sexual health Flashcards
is chalmydia gram +ve or -ve?
gram -ve
do pts w/ chlamydia usually have symptoms?
no, usually asymptomatic
how does chlamydia present in females?
abnormal vaginal discharge
pelvic pain
abnormal bleeding
painful sex (dyspareunia)
painful urination (dysuria)
how does chlamydia present in males?
urethral discharge or discomfit
painful urination (dysuria)
epididymis orchitis
reactive arthritis
what are the examination findings of chlamydia?
pelvic or abdo tenderness
cervical motion tenderness
inflamed cervix
purulent discharge
how is chlamydia diagnosed?
NAAT test
which samples can be used for NAAT tests to diagnose chlamydia?
vulvovaginal swab
endocervical swab
first catch urine sample
what is the treatment for chlamydia?
doxycycline 100mg twice daily for 7 days
when is doxycycline contraindicated?
pregnancy and breast feeding
other than treatment what else is involved in the management of chlamydia?
abstain for sex for 7 days of treatment
contact tracing and testing and treating partners
what are the complications of chlamydia?
PID
chronic pelvic pain
infertility
ectopic pregnancy
conjunctivitis
what are the pregnancy related complications of chalmydia?
pre term delivery
premature rupture of membranes
low birth weight
neonatal infection (conjunctivitis)
is gonorrhoea gram +ve or gram -ve?
gram -ve
is gonorrhoea more or less likely to be symptomatic than chlamydia?
more likely to be symptomatic
how does gonorrhoea present in females?
odourless purulent discharge (may be green / yellow)
dysuria
pelvic pain
how does gonorrhoea present in males?
odourless purulent discharge (may be green / yellow)
dysuria
testicualr pain / swelling (epididymis-orchitis)
how is gonorrhoea diagnosed?
NAAT test
which samples can be used for NAAT testing to diagnose gonorrhoea?
endocervical seal
vulvovaginal swab
urethral swab
first catch urine sample
which additional swabs are recommended for MSM who have gonorrhoea?
rectal and pharyngeal swabs
what is the management of gonorrhoea?
single dose of IM ceftriaxone 1g
should pts w/ gonorrhoea have a test of cure?
yes
should pts w/ chlamydia have a test of cure?
no
other than treatment what else is involved in the management of gonorrhoea?
no sex for 7 days of treatment
test and treat partners
what are the complications of gonorrhoea?
PID
chronic pelvic pain
infertility
epididymo-orchitis
conjunctivitis
what bacteria cases syphilis?
treponema pallidum
what is the average incubation period between initial infection and symptoms for syphilis?
21 days
what are the 4 stages of syphilis?
primary syphilis
secondary syphilis
latent syphilis
tertiary syphilis
how does primary syphilis present?
painless ulcer called chancre at the original site of infection
how does secondary syphilis present?
systemic symptoms esp of the skin and mucous membranes
what is the typical course of secondary syphilis?
symptoms can resolve after 3-12 weeks and the pt can enter the latent phase
what is the latent phase of syphilis?
the pt becomes asymptomatic while still being infected
what is the time frame for early latent syphilis?
w/in 2 years of the initial infection
what is the time frame for late latent syphilis?
> 2 years of the initial infection
what is tertiary syphilis?
can occur many years after the initial infection and affect many organs
when does secondary syphilis typically present?
after the chancre has healed
how does secondary syphilis present?
maculopapular rash
condylomata lata
low grade fever
lymphadenopathy
alopecia
oral lesions
what is condylomata lata?
grey warty lesions around the genitals and anus
how does tertiary syphilis present?
can present w/ several symptoms depending on the affected organ
gummatous lesions
aortic aneurysms
neurosyphilis
what are gummas?
granulomatous lesions that can affect the skin, organs and bones
what are the symptoms of neurosyphilis?
headache
altered behaviour
dementia
tabes doesalis
ocular syphilis
paralysis
sensory impairment
argyll robertson pupil
what is tabes doesalis?
demyelination of the spinal cord posterior columns
what is argyll Robertson pupil?
constricted pupil that accommodates but does not react to light
what is the diagnostic process for syphilis?
screening :antibody testing for antibodies to T pallidum bacteria
confirm T pallidum bacteria w/ dark field microscopy or PCR
what is the management of syphilis?
single deep IM dose off benzathine benzylpeincillin
what are the alternatives to benzathine benzyslpenacillin for the treatment of syphilis?
ceftriazone, amoxicillin and doxycycline
what are the causes of erectile dysfunction?
vascular
neurological
hormonal
drug induced
psychogenic
systemic disease
how can you differentiate between an organic cause and a psychogenic cause of erectile dysfunction?
whether or not the pt gets nocturnal erections
what is the management of erectile dysfunction?
counselling
phsophodisterase 5 inhibitors
hormone treatment (if hormonal cause)
what is the causative agent of genital warts?
human papilloma viruses 6 and 11
how can genital warts be transmitted?
skin to skin contact
perinatally
what is the incubation period of HPV for genital warts?
up to 8 months
what increases the risk of recurrence of genital warts?
smoking
what are the 2 management options for genital warts?
topical agents
physical ablation
what can be used for topical treatment of genital warts ?
topical podophyllotoxin
topical imiquimod
what are the 2 options for physical ablation of genital warts?
cryotherapy
surgical excision
what is the causative organism of trichomoniasis?
trichomonas vaginalis (flagellated protozoan)
how is trichomoniasis transmitted?
sexual intercourse
how does trichomoniasis present in females?
thin, frothy, yellow vaginal discharge
strawberry cervix on speculum
vaginal puritis
dysuria
how does trichomoniasis present in males?
urethral discharge
urethral itch
dysuria
how is trichomoniasis diagnosed?
mobile trichomonads on wet mount microscopy
NAAT - vulovaginal swabs for females and first pass urine samples for males
what is the first line management of trichomoniasis?
400-500 mg of metronidazole B.D for 7 days
what is the management of trichomoniasis in a patient who won’t comply w/ 7 days of treatment?
2g of oral metronidazole
what advice should be given when treating trichomoniasis?
alcohol should be avoided during treatment and for 72 hrs after
how does mycoplasma genitalium present in males?
clear urethral discharge
dysuria
epididymio-orchitis
how does mycoplasma genitalium present in females?
dysuria
post coital bleeding
is mycoplasma genitalium part of routine sexual health screening?
no
what is the gold standard investigation for mycoplasma genitalium?
NAAT
females - vaginal swab
males - first void urine sample
what is the management of an uncomplicated mycoplasma genitalium infection?
doxycycline 100mg B.D for 7 days then azithromycin 1g single dose then azithromycin 500mg daily for 2 days
what is the total duration of treatment for an uncomplicated mycoplasma genitalium infection?
10 days
what constitutes a complicated mycoplasma genitalium infection?
PID
epididymio-orchitis
what is the management of a complicated mycoplasma genitalium infection?
moxifloxacin 400mg daily for 14 days
is a test of cure done for mycoplasma genitalium?
yes
done at 5 wks following initiation of treatment
what are the 2 causative agents of herpes simplex?
HSV-1 and HSV-2
how is herpes simplex virus transmitted?
mucosal sufaces
broken skin
how many pts develop symptoms at the time of acquisition of herpes simplex virus?
1/3
what happens after acquisition of HSV?
the virus lies dormant in the local sensory ganglia
what is the course of HSV infection?
it is a lifelong infection w/ periods of reactivation and symptoms
what is the most common causative agent of herpes?
HSV-1
what causative agent is most likely to cause recurrent symptoms of HSV?
HSV-2
when are HSV symptoms most severe?
more severe at the time of initial infection rather than recurrent
what is the investigation of HSV?
PCR swabs from the base of the ulcer
what is the management of HSV?
400mg acyclovir orally T.D.S for 5 days
when should treatment of HSV be started?
w/in 5 days of the onset of symptoms or in the prodromal phase if there is one
what is the most common cause of abnormal vaginal discharge?
bacterial vaginosis
what is bacterial vaginosis caused by?
an overgrowth of anaerobic vaginal bacterial which causes an increase of vaginal pH (>4.5)
how does BV present?
most pts are asymptomatic
thin, white, smelly discharge
what is the management of asymptomatic non-pregnant women w/ BV?
no treatment
what is the management of symptomatic / pregnant women w/ BV?
400-500mg metronidazole B.D for 7 days
what are the complications of BV?
higher risk of acquiring and transmitting STIs
what is PID?
an upper genital infection
what is PID caused by?
a spreading infection from the endocervix which can be from STIs or commensal vaginal bacteria
how can PID present?
abdo pain
pain during sex
abnormal vaginal discharge
abnormal bleeding patterns
is there a diagnostic test for PID?
no
does a negative STI screen rule out PID?
no
what is the management of PID?
antibiotics to cover chlamydia, gonorrhoea and anaerobic bacteria
what is the first line outpatient management for PID?
1g IM ceftriaxone single dose
100mg oral doxycycline B.D 14 days
400mg oral metronidazole B.D 14 days
what is the first line inpatient management for PID?
2g IV ceftriaxone once daily
100mg IV or oral doxycycline B.D 14 days
400mg oral metronidazole B.D 14 days
for inpatient management of PID how long should IV treatment be continued for?
for 24hrs following clinical improvement
does first line treatment of PID cover mycoplasma genitalium?
no
if a pt w/ PID is positive for mycoplasma genitalium what should be added to the treatment?
moxifacin
are tests of cure requited for PID?
yes
if a pt w/ PID is positive for chlamydia when is a test of cure done?
3-5wks after completing treatment if still symptomatic or suspect poor compliance
if a pt w/ PID is positive for gonorrhoea when is a test of cure done?
2 wks after completing treatment
if a pt w/ PID is positive for mycoplasma genitalium when is a test of cure done?
5 wks after completing treatment
give 3 complications of PID
chronic pelvic pain
increased risk of ectopic pregnancies
sub fertility
what is the pathophysiology of HIV?
human immunodeficiency virus infects CD4+ cells resulting in progressive destruction of the immune system and onset of acquired immunodeficiency syndrome (AIDS)
which type of HIV is more common in the UK?
HIV1
describe what happens in stage 1 of HIV infection
HIV binds to CD4+ cells
infected CD4+ cells die and release visions which dissemate and infect more CD4+ cells
this goes on for 2-4 wks following exposure during which the pt is highly infectious
immune response to primary HIV causes mild to moderate non specific symptoms called seroconversion illness
what happens in stage 2 of HIV infection?
the immune response controls the virus therefore the pt is asymptomatic despite low levels of viral replication
no symptoms but still infectious
how long does stage 2 of HIV infection last?
timeline varies between individuals but can last for 10-15 yrs
what happens in stage 3 of HIV infection?
occurs when persistent HIV infection compromises the ability of the immune system to replenish CD4+ cells
ability of the immune system to combat infection is severely reduced and so the pt becomes susceptible to opportunistic infections and malignancy
what is the definition of AIDS?
1 or more AIDS defining illnesses in the presence of HIV infection OR by CD4+ count less than 200
list 5 AIDS defining illnesses
pneumocystis pneumoia (pneumocystis jirovecii)
kapsois sarcoma
cerebral lymphoma
cytomegalovirus
non-hodgkins lymphoma
what are the 2 investigations for HIV?
lab based tests on venipuncture samples
point of care tests on finger prick or mouth swab samples
how do lab based tests on venipuncture samples work in the diagnosis of HIV?
detects the presence of HIV IgM and IgG antibodies and the viral p24 antigen
what happens if there is a positive lab based test for HIV?
a second sample is done to confirm
what happens if there is a negative lab based test for HIV?
the test is repeated at 12 weeks to confirm
what is the benefit of point of care tests in the diagnosis of HIV?
they detect HIV IgM and IgG antibodies with increased sensitivity during early seroconversion and results are ready <1hr
what is the downside of point of care tests?
there is a higher rate of false positives and so needs confirmed w/ lab tests
is there a cure for HIV?
no
what is the aim of management of HIV?
anti retroviral treatment aims to suppress viral replication to the point where it is undetectable and cannot be transmitted
how many dif antiretrovirals are used in the treatment of HIV and why?
3 dif antiretrovirals
to target dif points of the HIV lifecycle
which 3 drugs comprise the antiretroviral treatment in HIV?
2 nucleoside reverse transcriptase inhibitors and either:
integrase inhibitor
boosted protease inhibitor
non nucleoside reverse transcriptase inhibitor
what are the 2 nucleoside reverse transcriptase inhibitors that are usually used for HIV treatment?
tenofovir disproval and emitricibaine
what is the purpose of PrEP?
reduces the risk of HIV acquisition in pts at high risk of HIV
what is used for PrEP?
emtriciitabine and tenofovir disoproxil taken daily before exposure
when should PEP be given?
following exposure to HIV
w/in 72 hrs of exposure and continued for 28 days
what is used for PEP?
emtricitabine, tenofovir disoproxil and raltegravir
does HIV affect life expectancy?
yes, lowers life expectancy
what are the 2 resp complications of HIV?
pneumonia and TB
what is the most common life threatening opportunistic infection in HIV?
pneumocystis carinii
what are the 3 GI complications of HIV?
oesophageal / oral candidiasis
chronic diarrhoea
hepatomegaly (due to viral hepatitis or drug induced)
what are the 2 neurological complications of HIV?
meningoencephalitis
toxoplasmosis
what is the eye complication of HIV?
CMV retinitis
what is the derm complication of HIV?
kaposis sarcoma
which vaccination should men who have sex w/ men be offered?
hepatitis A
