ulcerates (highly infective) then turn into a chancre.
Chancre is a 1-2cm moist base, well- defined margin, found in mucosal surfaces (genital or extra- genital)
Associated non- tender and rubbery inguinal lymphadenopathy
Resolves in 3-8 weeks
Secondary syphilis
Develops after 1-6 months of exposure
Systemic illness- lethargy, malaise, fever, anorexia, headache
Skin changes:
- generalised lesions affecting skin + mucous membranes
- symmetrical + non- itchy lesions- can be macular, papular, and rarely pustular
- condylomata lata- warty lesions on moist areas (that are smooth and moist)
- alopecia
Other:
- lymphadenopathy
- hep
- glomerulonephritis
- meningitis
- iritis
- optic neuritis
- ocular nerve palsy
- sensory- neural deafness
Latent syphilis
Asymptomatic
All untreated individuals become asymptomatic in 12- 24 months
No longer infectious after 24 months but women may still pass on infection to unborn fetus (vertical transmission)
Tertiary syphilis
Gummatous syphilis- necrotic nodules or plaques which develop 3-12 years after primary infection
Neurosyphilis- occurs 10-20 years after primary infection
Cardiovascular syphilis- aortic regurgitation, angina, aneurysm, 10- 40 years after infection
Syphilis serology
Progression: positive IgM -> IgG -> TPPA -> VDRL
Diagnosis of syphilis
T pallidum enzyme immunoassay (EIA)
Then TPPA or TPHA if positive EIA to confirm infection
Can also perform RPR for confirmation. Positive 3-5 weeks after infection
Treatment for syphilis
Primary + secondary: long acting Benzathine Penicillin G 2.4 MU IM x1 dose
Latent: 3 doses at 1- weekly intervals
If penicillin allergy: doxycycline
Repeat serology after treatment of syphilis
Repeat in 3, 6, 12 months
Serological cure- 4-fold drop in RPR titre
Reinfection- 4- fold rise in RPR titre
Inadequate treatment- if not reached 4- fold drop in RPR titre
Pathophysiology of HIV
HIV attaches to CD4 molecules on T cells and inhibit lymphocyte growth and enhances apoptosis
Copper IUD MOA
Inhibits fertilisation due to effect of copper on sperm and egg
Alteration in copper content of cervical mucus inhibits sperm penetration
Endometrial inflammatory reaction prevents implantation
COCP MOA
Inhibition of ovulation by providing high levels of synthetic oestrogen and progestogen so exerts negative feedback on pituitary to stop release of LH and FSH
Thickens cervical mucus which prevents sperm penetration
Thins endometrium which reduces receptiveness to implantation
POP MOA
Causes cervical mucuos to be viscous and hostile, preventing penetration of sper
Thins the endometrium inhibiting implantation
Cerazette inhibits ovulation
Risk of VTE among users of Drospirenone- containing oral contraceptive pills
Oestrogen interfere with the renin- angiotensin- aldosterone system which regulates body fluids and BP.
Oestrogen’s effect on RAAS leads to fluid retention, weight gain and a small increase in BP.
Ethinylestradiol increases plasma concentration of factors II, VII, VIII, X, XII and fibrinogen
Progesterone has a high affinity for the mineralocorticoid receptor and is an antagonist of aldosterone. Aldosterone is involved in haemostasis, leading to a decrease in coagulability.
Drospirenone has a high affinity for the progesterone and mineralocorticoid receptors. It promotes natriuresis (haemoconcentration) and counteracts the effect of ethinyloestradiol (hence weight gain, HTN and fluid retention less common with Drospirenone).
Drospirenone’s anti- mineralocorticoid properties in turn lead to a hypercoagulable state, creating a possible mechanism for the increased risk of VTE with the use of Drospirenone- containing OC’s
Mechanism of lactational amenorrhea for contraception
Suckling and the resultant hyperprolactinaemia disrupts pulsatile GnRH release. Sufficient FH is produced to stimulate folliculogenesis but insufficient LH hence preventing ovulation
