sexual health Flashcards
- Chlamydia Uncomplicated female
symptoms:
Increased vaginal discharge
Post coital/intermenstrual bleeding
Purulent vaginal discharge
Mucopurulent cervical discharge
Deep dyspareunia
Dysuria
Pelvic pain and tenderness
Cervical motion tenderness
Inflamed cervix
70% asymptomatic
- Chlamydia Uncomplicated males
symptoms:
Dysuria
Mucoid/mucopurulent urethral discharge
Epididymo-orchitis
Reactive arthritis
50 % asymptomatic
Chlamydia Treatment and complications
- Patients should be reassured that it is quickly and easily treated
- Doxycycline 100mg orally BD for 7 days (first line for men and non-pregnant women)
- Azithromycin 1g stat then 500mg daily for 2 days (second line option- appropriate for pregnant women)
- Patients should be advised no sexual contact during treatment and for seven days after course completed
- Individuals should be encouraged to participate in partner notification/contact tracing
- Repeat testing is not required if compliance to therapy has been adhered to
- Test of cure (3-4 weeks) post treatment recommended in pregnancy
If left untreated can develop reactive arthritis, pelvic inflammatory disease or epididymo-orchitis
Clamelle
Azithromycin (Clamelle®) is available over-the-counter (OTC) from pharmacies without a prescription, following its reclassification from POM to P
Clamelle® is indicated for men and women 16years of age or older who are asymptomatic and have tested positive for genital chlamydia infection. It is also indicated for treatment of their sexual partners without the need for a test
Gonorrhoea symptoms and completions in women
- Increased vaginal discharge (up to 50%)
- Lower abdominal pain and - tenderness (25%)
- Dysuria (up to 12%)
- Rarely IMB and PCB
50% notice symptoms
Complications
PID and Fitz-Hugh-Curtis syndrome
Miscarriage
Congenital infections
Gonorrhoea symptoms and complications in men
- 80-90% males are symptomatic
- Urethral discharge (>80%)
- Dysuria (>50%)
complications
- Epididymo-orchitis
- Prostatitis
- Urethral stricture
- Infertility
Gonorrhoea Management
- Ceftriaxone 1gm IM STAT
- For patients with needle phobia, true penicillin allergy or absolute contraindications azithromycin can be used
- Test of cure recommended after 7 days
- Patients should be advised to abstain from sexual intercourse until they or any partners have completed treatment
- If azithromycin is used this will be 7 days after treatment is given
Genital herpes simplex symptoms
Primary infection:
- Usually asymptomatic
- May have a febrile illness for 5-7 days, neuropathic pain in genital area, extensive bilateral crops of genital blisters, ulcers of fissures, lymphadenitis
Recurrent infections:
- Usually self limiting
- Unilateral ulcers (may be small and resemble non-specific erythema, erosions or fissures)
Genital herpes simplex complications
Autonomic neuropathy (can cause urinary retention), autoinoculation to fingers and adjacent skin and aseptic meningitis
Genital herpes simplex Management 1st episode
Oral antivirals
- Commence within 5 days of the start of the episode or while new lesions are forming
- Aciclovir 400mg TDS for 5-10 days or
- Aciclovir 200mg 5 times a day for 5-10 days
- Valaciclovir or famciclovir are also options
Genital herpes simplex Management recurrent episodes
- Take history about previous attacks
<6 attack per year - 800mg acyclovir TDS for two days or acyclovir 200mg five times a day for five days
>6 attacks aciclovir - 400mg BD for suppression long-term
- Ano-genital warts (HPV) symptoms
- Benign proliferative epithelial growths caused by infection with HPV
- Transmitted normally by direct skin to skin contact with the person who has clinical or sub clinical HPV
- Most usually via sexual contact, but very rarely can be perinatally and from hand warts
- life time risk 10%
Can resolve spontaneously in 10-30% patients in 3 months and within 6 months in 30% of patients
Ano-genital warts Management
- Treatment is chosen according to location and size
- For cosmetic benefit - cannot get rid of the virus
- Option of no treatment
- Ablative treatments: Cryotherapy, excision
Self applied treatments (not for use during pregnancy)
- Podophyllotoxin 0.5% solution (Condyline® cutaneous solution, Warticon® solution)
- Podophyllotoxin 0.15% cream (Warticon® cream)
- Imiquimoid 5% cream (Aldara®)
Syphilis symptoms:
- Two stages defined by disease duration
- Early Syphilis first 2 years of infection
- Late syphilis- 2yrs post infection (2 stages)
Early Syphilis first 2 years of infection
Primary
- Painless chancre at site of inoculation, highly infectious
Secondary
- Flu like symptoms, non-itchy skin rash, alopecia, swelling of lymph nodes and condylomata lata
Early latent syphilis
- Confirmed infection in absence of any current clinical features
