Sexual Health Flashcards

Question

What investigations do you do when someone presents with vaginal discharge?

Answer 1

Examination pH testing Vulvovaginal swab (NAAT for gonorrhoea and chlamydia) High vaginal swab - culture (T.vaginalis, candida) - microscopy (wet mount-TV, gram stain) Endocervical swab - gonorrhoea culture Other tests - culture for other organisms - HSV PCR from cervix - mycoplasma genitalium (VVS PCR)

Answer 2

Immunosuprresion Pregnancy HRT COCP Recent abx DM Musical breakdown

Answer 3

1st line non-pregnant - fluconazole 150mg stat (repeats after 72 hours if severe) 2nd line (suitable if pregnancy risk) - clotrimazole pessary - clotrimazole cream Pregnant - clotrimazole pessary Remember general skin care methods (douching, perfumed wash)

Answer 4

>4 symptomatic episodes per year (at least 2 confirmed by microscopy/culture) Induction then maintenance Fluconazole every 72 hours for 3 doses Then Give fluconazole for 6 months, once weekly

Answer 5

Douching/perfumed products ROI (receptive oral sex) Black race Recent changes in partner Smoking Presence of an STI

Answer 6

Bacterial Vaginosis (not an STI) - imbalance in vaginal flora - increased numbers of anaerobic and facultative bacteria (gardnerella, prevotella, mobiluncus)

Answer 7

pH testing >4.5 Gram stain High vaginal swab (loss of lactobacilli and increase in anaerobic bacteria, clue cells also)

Answer 8

1st line - Metronidazole 400mg BD for 5 days Alternative regimens - Metronidazole single dose - Metronidazole gel - Clindamycin cream Washing advice (avoid femfresh)

Answer 9

Discharge Itch Odour Vulvitis Vaginitis Strawberry cervix

Answer 10

Metronidazole 400mg PO BD for at least 7 days

Answer 11

Bacterial Vaginosis Non-sexually transmitted infection of the lower genital tract in females, which occurs due to a disturbance in the normal vaginal flora and subsequent increase in vaginal pH. Most common cause of abnormal discharge.

Answer 12

Normal vaginal flora is disturbed leading to reduction in the numbers of lactobacilli bacteria in the vagina. Lactobacilli are large rod-shaped organisms that produce hydrogen peroxide to help maintain the acidic pH of the vagina (<4.5) hence inhibiting the growth of other organisms. When lactobacilli populations are reduced, the pH rises, allowing growth of other microorganisms. Infection is polymicrobial, but most common organisms found are: - Gardnerella vaginalis - Anaerobes - Mycoplasmas

Answer 13

Sexual activity IUD Receptive oral sex Presence of an STI Vaginal douching Use of scented soaps/vaginal deodorants Recent antibiotic use Ethnicity (more common in black women) Smoking

Answer 14

50% of cases are asymptomatic. Offensive fishy smelling discharge. Not associated with soreness, itching, or irritation. Thing, white/grey homogenous discharge.

Answer 15

Vaginal candidiasis - profuse thick white, itchy curd-like discharge STIs - Gonorrhoea - Chlamydia - Trichomonas vaginalis (thin, frothy, offensive discharge with irritation, dysuria, vaginal inflammation) (cannot track to give PID)

Answer 16

History Vaginal examination - pH >4.5 - KOH whiff test (additional alkali added to discharge which releases a strong fishy odour) Microscopic examination (preferred method for diagnosis) - High vaginal smear (HVS) is gram stained and evaluated for 'clue cells' (vaginal epithelial cells studded with gram variable coccobacilli) & reduced numbers of lactobacilli with absence of pus cells The isolation of G.Vaginalis is not sufficient to diagnose BV as it can be cultured from the vagina in unaffected women.

Answer 17

Asymptomatic women may opt for no treatments. Treated with metronidazole (orally/gel directly to vagina) (Clindamycin/Tinidazole can be used) Lifestyle - avoid vaginal douching - avoid scented shower gels - avoid antiseptic agents - removal of IUD considered Test of cure not necessary

Answer 18

Untreated symptomatic BV can increase the risk of: - premature birth - miscarriage - chorioamnionitis

Answer 19

Same as for non-pregnant Treatment received following birth: lactating women are advised to be treated with lower dose of metronidazole and it can affect the taste of breast milk.

Answer 20

Fungal infection of the lower female reproductive tract.

Answer 21

Caused by Candida albicans, a yeast like fungus which is found as part of the body's normal flora in GI tract (meaning there are instances of oral candidiasis). Opportunistic infection (exploit opportunities) OR Hypersensitivity reaction to Candida albicans

Answer 22

Pregnancy DM Use of broad spectrum antibiotics Use of corticosteroids Immunosuppression/compromised immune system

Answer 23

- Pruritus vulvae (dominant symptom) - Vaginal discharge (white, curd like, non-offensive) - Dysuria (superficial) - Erythema/swelling of vulva - Satellite lesions (red, pustular lesions with superficial white/creamy plaques that can be scraped off)

Answer 24

BV (no soreness/irritation) Trichomonas vaginalis (vaginal soreness & pain) UTI- must be excluded Contact dermatitis- enquire about change in hygiene products Eczema/psoriasis- detailed history Rule out DM

Answer 25

Measure vaginal pH Complicated infection (recurrent/pregnancy/DM) - vaginal smear - microscopic investigations (Presence of spores & mycelia)

Answer 26

- Intravaginal antifungal (clotrimazole/fenticonazole) - Oral antifungal (fluconazole/itraconazole) - Topical imidazole (in adjunction with one of the above to address vulval symptoms) If symptoms not subsided in 7-14 days - Consider alternative diagnosis (measure pH and swab for microscopy and culture) - Consider predisposing risk factors and address them - Consider concordance with medication Lifestyle advice - avoid cleaning vaginal area more than once a day - avoid irritants - avoid wearing tight fitting clothing

Answer 27

Treat with intravaginal antifungal (clotrimazole) Do not give oral antifungals (fluconazole/itraconazole) Treat vulval symptoms with topical antifungal Advice patient to be careful when inserting intravaginal treatment applicator Look for any evidence of STI as this can affect the pregnancy

Answer 28

Oestrogen levels stimulate increased glycogen production. Provides more favourable environment for microorganisms to thrive. Oestrogen might have a direct influence on the candida organism by promoting its growth and encouraging it to stick to the walls of the vagina.

Answer 29

Infection of the upper genital tract in females which affects the uterus, Fallopian tubes and ovaries.

Answer 30

Infective inflammation of the endometrium, uterus, Fallopian tubes (salpingitis), ovaries and peritoneum. Caused by the spread of bacterial infection from the vagina or cervix to the upper genital tract. Chlamydia trachomatis & Neisseria gonorrhoea= most common organisms

Answer 31

Sexually active Aged under 15-24 Recent partner change Intercourse without barrier contraception History of STIs Personal history of PID Can also occur via instrumentation of the cervix (introducing bacteria into female reproductive tract)

Answer 32

Lower abdomen pain Deep dyspareunia Menstrual abnormalities Post-coital bleeding Dysuria Abnormal vaginal discharge (purulent/unpleasant odour) Advanced cases - severe lower abdominal pain - fever (>38 degrees) - N&V

Answer 33

Tenderness of the uterus/adnexae (bilaterally) (ovaries/Fallopian tubes/ligaments) Cervical excitation Palpable mass in lower abdomen (abscess)

Answer 34

Ectopic pregnancy Ruptured ovarian cyst Endometriosis UTI

Answer 35

Endocervical swabs for gonorrhoea & chlamydia High vaginal swab for Trichomonas vaginalis & BV Testing is via NAAT (Nucleic Acid Amplification Test) Full STI screen (HIV, syphilis, gonorrhoea, chlamydia) Urine dipstick & MSU Pregnancy test TV USS in severe disease Laparoscopy in severe cases

Answer 36

Diplococci shape Gram -ve (pink)

Answer 37

Diplococci shape Gram -ve (pink)

Answer 38

14 days broad spectrum abx: - Doxycycline, ceftriaxone and metronidazole OR - Ofloxacin and metronidazole Start immediately before results of swab are available. Analgesics & Rest Avoid sexual intercourse until abx course is complete and partner(s) are treated. All sexual partners from the last 6 months should be tested and treated to prevent spread and recurrence.

Answer 39

- Pregnant - Risk of ectopic pregnancy - Severe symptoms (N&V, high fever) - Signs of pelvic peritonitis - Unresponsive to abx, need IV therapy - Emergency surgery needed - Suspicion of alternate diagnosis

Answer 40

Delaying treatment/having repeated episodes can increase risk of: - Ectopic pregnancy (narrowing/scarring of Fallopian tubes) - Infertility - Tubo-ovarian abscess - Chronic pelvic pain - Fitz-Hugh Curtis Syndrome (peri hepatitis causing RUQP)

Answer 41

STI caused by Chlamydia trachomatis Most common STI in UK

Answer 42

It is an intracellular gram -ve bacterium. Serotypes A-C: ocular infection Serotypes D-K: genitourinary infection Serotypes L1-L3: LGV (lymphogranuloma venereum), infection in men who have sex with men resulting in proctitis

Answer 43

Via unprotected vaginal, anal or oral sex. Infection can spread via skin to skin contact. If infected semen/vaginal fluid enters the eye it can cause chlamydial conjunctivitis. Infected mother pass onto baby during delivery (vertical transmission)

Answer 44

Via unprotected vaginal, anal or oral sex. Infection can spread via skin to skin contact. If infected semen/vaginal fluid enters the eye it can cause chlamydial conjunctivitis. Infected mother pass onto baby during delivery (vertical transmission)

Answer 45

Enters host cell as elementary body (infectious form) Once inside cell it becomes a reticular body (non-infectious capable of replication) Following replication, these bodies mature back to elementary bodies and following cell rupture they infect other cells. Resulting in inflammation and tissue damage

Answer 46

Age <25 Sexual partner +ve Recent change in sexual partner Co-infection with another STI Non-barrier contraception

Answer 47

Often asymptomatic. Incubation period is 7-21 days after which they may become symptomatic. Dysuria Abnormal vaginal discharge Intermenstrual/postcoital bleeding Deep dysparenuria Lower abdominal pain Cervicitis +/- contact bleeding Mucopurulent endocervical discharge Pelvic tenderness Cervical excitation Chlamydial conjunctivitis Discomfort and discharge from rectum Pharynx can be infected

Answer 48

Urethritis= Dysuria, Urethral Discharge Epididymal-orchitis= testicular pain Epididymal tenderness Mucopurulent discharge

Answer 49

All STIs (Full STI screen should be done) Difficult to distinguish between chlamydia and gonorrhoea so many NAATs offer dual testing for both diseases. Treatment for gonorrhoea covers chlamydia also.

Answer 50

NAAT Women: vulvo-vaginal swab (1st choice), endocervical swab or 1st catch urine sample Men: 1st catch urine sample (1st choice), urethral swab If indicated swabs should be taken from rectum, eyes and throat. Contact tracing so recent partners can be tested.

Answer 51

Doxycycline 100mg BD for 7 days OR Azithromycin 1g single dose If contraindicated: Erythromycin 500mg BD 10-14 days OR Ofloxacin 200mg BD for 7 days Avoid sexual intercourse & oral sex until they have completed treatment (7 days after azithromycin)

Answer 52

Pregnant Poor compliance Persistent symptoms If <25 repeat testing recommended 3 months after treatment.

Answer 53

Women - Ascending infection: salpingitis/endometritis which can lead to PID Men - Epididymitis/epididymo-orchitis - Reactive arthritis (joints/eyes/urethra inflamed)

Answer 54

Premature delivery Low birth weight Miscarriage Stillbirth Vertical transmission

Answer 55

Azithromycin OR Erythromycin

Answer 56

Inflammation and discharge in eyes (neonatal chlamydial conjunctivitis): 5-12 days after birth Pneumonia (1-3 months after birth)

Answer 57

Oral erythromycin

Answer 58

Curable STI caused by gram -ve bacterium Neisseria gonorrhoea. 2nd most common STI

Answer 59

People <25 yo Men who have sex with men

Answer 60

Unprotected vaginal/oral/anal sex Vertically from mother to child

Answer 61

Has a strong affinity for mucous membranes. Organism can infect the uterus, urethra, cervix, Fallopian tubes, ovaries, testicles, rectum, throat and eyes. Once adhered to mucous membrane it invades the host cell and causes acute inflammation. It has surface proteins that bind to receptors of immune cells preventing an immune response.

Answer 62

Age <25 yo Men who have sex with men Living in high density urban areas Previous gonorrhoea infection Multiple sexual partners

Answer 63

Often asymptomatic. Symptoms usually develop 2-5 days following infection. GENITAL INFECTION Female - Altered/increased vaginal discharge (thin, watery, green/yellow) - Dysuria - Dyspareunia - Lower abdominal pain - Mucopurulent endocervical discharge - Easily induced cervical bleeding - Pelvic tenderness Male - Mucopurulent urethral discharge - Dysuria - Epididymal tenderness RECTAL INFECTION - anal discharge - anal pain/discomfort PHARYNGEAL INFECTION - asymptomatic

Answer 64

Full STI screen (chlamydia, gonorrhoea, herpes) (HIV, syphilis, Hep B/C from blood finger prick)

Answer 65

Females - Endocervical/vaginal swab (NAAT) - Endocervical/urethral swab (microscopy and culture) Males - First pass urine (NAAT) - Urethral/meatal swab (microscopy and culture) Swabs for NAAT & microscopy and culture can be obtained from the throat, rectum or eye if indicated. While waiting for the results the patient should be treated with empirical abx if signs are indicative of gonorrhoea.

Answer 66

Single dose IM ceftriaxone 1g Same treatment for pregnant woman who is infected. - Screening for all other STIs - Contact previous sexual partners and advise them to be screened and treated - Safe sex should be encouraged - Patients should abstain from sex until both partners have completed treatment Test of cure is recommended during a follow up appointment

Answer 67

PID Epididymo-orchitis Prostatitis Disseminated gonococcal infection (DGI)- causes joint pain and skin lesions

Answer 68

Systemic symptoms (malaise, joint pain, fever, rash): disseminated gonorrhoea which can develop into gonococcal meningitis Females showing signs of severe PID

Answer 69

Perinatal mortality Spontaneous abortion Premature labour Early foetal membrane rupture

Answer 70

Gonococcal conjunctivitis (eye pain, redness, discharge) Urgent referral Treatment to prevent long term damage and blindness

Answer 71

Single stranded RNA retrovirus that infects and replicates within the human immune system using CD4 cells. Without treatment, destruction of the immune system can lead to AIDS (Acquired immune deficiency syndrome).

Answer 72

HIV infects and replicates within CD4 cells (T helper cells). Penetrates CD4 cell and empties its contents. Single strands of viral RNA are converted to double stranded DNA by reverse transcriptase and combined with the host DNA using the enzyme integrase. When infected cell divide, viral DNA is read creating protein chains and the immature virus pushes out of the cell retaining some cell membrane. Virus matures when the protease enzyme cuts the viral protein chains and they assemble to create a working virus. Host cell is destroyed during this process.

Answer 73

Upon seroconversion (producing anti-HIV antibodies during primary infection) patient experiences flu like symptoms. CD4 levels fall in response to initial rapid replication of HIV. Patient is extremely infectious. Over next months-years infection enters a latent phase. Patient may be asymptomatic but with levels of CD4 falling and viral load increasing they may become more susceptible to infections. HIV can later become asymptomatic and eventually (over 10 years) develop into AIDS.

Answer 74

Unprotected sexual contact (vaginal, anal, oral) Sharing of injecting equipment Medical procedures (blood products, skin grafts, organ donation, artificial insemination) Vertical transmission (mother to child in utero, in childbirth or breast feeding)

Answer 75

Exposed to a higher viral level STIs causing anogenital inflammation Any breaks in skin/mucosa

Answer 76

Men who have sex with men IV drug users Those in high prevalence areas Unprotected sex with a partner who has lived/ travelled in Africa

Answer 77

Seroconversion illness (2-6 weeks after exposure) - Fever - Muscle aches - Malaise - Lymphadenopathy - Maculopapular rash - Pharyngitis Symptomatic HIV - Weight loss - High temperatures - Diarrhoea - Frequent minor opportunistic infections

Answer 78

Pneumocystis Jiroveci Pneumonia Non-Hodkin's Lymphoma TB

Answer 79

ELISAs that test for serum (or salivary) HIV antibodies and p24 antigen - give reliable results 4-6 weeks after exposure Rapid test kits can give results in 30 mins Home sampling/testing kits are now available But these are less reliable so still needs to be confirmed by an ELISA. Contact tracing

Answer 80

HAART (Highly active antiretroviral therapy) - does not cute HIV - reduces viral load to undetectable levels in the serum - excellent prognosis - risk of transmission is very small - reduces risk of AIDS-related and non-AIDS related mortality NRTIs (Nucleoside reverse transcriptase inhibitors) PIs (Protein Inhibitors) NNRTIs (Non-nucleoside reverse transcriptase inhibitors) InSTIs (Integrase strand transfer inhibitors) These are used in combination to target enzymes used in viral replication and maturation. Compliance is key for the rest of their lives. Non-adherence to HAART can result in resistance mutations making treatment difficult/impossible to treat. Manage psychological impact.

Answer 81

Regular tests - CD4 count - HIV viral load - FBC - U&Es - Urinalysis - ALT/AST and bilirubin Pregnancy testing may be required Resistance testing may be required

Answer 82

If somebody suspects/has been exposed to HIV within the last 72 hours commence PEP (Post-Exposure Prophylaxis) to lower the risk of becoming infected. PEP course lasts for 1 month - Truvada & Raltegravir

Answer 83

Antenatal antiretroviral therapy during pregnancy and delivery. Avoidance of breastfeeding. Neonatal post-exposure prophylaxis. C section is recommended if CD4 count is high. It is no longer recommended if there is undetectable viral load at delivery.

Answer 84

An STI caused by spirochete gram -ve bacterium Treponma palladium subspecies palladium.

Answer 85

Sexual transmission Vertical (causing congenital syphilis) Infected blood products

Answer 86

The motile Treponema pallidum enters through a break in the skin or through intact mucous membranes. The bacteria divide and an infectious hard ulcer (chancre) forms at the site of contact after an incubation period of 2-3 weeks. This is the first stage of acquired symptomatic syphilis: primary syphilis. If left untreated, T. pallidum can persist and cause systemic damage via obliterating arteritis. This is where endothelial cells of the vessels excessively proliferate causing the lumen of the vessels to become narrowed. This can then result in ischaemia at the tissues supplied by these arteries which leads to the symptoms associated with syphilis.

Answer 87

Engaging in unprotected sex (especially with high risk partners) Multiple sexual partners MSM HIV infection

Answer 88

Primary syphilis - papule will appear before ulcerating into a chancre (painless ulcer developing 9-90 days post infection on a genital site, they are painless, singular, hard and not itchy) - chancres usually heal within 3-10 weeks Secondary syphilis (3 months post infection) - skin rash (hands and soles of feet) - fever - malaise - arthralgia - weight loss - headaches - condylomata lata (elevated papules like warts in moist areas of skin) - painless lymphadenopathy - silvery grey mucous membrane lesions Following secondary syphilis the disease enters the asymptomatic latent phase. Tertiary syphilis (present years after) Gummatous syphilis - granulomas can form in bone, skin, mucous membranes of URT, mouth, viscera or connective tissue - non infectious Neurosyphilis - Tabes dorsalis (ataxia, numb legs, absence of deep tendon reflexes, lightning pains, loss of pain and temperature sensation, skin and joint damage) - Dementia (cognitive impairment, mood alterations, psychosis) - Meningovascular complications (cranial nerve palsies, stroke) - Argyll Robertson Pupil (constricted and unreactive to light, but reacts to accommodation) Cardiovascular syphilis - aortic regurgitation due to aortic valvulitis (diastolic murmur) - aortic root dilatation - angina due to stenosis of coronary ostia - dilation and calcification of ascending aorta

Answer 89

Dark ground microscopy of chancre fluid (detects spirochaete in primary syphilis) PCR testing of swab from active lesion Serology - Treponemal tests (Treponemal ELISA IgG/IgM remains +ve for life. TPPA/TPHA remains +ve for life) - Non-treponemal tests (RPR/VDRL rises in early disease, falling titres indicate successful treatment or progression to late disease. False positives can occur in inflammatory conditions/pregnancy) Lumbar puncture (CSF antibody tests in neurosyphilis)

Answer 90

1st line: Early syphilis: Benzathine penicillin single dose Late syphilis: Benzathine penicillin 3 doses at weekly intervals Neurosyphilis: - Procaine penicillin & probenecid for 14 days OR - Benzylpenicillin for 14 days Advise patients to avoid sexual contact of any kind until treated successfully. Screening for other STIs Patient education Contact tracing Follow up serology to determine response to treatment

Answer 91

Inflammatory response secondary to death of Treponemes resulting in a flu like illness within 24 hours of treatment. Supportive measures required unless patient has cardiovascular/neurosyphilis then oral steroids should be given prior to abx to reduce risk of acute localised inflammatory reaction.

Answer 92

Inflammatory response secondary to death of Treponemes resulting in a flu like illness within 24 hours of treatment. Supportive measures required unless patient has cardiovascular/neurosyphilis then oral steroids should be given prior to abx to reduce risk of acute localised inflammatory reaction.

Answer 93

Syphilis HIV Hep B At 1st antenatal appointment.

Answer 94

Miscarriage Stillbirth Pre-term labour Congenital syphilis

Answer 95

Severe and debilitating - saddle nose - rashes - fever - failure to gain weight

Answer 96

Benign epithelial or mucosal outgrowths caused by HPV (Human Papilloma Virus). Not curable. HPV is the most prevalent viral STI, rates are expected to decrease due to introduction of HPV vaccine.

Answer 97

Anogenital warts: HPV6 & HPV11 Following infection the virus penetrates the epithelial barrier and infects basal keratocytes. Within the keratinocyte the virus replicates resulting in multiplication of the keratinocyte and this rapid growth manifests as lesions.

Answer 98

Spread through skin to skin contact during vaginal and anal sexual intercourse, however penetrative sex is not necessary for transmission. Condoms do not protect against HPV as not all skin is covered. Can be passed from hand to genitals. Passed on during oral sex Neonate during delivery

Answer 99

Persistent infection with high risk types can lead to cancer of the vulva, vagina, cervix and anus. HPV16 & HPV18 Usually picked up on cervical screening.

Answer 100

Early age at 1st sexual intercourse Multiple partners Immunosuppression Smoking Diabetes associated with persistence of warts

Answer 101

Most are asymptomatic and resolve spontaneously. Symptomatic men/women present with: - warts affecting penicillin, scrotum, vulva, vagina, cervix, perianal skin, anus (weeks/months/years after infection) - lesions are painless, fleshy growths than can be soft/hard, singular/multiple - extra-genital lesions affecting oral cavity, larynx, conjunctivae, nasal cavity

Answer 102

Vestibular papillomatosis - projections of the vestibular epithelium or labia minora - non-viral - not sexually transmitted - application of acetic acid does not change their colour (HPV lesions turn white) Molloscum contagiosum - viral infection causing small firm raised papules on the skin Patients should be offered full STI screen due to possibility of co-infection

Answer 103

Examination Small lesions may require magnification with a colposcope Proctoscopy may be necessary if symptoms such as bleeding and irritation. Females- speculum to look for any internal warts Biopsy may be required for atypical lesions

Answer 104

Treatment not always necessary and lesions will resolve spontaneously over time, especially postpartum. Topical treatments - Podophyllotoxin (clusters of small warts) - Imiquimod (larger warts) Topical treatments may weaken latex condoms. They are also CI in pregnancy and breastfeeding. SE of local inflammation Physical ablation - Excision (large warts) - Cryotherapy (multiple small warts) - Electrosurgery (large warts failed to respond to topical) - Laser surgery (difficult to access)

Answer 105

All girls aged 12-13 Vaccine is most beneficial administered before 1st sexual contact

Answer 106

HPV 16, 18, 6, 11

Answer 107

NOT associated with miscarriage, premature birth or other complications.

Answer 108

Due to hormonal changes genital warts may multiply or enlarge. Treatment aims to reduced burden of lesions do during childbirth the neonates exposure is reduced. Risk of transmission to neonate is low and if baby does become infected the immune system will clear the virus. In rare cases the baby may develop respiratory papillomatosis where genital warts develop in the throat.

Answer 109

Physical ablation methods.

Answer 110

Non-curable STI caused by Herpes Simplex virus.

Answer 111

Skin to skin contact Vaginal, anal, oral sex - Once infected people may be symptomatic for long periods of time until the first flare up. - Following the primary symptomatic infection the virus can lie dormant until it recurs later in life causing recurrent outbreaks.

Answer 112

HSV-1: genital herpes, also affects areas around the mouth and nose causing cold sores HSV-2: genital herpes HSV enters body through small cracks in the skin or through mourns membranes of mouth, vagina, rectum, urethra or under foreskin. After infecting the surface the virus travels up the nearest nerve to the ganglion and remains there. It can stay dormant here as it cannot be reached by the immune system. During reactivation it travels back down the nerve onto the surface of the genitals to cause a symptomatic outbreak. Asymptomatic shedding can cause transmission as many people can shed and transmit the virus even if they are unaware they have it.

Answer 113

Skin to skin contact Penetrative sex Oral sex with someone who has cold sores

Answer 114

Multiple sexual partners Oral sex with partner suffering from cold sores

Answer 115

Primary infection - Small red blisters around genitals that are very painful and can form open sores (penis, anus, buttocks, thigh, vulva, clitoris) - Vaginal/penile discharge - Flu like symptoms (fever, muscle aches) - Itchy genitals After 20 days the lesions crust and heal Secondary infection (shorter and less severe, due to antibody recognition) - Burning and itching around genitals - Painful red blisters around genitals Cold sores - painful lesions around mouth/nose that last 7-10 days - mainly caused by HSV1

Answer 116

Varicella-zoster virus Trauma Vesiculobullous disorders Many outbreaks of herpes (>5 in a year) may indicate a weakened immune system and an underlying diagnosis of HIV.

Answer 117

History Swab for open sore (PCR) Screen patients for other STIs

Answer 118

Primary infection - Aciclovir (reduces size and number of lesions) - Full sexual health screen - Advice about preventing transmission - Avoid all sexual contact - Disclose infection to recent and current sexual partners - Supportive measures Recurrent outbreaks - Painkillers - Petroleum jelly - Ice packs - Episodic treatment (taking aciclovir as soon as symptoms develop) - If >6 per year suppressive treatment is recommended (daily doses of aciclovir)

Answer 119

Baby should be protected due to antibodies through placenta. Aciclovir may be required. Vaginal delivery is offered, but C section may be wanted.

Answer 120

More dangerous for baby. Mother has not produced antibodies to pass onto foetus. Baby more likely to contract herpes in vaginal birth so C section is recommended.

Answer 121

SEM (skin eyes mouth) - antiviral treatment DIS (disseminated): internal organs affected CNS: nervous system and brain affected (can lead to encephalitis)

Answer 122

Curable STI caused by protozoan Trichomonas vaginalis

Answer 123

It is an anaerobic flagellated protozoan that can affect the female urethra, vagina, paraurethral glands, male urethra, and underneath the foreskin. Urethral infection is present in nearly all cases, and in women there is often infection more than 1 site. TV replicates via binary fission whilst destroying epithelial cells through direct cell contact by release of cytotoxins. It binds host plasma proteins preventing precognition by complement pathway. This destruction leads to an increased risk of contracting HIV.

Answer 124

Unprotected vaginal sexual intercourse (not through oral/anal sex) Vertical transmission

Answer 125

Multiple sexual partners Unprotected sex History of STIs Older women

Answer 126

Often asymptomatic. If symptomatic, they usually develop within 28 days following infection. Female - Offensive vaginal odour - Abnormal vaginal discharge (thick/thin/frothy/yellow/green) - Itchiness/soreness of vagina - Dyspareunia - Dysuria - Vuvlitis - Vaginitis - Strawberry cervix (punctuate and papilliform appearance) Male - Urethral discharge - Dysuria - Urinary frequency - Pain/itching around foreskin

Answer 127

Female: - High vaginal swab from posterior fornix - Self-administered vaginal swab Male - Urethral swab - First void urine sample Specimens sent for culture, sensitivity and microscopy. Full STI screen. Bloods if systemic features. Contact tracing.

Answer 128

Metronidazole. Current partners and sexual partners preceding 4 weeks should be tested. Abstain from sex whilst being treated or 1 weeks following single dose. Test of cure not necessary.

Answer 129

Premature labour Low birth weight baby Maternal post-partum sepsis

Answer 130

Metronidazole. High dose regimens not recommended as it can affect the taste of milk.

Answer 131

Prevents pregnancy by stopping the male's sperm from coming into contact with the females ovum. Convey decreased risk of STI transmission.

Answer 132

Male condoms - Latex - Rolled from tip of penis to the base - Reduce transmission of STIs Female condoms - Polyurethane - Tubular shaped with open outer ring sitting outside the vulva - Reduce STI transmission Diaphragm - Rubber structure with metal inner frame that spans the posterior fornix to antero-inferior wall of vagina covering the cervix and preventing entry of semen - Held in place via vaginal tone, inner frame, and pubic symphysis - Combined with spermicide to increase their efficiency Cervical caps - Sit directly over the cervix - Held in place by suction and vaginal tone - Combined with spermicide

Answer 133

Advantages - Not CI by any condition (except latex allergy- use polyurethane) - Only contraceptive controlled by male - Widely available and only use before intercourse - Protective against most STIs Disadvantages - Perfect use is rarely achieved - Can reduce sensitivity/arousal

Answer 134

Advantages - No CIs - Less likely to tear than male condom - May protect against some STIs - Can be inserted up to 8 hours before intercourse Disadvantages - Perfect use is rarely achieved - Penis may be inserted between condom and vaginal wall - Can be noisy or uncomfortable

Answer 135

Advantages - Can be inserted 3 hours before intercourse Disadvantages - Perfect use is rarely achieved - Require prior planning and careful insertion - Require measuring and fitting to get correct size (any weight gain/pregnancy requires refitting) - Associated with UTIs - STI transmission not reduced

Answer 136

Failure rates are much higher than those of long acting reversible contraception. Male condoms - perfect use 2% - typical rate 16% Female condoms - perfect use 5% - typical rate 21% Diaphragm - perfect use 6% - typical rate 16% Cervical cap nulliparous - perfect use 9% - typical rate 16% Cervical cap porous - perfect use 20% - typical rate 32%

Answer 137

Yes. If they meet the Fraser Criteria.

Answer 138

Act to inhibit ovulation due to the negative feedback effect of the oestrogen and progesterone on the hypothalami-pituitary axis. It prevents a surge in LH therefore preventing ovulation. The progesterone acts to inhibit proliferation of the endometrium creating unfavourable conditions for implantation. It also increased the thickness of cervical mucus preventing the passage of sperm. The period free of hormones (pill-free/taking placebos) causes a fall in hormonal concentration which leads to degeneration of the endometrium and menstrual bleeding.

Answer 139

COCP= Monophasic pills (every pill contains the same levels of oestrogen and progesterone, most common) - Microgynon30 - Brevinor Phasic pills (level of oestrogen and progesterone changes throughout cycle so important to take in correct order) - Qlaira - BiNovum Packet of 21: taken consecutively for 21 days then 7 day break between packets Packet of 28: taken consecutively for 28 days, there is no break due to placebos Contraceptive Transdermal Patch - Stuck onto upper arm, abdomen, buttock or back - Ortho Evra - Applied and changed every 7 days over a period of 3 weeks - Patch then removed for a 7 days where patient will experience withdrawal bleed - Extremely sticky and can be used when bathing and swimming Contraceptive Vaginal Ring - NuvaRing - Once inserted into vagina it can stay there for 21 days - Then removed for 7 days before inserting a new ring

Answer 140

- Non invasive - More effective than barrier methods if taken correctly - Sex doesn't need to be interrupted - Menses become regular, lighter and less painful - Reduced risk of cancer of the ovary, uterus and colon - Reduced risk of functional ovarian cysts - Normal fertility returns immediately after stopping usage

Answer 141

- User dependant - Adverse effects (headaches, breast tenderness, mood changes) - BP may increase - Women may experience breakthrough bleeding and spotting for the 1st few months - Increased risk of VTE - Increase in risk of MI/Stroke - Increase in risk of breast/cervical cancer

Answer 142

- BMI>35 - Breast feeding - Smoking over the age of 35 - HTN - Hx or FHx of VTE - Prolonged immobility due to surgery/disability - DM with complications - History of migraines with aura - Breast cancer - Primary liver tumours

Answer 143

Perfect use: 0.3% Typical rate: 9%