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Phase 3a > Sexual health > Flashcards

Sexual health Flashcards

1
Q

What is bacterial vaginosis?

A

Overgrowth of anaerobic bacteria in the vagina. It is not a STI, but increases risk of getting one.

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2
Q

What causes BV?

A

Caused by a loss of lactobacilli in the vaginal flora. They produce lactic acid to keep the vaginal pH acidic (under 4.5). As the vaginal pH becomes more alkaline, it allows anaerobic bacteria to multiply.

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3
Q

What are the most common organisms that cause BV?

A
  • Gardnerella vaginalis
  • Mycoplasma hominis
  • Prevotella species

Other infections can occur alongside BV (chlamydia, gonorrhoea etc)

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4
Q

What are the risk factors for developing BV?

A
  • Multiple sexual partners (not STI)
  • Excessive vaginal cleaning - douching, use of cleaning products and vaginal washes
  • Recent antibiotics
  • Smoking
  • Copper coil

Lower risk with condoms and COCP

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5
Q

How does BV present?

A

50% are asymptomatic.

  • White/grey fish smelling discharge

Not associated with pain, itching, irritation (suggests co-infection)

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6
Q

What is Amsel’s criteria for BV?

A

3/4 of the following:

  • Thin, white homogenous discharge
  • Clue cells on microscopy: stippled vaginal epithelial cells
  • Vaginal pH > 4.5
  • Positive whiff test (addition of potassium hydroxide results in fishy odour)
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7
Q

What is the management of BV?

A

If asymptomatic: No treatment required unless undergoing TOP

Symptomatic: 5-7 days of oral metronidazole
- relapse rate 50% within 3 months
- Can’t drink alcohol (flushing, N&V, shock)
- Can have a single dose 2g

Topical clindamycin or metronidazole is an alternative

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8
Q

What are the risks of BV in pregnancy?

A

Miscarriage
Preterm delivery
Premature rupture of membranes
Chorioamnionitis
Low birth weight
Postpartum endometritis

Oral metronidazole 5-7 days can be used in pregnancy.

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9
Q

What is Chlamydia trachomatis?

A

Gram negative bacteria which is intracellular. Most common STI in the UK. Many cases are asymptomatic.

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10
Q

What increases the risk of Chlamydia infection?

A
  • Young age
  • Sexually active
  • Multiple sexual partners
  • BV
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11
Q

What is the National Chlamydia Screening Programme?

A

Aims to screen men and women under 25 for chlamydia annually or when they change sexual partner.

  • Screen 3 months after treatment for a positive test
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12
Q

How does chlamydia present?

A

Women:
- Abnormal vaginal discharge
- Abnormal vaginal bleeding
- Pelvic pain
- Dyspareunia
- Dysuria

Men:
- Urethral discharge
- Dysuria
- Epididymo-orchitis
- Reactive arthritis

70% women and 50% men are asymptomatic

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13
Q

What are potential examination findings in chlamydia?

A

Pelvic or abdominal tenderness
Cervical motion tenderness (cervical excitation)
Inflamed cervix (cervicitis)
Purulent discharge

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14
Q

How is chlamydia investigated?

A

NAAT swabs - endocervical, vulvovaginal or first-void urine sample

Women (vulvovaginal or endocervical)
Men (urine sample or urethral swab)

Rectal and throat NAAT swabs can be used if oral/anal sex occur.

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15
Q

What is the management of Chlamydia?

A

1st line (uncomplicated): 200mg Doxycycline (2 a day for 7 days)

Pregnancy: test of cure
Azithromycin (1g stat then 500mg for 2 days)
Erythromycin (500mg 4x a day for 7 days)
Amoxicillin (500mg TDS for 7 days)

Other:
- Contact tracing (last 6 months)
- Abstain from sex for 7 days after treatment

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16
Q

What are the potential complications of Chlamydia infection?

A

Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Lymphogranuloma venereum
Reactive arthritis (Reiter’s)
Fitz-hugh-curtis

Pregnancy:
Preterm delivery
Premature rupture of membranes
Low birth weight
Postpartum endometritis
Neonatal infection (conjunctivitis and pneumonia)

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17
Q

What is lymphogranuloma venereum?

A

Affects lymphoid tissue around the site of chlamydia infection. Usually occurs in men who have sex with men. Associated with HIV.

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18
Q

What are the three stages of lymphogranuloma venereum?

A

Stage 1: Painless pustule then ulcer (penis in men, vaginal wall in women)

Stage 2: Painful inguinal lymphadenitis

Stage 3: Inflammation of rectum (Proctocolitis - anal pain, change in bowel habit, tenesmus)

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19
Q

What is the treatment of lymphogranuloma venereum?

A

1st line: Doxycycline 100mg twice daily for 21 days

Alternatives are Erythromycin, azithromycin and ofloxacin

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20
Q

What type of bacteria is Gonorrhea?

A

Gram negative diplococcus (neisseria gonorrhoeae). It affects mucous membranes with a columnar epithelium including the endocervix (women), urethra, rectum, conjunctiva and pharynx.

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21
Q

Why are traditional antibiotics azithromycin and ciprofloxacin not used to treat Gonorrhea?

A

High levels of antibiotic resistance

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22
Q

How does Gonorrhea present?

A

Much more likely to be symptomatic than chlamydia

Women:
Odorless purulent discharge (green or yellow)
Dysuria
Pelvic pain

Men:
Odorless purulent discharge (green or yellow)
Dysuria
Epididymo-orchitis

Others:
Rectal infection
Sore throat
Prostatitis
Conjunctivitis (purulent)

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23
Q

How is Gonorrhea diagnosed?

A

NAAT swabs for RNA or DNA of gonorrhoea (detection)

Charcoal swab for MC&S

24
Q

What is the management of Gonorrhea?

A

Single dose of IM Ceftriaxone 1g (organism not known)

Single dose of oral ciprofloxacin 500mg (if organism known and sensitive)

Oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose) - if IM refused

Contact tracing, abstain from sex, education

25
Q

What follow up should be done after Gonorrhea treatment?

A

Test of cure:
72 hours after treatment for culture
7 days after treatment for RNA NAAT
14 days after treatment for DNA NAAT

26
Q

What are the complications of Gonorrhea?

A

PID
Chronic pelvic pain
Infertility
Epididymo-orchitis (men)
Prostatitis (men)
Conjunctivitis - especially neonates (emergency - sepsis, blindness)
Urethral strictures
Disseminated gonococcal infection
Skin lesions
Fitz-Hugh-Curtis syndrome
Septic arthritis
Endocarditis

27
Q

What is Disseminated Gonococcal infection?

A

Bacteria spreads to the skin and joints. It causes:

Various non-specific skin lesions
Polyarthralgia (joint aches and pains)
Migratory polyarthritis (arthritis that moves between joints)
Tenosynovitis - tendon pain
Systemic symptoms such as fever and fatigue

28
Q

What is Thrush?

A

Vaginal candidiasis, caused by infection with a yeast of the candida family (mainly candida albicans).

May colonise vagina without symptoms and then progress after opportunity (pregnancy/ABx treatment)

29
Q

What are the risk factors for developing thrush?

A

Diabetes mellitus
Drugs: broad spectrum antibiotics, steroids
Pregnancy
Immunosuppression: HIV

30
Q

How does thrush present?

A
  • Thick, white discharge (cottage cheese) - doesn’t smell
  • Vulval/vaginal irritation, itching

More severe:
Vulval erythema
Fissures
Dyspareunia
Excoriations
Dysuria

31
Q

How is thrush diagnosed?

A

Usually clinical

Vaginal pH testing (pH <4.5) - rule out BV and trichomoniasis

Charcoal swab w/ microscopy

32
Q

How is Thrush managed?

A

Topical, oral or pessaries can be used:

Oral fluconazole (150mg single dose) - tetratogenic
Clotrimazole cream (5g of 10% cream at night - single)
Clotrimazole pessary (500mg single dose at night)

33
Q

What is recurrent thrush and how is it managed?

A

> 4 episodes in a year

Check compliance, high vaginal swab, blood glucose

Induction-maintenance regime:
- Induction: oral fluconazole every 3 days for 3 doses
- Maintenance: oral fluconazole weekly for 6 months

34
Q

What is trichomoniasis?

A

A highly motile, flagellated protozoan parasite. It is an STI which lives in the urethra of men and vagina of women.

35
Q

What can trichomoniasis infection increase the risk of?

A

Contracting HIV - damages the vaginal mucosa
Bacterial vaginosis
Cervical cancer
Pelvic inflammatory disease
Pregnancy-related complications such as preterm delivery

36
Q

How does trichomoniasis present?

A

50% are asymptomatic.

Vaginal discharge: offensive (fishy), yellow/green, frothy
Vulvovaginitis - dysuria, dyspareunia
strawberry cervix
pH > 4.5
In men is usually asymptomatic but may cause urethritis and/or balanitis

37
Q

How is trichomoniasis diagnosed?

A

Charcoal swab with microscopy - motile trophozoites

Women - swab posterior fornix of the vagina

Men - urethral swab or first-catch urine

38
Q

What is the management of trichomoniasis?

A

Oral metronidazole 5-7 days

Single dose of 2g metronidazole can be used

39
Q

What is syphilis?

A

Primarily a sexually transmitted infection caused by the spirochaete (spiral-shaped) Treponema pallidum. The infection is characterised by three distinct stages.

40
Q

What is the incubation period for syphilis?

A

9-90 days with an average of 21 days

41
Q

How is syphilis transmitted?

A
  • Oral, vaginal or anal sex involving direct contact with an infected area
  • Vertical transmission
  • Intravenous drug use
  • Blood transfusions and other transplants (Rare due to screening of blood products)
42
Q

What are the features of the primary stage of syphilis?

A

Chancre - painless ulcer at the site of sexual contact

Painless regional lymphadenopathy (may be present)

43
Q

What are the features of secondary syphilis?

A

Occurs 6-10 weeks after primary infection:

  • Systemic symptoms: fevers, lymphadenopathy
    rash on trunk, palms and soles
  • Buccal ‘snail track’ ulcers (30%)
  • Condylomata lata (painless, warty lesions on the genitalia)

Latent period - Sx resolve spontaneously

44
Q

What are the features of tertiary syphilis?

A

Occurs many years after initial infection:

  • Gummas (granulomatous lesions of the skin and bones)
  • Cardiovascular (ascending aortic aneurysms/ aortic regurgitation)
  • Neuro (Tabes dorsalis, dementia, paralysis, altered behaviour)
  • Argyll-Robertson pupil (accommodates but does not react)
45
Q

How is suspected syphilis investigated?

A

A combination of both:

Non treponemal tests:
- Rapid plasma reagin and venereal disease research laboratory tests
- Non-specific (many false positives)
- Assess quantity of antibodies

Treponemal tests:
- More complex and expensive
- Include TP-EIA and TPHA
- Qualitative only and do not become negative once treated

46
Q

What is the management of syphilis?

A

1st line: IM dose Benzathine Penicillin single dose

Longer course may be required in tertiary disease

Alternatives are co-amoxiclav, doxycycline and amoxicillin

Should be a 4 fold decrease in titres (non-treponemal tests) is considered an adequate response)

47
Q

What is a Jarisch-Herxheimer reaction?

A

Sometimes seen after treatment initiation for syphilis:

  • Fever, rash, tachycardia present

No treatment needed except antipyretics

48
Q

What causes genital herpes?

A

HSV-1 and HSV-2. It used to be considered that HSV1 caused cold sores and HSV-2 cause genital herpes. But it is now known that there is overlap.

49
Q

How is herpes spread?

A

Through direct contact with affected mucous membranes or viral shedding in mucous secretions. Can be spread through asymptomatic individuals.

50
Q

How does genital herpes present?

A

May be latent and re-activate or present around 2 weeks after initial infection:

  • Painful genital ulceration - dysuria and pruritus
  • 1st episode is usually more severe: Headache, fever, malaise
  • Neuropathic pain
  • Tender inguinal lymphadenopathy
51
Q

How is genital herpes diagnosed?

A

Clinical history and swab
NAAT swab

52
Q

What is the management of genital herpes?

A

Oral aciclovir

Supportive: saline bath, topical lidocaine, analgesia

53
Q

How should genital herpes be managed in pregnancy?

A

Primary genital herpes >28 weeks: Oral aciclovir + prophylactic aciclovir. Recommend caesarean

Recurrent genital herpes: Consider prophylactic aciclovir (transmission to baby is low even with active lesions)

54
Q

What are the main causes of genital warts?

A

HPV 6 and 11, spread primarily through skin-skin contact during sexual activity.

55
Q

How do genital warts present?

A
  • Small (2 - 5 mm) fleshy protuberances which are slightly pigmented
  • May be keratinised (hard) or non-keratinised (soft)
  • May bleed or itch
56
Q

What is the management of genital warts?

A

Topical podophyllum or Cryotherapy - 1st line

Topical imiquimod - 2nd line

Prevention - vaccine in school

Phase 3a (9 decks)

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