Sexual Health

Question 1

Complications of chlamydia

Answer 1

PID
Ectopic Pregnancy
Infertility
Epididyorchitis
Sexually acquired reactive arthritis

Question 2

Testing for chlamydia

Answer 2

PCR - dry swab/ cst fluid /
- first pass urine (add gonorrhoea
- self-collected vaginal swab (CST)
- endocervical swab (CST)
- anorectal swab (anal sex or MSM) can be self-collected - if add HIV, Syphillus, mycoplasma genitalia to request
- pharyngeal swab (can be self collected - add chlamydia and gonorrhoea)
- eye swab (add gonorrhoea)

Question 3

Treatment chlamydia

Answer 3

Doxycycline 100mg BD for 7 days

Only use Azithromycin 1g orally immediately if likely to be poor adherence

Question 4

Prevent Re-infection and transmission of chlamydia

Answer 4

1. Advise about sexual conduct:
   - Abstain from sex until 7 days post treatment
   - Abstain contact regular sexual partners until 7 days after they have been treated
   - Abstain sec partners last 6 months until they have been tested and treated
2. Initiate Contact Tracing
   - Drs or delegates responsibility
   - trace partners back at least 6 months
   - can be done anonymously or by patient in person
3. Treat sexual contacts
   - test anatomical sites and await results
   - perform sexual health screen (incl chlamydia)
   - presumptive tx of partners of sexual contact in last 2 weeks
   - consider patient delivered partner therapy tx

Question 5

STI summary

Answer 5

Chlamydia - asymptomatic- Urine or swab PCR - doxy 100mg bd 7 days or 1g oral azithro if likely non-compliant

Gonorrhoea - purulent discharge - PCR swab - Ceftriaxone 500mg in 2ml of 1% lignocaine IM + Azithromycin 1g PO stat

Trichomonas

Mycoplasma genitalia

Genital Herpes - painful vesicular lesions - PCR vesicle fluid - Aciclovir (safe in pregnancy)
- initial infection Aciclovir 400mg tds for 7-10 days
- recurrent episodic infection Aciclovir 800mg tds for 2 days
- suppressive therapy Aciclovir 400mg bd ongoing

Question 6

SAFE Pregnancy medications

Answer 6

Genital herpes - Aciclovir

Bipolar disorder - lamotrigine during pregnancy
(Valproate or carbomazapine breastfeeding)

Hypertension - labetaolol, nifedipine, methyldopa, hydralazine, prazocin

Depression - sertraline (Zoloft) 25-50mg daily