Sexual Health

Question 1

Recommended treatment for N.Gonorrhoea UK (BASSH)?

Answer 1

1st line: single dose IM 1g Ceftriaxone

(If resistance known and sensitive to Ciprofloxacin then can give single dose Ciprofloxacin 500mg PO)

2nd line (if needle-phobic): single dose PO 400mg Cefixime + single dose PO 2g Azithromycin

Question 2

Amsel criteria for diagnosing bacterial vaginosis?

Answer 2

Amsel criteria are satisfied if 3 out of 4 of the below are present;
1) thin white homogenous discharge
2) clue cells on microscopy
3) pH > 4.5
4) Positive whiff test

Question 3

Recommended treatment for bacterial vaginosis?

Answer 3

If asymptomatic - don’t treat [unless undergoing TOP]

If symptomatic - Metronidazole 400mg TDS for 5-7 days [or Met 2g stat if adherence likely to be an issue]

If pregnant; if asympto -> d/w obstetric team re whether to Tx or not. if sympto -> Metronidazole 400mg TDS for 5-7 days OR topical metronidazole gel (Avoid the 2g stat in pregnancy)

Question 4

BASHH PID Guidelines?

Answer 4

Chlamydia & Gonorrhoea account for ~ 1/4 of UK PID cases
IUD insertion ^ risk of PID in initial 4-6 weeks only. Limited evidence on whether removal of IUD improves outcomes if mild PID present, balance with risk of pregnancy, should be removed if more severe.
HIV pts may have more severe PID but respond well to the same Tx.

Ix: Swabs for NG, CT and M gen. HCG.

Low threshold to start empirical abx

Outpatient regimen:
IM Ceftrixone 1g stat & PO Doxycycline 100mg BD & PO Metronidazole 400mg BD for 14/7
OR
PO Ofloxacin 400mg bd for 14/7 & PO Metronidazole 400mg bd for 14/7
OR
PO Moxifloxacin 400mg OD for 14/7

Moxifloxacin is most effective for M Gen so if M Gen swab positive then switch to Moxi then repeat testing at 4 weeks to ensure cleared.

Indications for IV / inpatient therapy:
Temp > 38, suspected tuboovarian abscess, pelvic peritonitis, pregnancy
IV abx for 24 hrs then switch to 14/7 oral
=
IV Ceftriaxone 2g OD & IV Doxycycline 100mg BD
THEN
Doxycycline 100mg BD & Metronidazole 400mg BD for 14/7

Test regular partner for chlamydia and gonorrhoea (and M gen if M gen positive) and offer empirical tx with Doxycycline PO 100mg BD for 7/7. Nil UPSI until asympto and completed tX.

Question 5

Vaccination schedule for HPV vaccine?

Answer 5

BOTH girls & boys aged 12/13 offered SINGLE DOSE Gardasil-9 - protects from 9 strains inc 6,11 (warts) & 16,18 (oncogenic)

Currently no catch up vaccine for girls & boys that were not offered the vaccine at school.

HPV vaccine can also be offered to MSM or bisexual men < 45 yrs (if < 25 get 1 dose regime, if 25-45 get 2-dose regime) via sexual health clinics

Immunosupressed / HIV positive - get 3-vaccine regime