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3a PTS - PM - ZTF > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

Commonest bacterial STD in the UK

A

Chlamydia

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2
Q

1st line for uncomplicated chlamydia infection

A

Doxycycline 100mg twice a day for 7 days

Azithromycin removed as alternative 1st line due to mycoplasma genitalium resistance

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3
Q

2nd line for chlamydia infection (if doxycycline is contraindicated e.g. pregnancy, breastfeeding, intolerance)

A

Azithromycin 1g OD for one day, then 500mg for 2 days
Erythromycin
Amoxicillin

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4
Q

Clinical features of chlamydia

A

Asymptomatic in 70% women and 50% men
Women: cervicitis (discharge, bleeding), dysuria
Men: urethral discharge, dysuria

Discharge = yellow, odourless

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5
Q

Complications of chlamydia

A

PID
Epididymitis
Ectopic pregnancy
Infertility
Reactive arthritis
Perihepatitis (Fitz-Hugh-Curtis syndrome)

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6
Q

Investigation of choice for chlamydia

A

Nuclear acid amplification tests (NAATs) (first void urine sample, vulvovaginal swab or cervical swab)
*1st line for women: vulvovaginal
*1st line for men: first void urine sample (site of chlamydia = urethra)

Should be carried out 2 weeks after a possible exposure

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7
Q

Chlamydia incubation period

A

7-21 days

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8
Q

Syphilis (Treponema pallidum) incubation period

A

9-90 days

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9
Q

Primary features of syphilis

A

Usually 3 weeks from infection
Chancre (painful ulcer at the site of sexual contact) lasting 2-6 weeks
Local non-tender lymphadenopathy
Often not seen in women (the lesion may be on the cervix)

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10
Q

Secondary features of syphilis

A

Occur 6-10 weeks after primary infection

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

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11
Q

Tertiary features of syphilis

A

Gummas (granulomatous lesions of the skin and bones)
Ascending aortic aneurysms
General paralysis of the insane
Tabes dorsalis
Argyll-Robertson pupil
Ejection systolic murmur

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12
Q

Features of congenital syphilis

A

Blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars
Rhagades (linear scars at the angle of the mouth)
Keratitis
Saber shins
Saddle nose
Deafness

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13
Q

Syphilis investigations

A

Screening test: Treponemal-specific test e.g. TPHA
- specific but remains positive even after treatment

Cardiolipin / Non-treponemal tests e.g. RPR and VDRL
- non-specific enzymes produced in active infection
- becomes negative after treatment so can measure treatment effectiveness

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14
Q

Syphilis 1st line treatment

A

Intramuscular benzathine penicillin

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15
Q

Pregnancy-related complications of chlamydia

A

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

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16
Q

Associated conditions of hypospadias

A

Cryptorchidism (absence of testicle)
Inguinal hernia

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17
Q

Management of Hypospadias

A

Usually identified on NIPE

Corrective surgery typically performed when the child is around 12 months of age

Essential that the child is NOT circumcised prior to surgery as the foreskin may be used in the corrective procedure

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18
Q

Major organism responsible for BV

A

Gardnerella vaginalis + other anaerobic organisms

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19
Q

Amsel’s criteria for diagnosis of BV

A

atleast 3 of:

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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20
Q

Symptomatic BV management

A

oral metronidazole for 5-7 days

in all patients inc. pregnancy

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21
Q

Risk of BV in pregnancy

A

increased risk of preterm labour
low birth weight
chorioamnionitis
late miscarriage

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22
Q

80% of vaginal candidiasis causal organism

A

Candida albicans

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23
Q

Risk factors for vaginal candidiasis

A

diabetes mellitus
drugs: antibiotics, steroids
pregnancy
immunosuppression: HIV

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24
Q

Features of thrush

A

Discharge = ‘cottage cheese’, non-offensive
vulvitis: superficial dyspareunia, dysuria
itch
vulval erythema, fissuring, satellite lesions may be seen
pH < 4.5

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25
Q

investigations of vaginal thrush

A

clinical diagnosis high vaginal swab not routinely required

26
Q

1st line treatment for non-pregnant women with vaginal thrush

1st line for pregnant women

A

1st line: oral fluconazole as a single dose

1st line for pregnant women (oral treatments are C/I): clotrimazole intravaginal pessary as a single dose

27
Q

key further test in recurrent vaginal candidiasis

A

blood glucose to exclude diabetes

28
Q

management of recurrent vaginal candidiasis

A

induction-maintenance regime

induction: oral fluconazole every 3 days

maintenance: oral fluconazole weekly for 6 months

29
Q

features of Trichomonas vaginalis

A

Discharge = offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis

30
Q

investigation of trichomoniasis

A

microscopy of a wet mount shows motile trophozoites

31
Q

management of trichomoniasis

A

oral metronidazole for 5-7 days

32
Q

balanitis definition

A

inflammation of the glans penis

sometimes extends to the underside of the foreskin which is known as balanoposthitis

33
Q

3 common causes of balanitis

A

Candidiasis
Dermatitis (contact or allergic)
Dermatitis (eczema or psoriasis)

34
Q

investigation of choice in genital herpes

A

nucleic acid amplification tests (NAAT)

35
Q

management of genital herpes

A

oral aciclovir

general measures include:
saline bathing
analgesia
topical anaesthetic agents e.g. lidocaine

36
Q

types human papillomavirus HPV that cause genital warts

A

6 & 11

37
Q

management of genital warts: multiple, non-keratinised warts

A

topical podophyllum

38
Q

management of genital warts: solitary, keratinised

A

cryotherapy

39
Q

incubation period of gonorrhoea

A

2-5 days

40
Q

features of gonorrhoea

A

males: urethral discharge, dysuria
females: cervicitis e.g. leading to vaginal discharge
rectal and pharyngeal infection is usually asymptomatic

Discharge = purulent (thick, milky white) green or yellow

41
Q

2 complications of gonorrhoea

A

epididymitis
Disseminated gonococcal infection (DGI) and gonococcal arthritis

42
Q

first line treatment for gonorrhoea

A

Sensitivities NOT known = single dose of IM ceftriaxone 1g

Sensitivities known (and the organism is sensitive to ciprofloxacin) = single dose of oral ciprofloxacin 500mg

43
Q

Disseminated gonococcal infection triad

A

tendosynovitis
migratory polyarthritis
dermatitis

44
Q

Diagnosis gonorrhoea

A

NAAT (endocervical, vulvovaginal, urethral, first void urine sample) = infection present
Charcoal endocervical swab for microscopy, culture + antibiotic sensitivities

Microscopy = gram negative diplococci

45
Q

Neonatal complication gonorrhoea

A

Gonococcal conjunctivitis (ophthalmia neonatorum)

46
Q

Differentiation between hypoactive sexual arousal disorder and female sexual arousal disorder and sexual aversion disorder

A

HSAD: no desire to initiate sex (hypoactive) but can become physiologically aroused
FSAD: no desire to have sex and experiences vaginal dryness when initiated (female)
SAD: disgusted by the idea of sex

47
Q

2 causes of neonatal meningoencephalitis

A

Group B Strep
Herpes virus

48
Q

4 causes of superficial dysparaeunia

A

genital herpes
lichen sclerosus
thrush
vaginismus

49
Q

Causative bacteria of syphilis and type of bacterium

A

Treponema pallidum
Spirochaete bacterium

50
Q

Which Abx can be used for the treatment of gonorrhoea and chlamydia

A

Azithromycin

51
Q

chlamydia trachomatis under microscopy

A

gram negative rod shape

52
Q

4 risk factors ED

A
  1. Vascular problems (obesity, DM, smoking)
  2. Alcohol use
  3. Drugs (SSRIS, beta blockers)
  4. Increasing age
53
Q

2 ED investigations

A
  1. Lipid and fasting glucose serum levels (CVD risk)
  2. Free testosterone between 9am and 11am
54
Q

How late can the depo provera (medroxyprogesterone acetate) injection be given after last dose without need for extra precautions

A

14 weeks

55
Q

Adverse effects of depo injection (4)

A
  1. Irregular bleeding
  2. Weight gain
  3. Osteoporosis increased risk
  4. Fertility may not return for up to 12 months
56
Q

Chancroid

A

Tropical sexually transmitted disease caused by Haemophilus ducreyi

Causes painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement

The ulcers typically have a sharped defined, ragged, undermined border

Treated with antibiotics - azithromycin, ceftriaxone, ciprofloxacin, erythromycin

57
Q

Lymphogranuloma venereum

A

Caused by chlamydia trachomatis

58
Q

Risk factors lymphogranuloma venereum

A

Men who have sex with men
HIV

59
Q

Treatment lymphogranuloma venereum

A

Doxycycline

60
Q

Testosterone therapy and contraceptive advice in a person assigned female at birth and with a uterus

A

Does not provide protection against pregnancy and if the person gets pregnant testerone therapy is teratogenic

Oestrogen contraceptive regimes are not recommended as they can antagonise the effect of testosterone therapy - progesterone contraceptives can be used

61
Q

Contraceptive advice for patients assigned male at birth using oestradiol, gonadotropin-releasing hormone analogs, finasteride or cyproterone acetate

A

There may be a reduction or cessation of sperm production but this is not reliable and condoms should be recommended when engaging in vaginal sex

62
Q

Treatment for pubic lice

A

Permethrin

3a PTS - PM - ZTF (8 decks)

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