Sexual Health Flashcards
1
Q
Treatment for BV?
A
Metronidazole
2
Q
How does chlamydia present in females?
A
- increased / purulent vaginal discharge
- post-coital / inter-menstrual bleeding
- deep dyspareunia
- pelvic pain
3
Q
How does chlamydia present in males?
A
- urethral discharge
- dysuria
- reactive arthritis
4
Q
Causative organism of syphilis?
A
Treponema pallidum
5
Q
Risk factors for chlamydia?
A
- young
- sexually active
- multiple partners
6
Q
Pathophysiology of chlamydia?
A
- gram-negative bacteria
- intracellular - enters and replicates within cells which then rupture
7
Q
How many cases of chlamydia are asymptomatic?
A
- 50% cases in men
- 75% cases in women
8
Q
How does chlamydia present in females?
A
- abnormal vaginal discharge (increased / purulent)
- pelvic pain and tenderness
- inter-menstrual / post-coital
- dyspareunia
- dysuria
- cervical motion tenderness
9
Q
How does chlamydia present in males?
A
- urethral discharge
- dysuria
- epididymo-orchitis
- reactive arthritis
10
Q
How does chlamydia screening work?
A
- sexually active under-25s
- annual test / test when sexual partner changes
- re-test 3 months later (to ensure they have not been reinfected)
11
Q
How is chlamydia diagnosed?
A
Nucleic acid amplification test (NAAT).
12
Q
What is the order of sample preference for chlamydia NAAT in females?
A
- Endocervical swab.
- Vulvovaginal swab.
- First-catch urine sample.
13
Q
Where can samples be taken for chlamydia NAAT in males?
A
- First-catch urine sample.
- Urethral swab.
14
Q
What other sample sites could be considered for chlamydia NAAT?
A
- rectal swab (anal sex)
- pharyngeal swab (oral sex)
15
Q
First-line management of chlamydia?
A
Doxycycline 100mg BD for 7 days.
16
Q
When should doxycycline not be given for chlamydia?
A
Pregnancy and breastfeeding.
17
Q
Alternative treatment for chlamydia if pregnant / breastfeeding?
A
- erythromycin 500mg QDS for 7 days
- amoxicillin 500mg TDS for 7 days
18
Q
Additional management of chlamydia (apart from antibiotics)?
A
- abstain from sex for 7 days
- contact tracing & partner notification
19
Q
When should test of cure be done for chlamydia?
A
- rectal cases
- pregnancy
- symptoms persist after treatment
20
Q
Complications of chlamydia?
A
- PID
- infertility
- ectopic pregnancy
- epididymo-orchitis
- conjunctivitis
- lymphogranuloma venereum
- reactive arthritis
21
Q
Complications of chlamydia in pregnancy?
A
- preterm delivery
- low birth weight
- postpartum endometritis
- neonatal infection - conjunctivitis, pneumonia
22
Q
What is lymphogranuloma venereum?
A
Complication of chlamydia, affects the lymphoid tissue around the site of infection.
23
Q
Which group does lymphogranuloma venereum most commonly affect?
A
Men who have sex with men.
24
Q
Primary stage of lymphogranuloma venereum?
A
Painless ulcer on the penis / vaginal wall / rectum.
25
Secondary stage of lymphogranuloma venereum?
Lymphadenitis of the inguinal / femoral lymph nodes - swelling, inflammation and pain.
26
Tertiary stage of lymphogranuloma venereum?
Proctitis - anal pain, change in bowel habit, tenesmus, discharge.
27
How is lymphogranuloma venereum treated?
Doxycycline 100mg BD for 21 days.
28
Pathophysiology of gonorrhoea?
- gram-negative diplococcus
- infects mucous membranes with a columnar epithelium (endocervix, urethra, rectum, conjunctiva, pharynx)
- spreads via contact with mucous secretions
29
Risk factors for gonorrhoea?
- young people
- sexually active
- multiple partners
- other STIs
30
How many people with gonorrhoea are symptomatic?
- 90% of men
- 50% of women
31
Clinical presentation of gonorrhoea in females?
- odourless purulent discharge (yellow / green)
- dysuria
- pelvic pain
32
Clinical presentation of gonorrhoea in males?
- odourless purulent discharge (yellow / green)
- dysuria
- epididymo-orchitis
33
How is gonorrhoea diagnosed?
- NAAT
- charcoal swab for microscopy, culture & sensitivities
34
Where can NAAT swabs for gonorrhoea be taken in females?
- endocervical
- vulvovaginal
- first-catch urine
35
Where should the charcoal swab for gonorrhoea be taken in females?
Endocervix
36
What additional swabs might be taken for gonorrhoea? (E.g. in men who have sex with men).
- rectal
- pharyngeal
37
How is gonorrhoea managed?
- refer to GUM clinic
- abstain from sex for 7 days
- contact tracing & partner notification
- IM ceftriaxone 1g (if sensitivities unknown)
- oral ciprofloxacin 500mg (if sensitivities known)
- test of cure (due to high antibiotic resistance)
38
How should test of cure be done for gonorrhoea?
- NAAT if asymptomatic
- cultures if symptomatic
39
Complications of gonorrhoea?
- PID
- infertility
- epididymo-orchitis
- prostatitis
- conjunctivitis
- disseminated gonococcal infection
- Fitz-Hugh-Curtis syndrome
- septic arthritis
- endocarditis
40
Neonatal complications of gonorrhoea?
- ophthalmia neonatorum
- medical emergency, associated with sepsis, eye perforation, blindness
41
What is disseminated gonococcal infection?
Bacteria spread to skin & joints.
42
How does disseminated gonococcal infection present?
- skin lesions
- polyarthralgia
- tenosynovitis
- systemic symptoms (fever, fatigue)
43
What is bacterial vaginosis?
Overgrowth of (anaerobic) bacteria in the vagina, due to loss of lactobacilli.
44
Risk factors for BV?
- excessive vaginal cleaning
- recent antibiotics
- multiple sexual partners
- smoking
- copper IUD
45
Pathophysiology of BV?
- lactobacilli are the main component of vaginal bacterial flora
- they produce lactic acid and keep vaginal pH low (< 4.5), preventing overgrowth of other bacteria
- decreased lactobacilli causes a rise in vaginal pH, enabling anaerobic bacteria to multiply
46
Which bacteria are commonly responsible for BV?
- gardnerella vaginalis
- mycoplasma hominis
- prevotella species
47
How many women with BV are asymptomatic?
50%
48
How does BV present?
- fishy-smelling watery grey / white discharge
- itching, irritation and pain suggest co-occurring infection (or alternative cause) - not typically associated with BV alone
49
How is BV investigated?
- vaginal pH > 4.5
- charcoal vaginal swab for microscopy - shows clue cells
50
How is BV managed?
- metronidazole (oral or vaginal gel) - patients must avoid alcohol
- swabs for chlamydia & gonorrhoea
- advise to avoid vaginal irrigation or cleaning with soaps
51
What complications can arise from BV?
Increased risk of catching STIs
52
Pregnancy complications from BV?
- miscarriage
- preterm delivery
- chorioamnionitis
- low birth weight
- postpartum endometritis
53
What is trichomoniasis?
Sexually transmitted parasite infection.
54
Pathophysiology of trichomoniasis?
- protozoan, single-celled organism with flagella
- lives in the urethra and vagina
55
How many patients with trichomoniasis have symptoms?
50%
56
How does trichomoniasis present?
- vaginal discharge (frothy, yellow-green, fishy smell)
- itching
- dysuria
- dyspareunia
- balanitis
- strawberry cervix
57
What investigations should be done for trichomoniasis?
- vaginal pH > 4.5
- charcoal swab with microscopy (posterior vaginal fornix in females or urethra / urine in males)
58
How is trichomoniasis managed?
- refer to GUM clinic
- contact tracing & partner notification
- metronidazole
59
Why can’t you drink alcohol when taking metronidazole?
Causes nausea & vomiting, flushing, occasionally shock & angioedema.
60
What is the causative organism in syphilis?
Treponema pallidum bacteria
61
How is syphilis transmitted?
- mainly sexually transmitted
- vertical transmission in pregnancy
- contaminated needles
62
What type of bacteria is treponema pallidum?
- gram-negative bacteria
- spirochete
63
Incubation period of syphilis?
21 days
64
How does primary syphilis present?
- painless genital ulcer - chancre
- resolves over 3-8 weeks
- local lymphadenopathy
65
How does secondary syphilis present?
- occurs after chancre has healed
- maculopapular rash
- condylomata lata
- low-grade fever
- lymphadenopathy
- alopecia
- oral lesions
66
How does tertiary syphilis present?
- gummatous lesions (skin, organs, bones)
- aortic aneurysms
- neurosyphilis
67
How does neurosyphilis present?
- headache
- altered behaviour
- dementia
- tabes dorsalis
- ocular syphilis
- paralysis
- sensory impairment
- Argyll-Robertson pupil (often irregularly shaped, accommodates but does not react to light)
68
What is tabes dorsalis?
Demyelination of posterior columns of the spinal cord.
69
What investigations are done for syphilis?
- antibody testing (screening test)
- infection site samples for dark field microscopy & PCR
- rapid plasma reagin (RPR) and VDRL tests
70
What are rapid plasma reagin (RPR) and venereal disease research laboratory (VDRL) tests?
- non-specific but sensitive tests for active syphilis infection
- assess quantity of antibodies produced (higher number of antibodies = greater chance of active disease
- often produce false positive results
71
How is syphilis managed?
- GUM clinic referral
- avoid sexual activity until treated
- contact tracing and partner notification
- single deep IM dose of benzylpenicillin
72
Pathophysiology of herpes?
- spread through direct contact with affected mucous membranes / viral shedding in mucous secretions
- after initial infection, HSV becomes latent in the associated sensory nerve ganglia and can be reactivated
- HSV-1 is most associated with cold sores (or genital herpes contracted through oral sex)
- HSV-2 is most associated with genital herpes
73
How does genital herpes present?
- genital ulcers
- neuropathic pain
- flu-like symptoms
- dysuria
- inguinal lymphadenopathy
74
How is genital herpes diagnosed?
Clinical diagnosis - viral PCR from a lesion can confirm the diagnosis.
75
Management of genital herpes?
- refer to GUM clinic
- aciclovir
- analgesia - paracetamol, topical lidocaine 2% gel
- advice - topical Vaseline, additional oral fluids, wear loose clothing, avoid intercourse with symptoms
76
How does Kaposi’s sarcoma present?
Lesions on the skin, mucous membranes, internal organs - appear as red / purple / brown patches or nodules.
