Sexual health Flashcards
What is the pH of the vagina in bacterial vaginosis?
> 4.5
Normal is <4.5
Why does BV occur?
Loss of lactobacilli (good bacteria) in the vagina which enables other bacteria to proliferate
What are the risk factors for developing BV?
Multiple sexual partners, excessive vaginal cleaning, recent antibiotics, smoking, copper coil
What is the classic discharge associated with BV?
Fishy smelling watery grey or white vaginal discharge
There should be no itching/irritation or pain
What sign is seen on MC+S on those with BV?
Clue cells
What is the treatment for BV?
Metronidazole (as it targets anaerobes)
PO or vaginal gel
What is he most common infective cause of thrush?
Candida albicans
What are the risk factors for thrush?
Increased oestrogen, poorly controlled diabetes, immunosuppression, broad spectrum antibiotics
What is the presentation of thrush?
Thick, white discharge that does not typically smell, vulval itching or discomfort
What is the management for thrush?
Clotrimazole cream/pessary
Oral fluconazole (contraindicated in pregnancy)
What does the national screening survey for chlamydia aim to do?
Screen every sexually active person under 25 annually or when they change partner
Everyone that tests positive should re-test 3 months after treatment
What swabs are taken to test for all STIs?
Charcoal swabs (high vaginal) - BV, thrush, gonorrhoea, trichomonas
NAAT (first catch urine or vulvovaginal swab) - DNA or RNA of chlamydia or gonorrhoea
What is the presentation of chlamydia?
Abnormal vaginal discharge, pelvic pain, abnormal bleeding, dyspareunia, dysuria, cervical motion tenderness, inflamed cervix
What is the management of chlamydia?
1st line = doxycyline 100mg BD for 7 days
Other options = azithromycin, erythromycin, amoxicillin
When is a test of cure recommended for chlamydia?
Rectal cases, pregnancy or when symptoms persist
What counselling should be given to someone after a STI diagnosis?
Abstain from sex for 7 days
Contact tracing and notification
Provide advice about how to prevent
Consider safeguarding
What are the complications of chlamydia infection?
PID, chronic pelvic pain, infertility, ectopic pregnancy, conjunctivitis, lymphogranuloma venereum, reactive arthritis
What type of bacteria is gonorrhoea?
Gram negative diplococci
What is the presentation of gonorrhoea?
Odourless purulent discharge possible green/yellow, dysuria, pelvic pain
What is the management of gonorrhoea (sensitivities not known and known)?
If not know - IM ceftriaxone 1g
If known - oral ciprofloxacin 500mg (single dose)
Is a test of cure recommended for gonorrhoea?
Yes for everyone - 72 hours after treatment if culture or 7 days for RNA NAAT or 14 days for DNA NAAT
What type of infection is trichomonas vaginalis?
Protozoa infection
What is the typical discharge associated with trichomonas?
Frothy yellow/green, may have fishy smell
What is seen on speculum examination in women with trichomonas?
Strawberry cervix
Inflammation of the cervix
What is the vaginal pH in someone with trichomonas?
> 4.5
What is the 1st line investigation for trichomonas?
Charcoal swab from posterior fornix of vagina
How is trichomonas managed?
Referral to GUM clinic
Metronidazole PO for 5-7 days
Which strain of HSV commonly causes genital herpes?
HSV-2
What is the presentation of genital herpes?
Painful blisters/ulcers affecting genital area, neuropathic pain, dysuria, inguinal lymphadenopathy
Initial episode is often most severe and can last 3 weeks, recurrent episodes can occur whenever
Can you get genital herpes from someone with a cold sore?
Yes - via oral sex
Cold sores are usually caused by HSV-1 so will get that strain
What is the management of genital herpes?
Aciclovir
Paracetamol, topical lidocaine, loose clothing, avoid intercourse when symptoms are present
What are the complications associated with herpes infection during pregnancy?
Neonatal infection has high morbidity and mortality
Primary genital herpes before 28 weeks - aciclovir during initial infection + from 36 weeks onwards, c-section
Primary genital herpes >28 weeks - aciclovir followed by prophylactic aciclovir, C-section recommended
Recurrent - regular prophylactic aciclovir considered from 36 weeks
What bacteria causes syphillis?
Treponema pallidum
How can syphilis be contracted?
Sexual contact, vertical transmission, IVDU, blood products
How does primary syphilis present?
PAINLESS solitary ulcer on penis/vulva (21 days after contracting)
What are the symptoms of secondary syphilis?
Systemic symptoms particularly of skin and mucous membranes e.g. maculopapular rash, lymphadneopathy , oral lesions
What are the features of tertiary syphilis?
Involvement of different organs e.g. neurological symptoms such as dementia, altered behaviour
What investigations are done to diagnose syphilis?
Antibody testing and enzyme immunoassay
What is the treatment for syphilis?
IM benzathine benzylpenicillin
What is the infective cause of genital warts?
HPV
How are genital warts spread?
Via skin to skin contact in intimate areas
What is the treatment for genital warts?
Self-limiting
Topical wart treatment can be sued or cryotherapy, excision, laser etc.
What is the presentation of PID?
Pelvic or lower abdominal pain, abnormal discharge, pain during sex, fever, dysuria, cervical motion tenderness, inflamed cervix
What is seen in microscopy in PID which can help aid diagnosis?
Pus cells - absence of pus cells can exclude PID
What is Fitz-Hugh-Curtis syndrome?
Inflammation and infection of the liver capsule leading to adhesions between liver and peritoneum
Bacteria may spread from pelvis via peritoneal cavity
What is lymphogranuloma venereum?
Caused by chlamydia trachomatis
Stage 1:Leads to small painless pustule –> ulcer
Stage 2: painful inguinal lymphadenopathy
Stage 3: proctocolitis
What are the risk factors for lymphogranuloma venereum?
MSM, HIV, used to be seen more in the tropics
What is the treatment for lymphogranuloma venereum?
Doxycycline
How does chancroid present?
Multiple painful ulcer on genitals that start off as papules and spread
