Sexual Health Flashcards
Commonest bacterial STD in the UK
Chlamydia
1st line for uncomplicated chlamydia infection
Doxycycline 100mg twice a day for 7 days
Azithromycin removed as alternative 1st line due to mycoplasma genitalium resistance
2nd line for chlamydia infection (if doxycycline is contraindicated e.g. pregnancy, breastfeeding, intolerance)
Azithromycin 1g OD for one day, then 500mg for 2 days
Erythromycin
Amoxicillin
Clinical features of chlamydia
Asymptomatic in 70% women and 50% men
Women: cervicitis (discharge, bleeding), dysuria
Men: urethral discharge, dysuria
Discharge = yellow, odourless
Complications of chlamydia
PID
Epididymitis
Ectopic pregnancy
Infertility
Reactive arthritis
Perihepatitis (Fitz-Hugh-Curtis syndrome)
Investigation of choice for chlamydia
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
Chlamydia incubation period
7-21 days
Syphilis (Treponema pallidum) incubation period
9-90 days
Primary features of syphilis
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)
Secondary features of syphilis
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)
Tertiary features of syphilis
Gummas (granulomatous lesions of the skin and bones)
Ascending aortic aneurysms
General paralysis of the insane
Tabes dorsalis
Argyll-Robertson pupil
Ejection systolic murmur
Features of congenital syphilis
Blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars
Rhagades (linear scars at the angle of the mouth)
Keratitis
Saber shins
Saddle nose
Deafness
Syphilis investigations
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
Syphilis 1st line treatment
Intramuscular benzathine penicillin
Pregnancy-related complications of chlamydia
Preterm delivery
Premature rupture of membranes from chorioamnionitis
Low birth weight
Postpartum endometritis
Neonatal infection (conjunctivitis and pneumonia)
Associated conditions of hypospadias
Cryptorchidism (absence of testicle)
Inguinal hernia
Management of Hypospadias
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
Major organism responsible for BV
Gardnerella vaginalis + other anaerobic organisms
Amsel’s criteria for diagnosis of BV
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)
Symptomatic BV management
oral metronidazole for 5-7 days
in all patients inc. pregnancy
Risk of BV in pregnancy
increased risk of preterm labour
low birth weight
chorioamnionitis
late miscarriage
80% of vaginal candidiasis causal organism
Candida albicans
Risk factors for vaginal candidiasis
diabetes mellitus
drugs: antibiotics, steroids
pregnancy
immunosuppression: HIV
Features of thrush
Discharge = ‘cottage cheese’, non-offensive
vulvitis: superficial dyspareunia, dysuria
itch
vulval erythema, fissuring, satellite lesions may be seen
pH < 4.5
investigations of vaginal thrush
clinical diagnosis high vaginal swab not routinely required
1st line treatment for non-pregnant women with vaginal thrush
1st line for pregnant women
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
key further test in recurrent vaginal candidiasis
blood glucose to exclude diabetes
management of recurrent vaginal candidiasis
induction-maintenance regime
induction: oral fluconazole every 3 days
maintenance: oral fluconazole weekly for 6 months
features of Trichomonas vaginalis
Discharge = offensive, yellow/green, frothy
vulvovaginitis
strawberry cervix
pH > 4.5
in men is usually asymptomatic but may cause urethritis
investigation of trichomoniasis
microscopy of a wet mount shows motile trophozoites
management of trichomoniasis
oral metronidazole for 5-7 days
balanitis definition
inflammation of the glans penis
sometimes extends to the underside of the foreskin which is known as balanoposthitis
3 common causes of balanitis
Candidiasis
Dermatitis (contact or allergic)
Dermatitis (eczema or psoriasis)
investigation of choice in genital herpes
nucleic acid amplification tests (NAAT)
management of genital herpes
oral aciclovir
general measures include:
saline bathing
analgesia
topical anaesthetic agents e.g. lidocaine
types human papillomavirus HPV that cause genital warts
6 & 11
management of genital warts: multiple, non-keratinised warts
topical podophyllum
management of genital warts: solitary, keratinised
cryotherapy
incubation period of gonorrhoea
2-5 days
features of gonorrhoea
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
2 complications of gonorrhoea
epididymitis
Disseminated gonococcal infection (DGI) and gonococcal arthritis
first line treatment for gonorrhoea
Sensitivities NOT known = single dose of IM ceftriaxone 1g
Sensitivities known (and the organism is sensitive to ciprofloxacin) = single dose of oral ciprofloxacin 500mg
Disseminated gonococcal infection triad
tendosynovitis
migratory polyarthritis
dermatitis
Diagnosis gonorrhoea
NAAT (endocervical, vulvovaginal, urethral, first void urine sample) = infection present
Charcoal endocervical swab for microscopy, culture + antibiotic sensitivities
Microscopy = gram negative diplococci
Neonatal complication gonorrhoea
Gonococcal conjunctivitis (ophthalmia neonatorum)
Differentiation between hypoactive sexual arousal disorder and female sexual arousal disorder and sexual aversion disorder
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
2 causes of neonatal meningoencephalitis
Group B Strep
Herpes virus
4 causes of superficial dysparaeunia
genital herpes
lichen sclerosus
thrush
vaginismus
Causative bacteria of syphilis and type of bacterium
Treponema pallidum
Spirochaete bacterium
Which Abx can be used for the treatment of gonorrhoea and chlamydia
Azithromycin
chlamydia trachomatis under microscopy
gram negative rod shape
4 risk factors ED
- Vascular problems (obesity, DM, smoking)
- Alcohol use
- Drugs (SSRIS, beta blockers)
- Increasing age
2 ED investigations
- Lipid and fasting glucose serum levels (CVD risk)
- Free testosterone between 9am and 11am
How late can the depo provera (medroxyprogesterone acetate) injection be given after last dose without need for extra precautions
14 weeks
Adverse effects of depo injection (4)
- Irregular bleeding
- Weight gain
- Osteoporosis increased risk
- Fertility may not return for up to 12 months
Chancroid
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
Lymphogranuloma venereum
Caused by chlamydia trachomatis
Risk factors lymphogranuloma venereum
Men who have sex with men
HIV
Treatment lymphogranuloma venereum
Doxycycline
Testosterone therapy and contraceptive advice in a person assigned female at birth and with a uterus
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
Contraceptive advice for patients assigned male at birth using oestradiol, gonadotropin-releasing hormone analogs, finasteride or cyproterone acetate
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
Treatment for pubic lice
Permethrin
