Sexual Health Flashcards
What is bacterial vaginosis?
Overgrowth of vaginal anaerobic bacteria
What is lost in BV?
Lactobacilli in vagina that normally produce lactic acid to keep pH under 4.5
What are anaerobes that can grow in higher pH in BV?
Gardnerella vaginalis is most common
What are some risk factors for BV?
Multiple sexual partners
Recent antibiotics
Excessive vaginal cleaning
Smoking
Copper coil
What is the presentation of BV?
Fishy smelling watery grey or white vaginal discharge
Asymptomatic
What is the pH of BV?
Above 4.5
What does BV show on microscopy?
Clue cells - cervix epithelial cells with bacteria stuck inside them
What is the 1st line treatment for BV?
Metronidazole
Why do you avoid alcohol with Metronidazole?
It can cause a difulfiram like reaction with nausea, vomiting, flush, shock and angiodema
What is thrush?
Vaginal infection with a yeast of the candida family
What is the most common cause of thrush?
Candida albicans
What is the presentation of thrush?
Irritation
Discomfort
Erythema
Fissures
Thick white discharge
Vulval and vaginal itching
Excoriation
What is the management of thrush?
Antifungal cream and pessary
What is canesten duo?
OTC thrush treatment of fluconazole tablet and clotrimazole cream
What is trichomoniasis?
Parasite spread via sexual intercourse
What does trichomonas vaginalis show on examination?
Strawberry cervix - haemorrhages across surface
What is balanitis?
Inflammation of glans penis
What is posthitis?
Inflammation of foreskin
What is the presentation of balanitis?
Penile discomfort and itch
Bleeding
Skin splitting
Urethral discharge
Urinary symptoms
Redness and swelling
What is the management of balanitis?
Topical Imidazole and topical corticosteroid
What is chlamydia?
Gram negative bacteria
Most common STI in the UK
What is the presentation of chlamydia?
Asymptomatic
Abnormal vaginal discharge
Pelvic pain
Dysuria
What is a test for chlamydia?
NAAT and charcoal swabs
What is the 1st line management for chlaymdia?
Doxycycline 100mg twice a day for 7 days
What is lymphogranuloma venereum?
Mainly in men who have sex with men
Lymphoid tissue is affected around chlamydia site of infection
What is chalmydial conjunctivitis?
Genital fluid comes into contact with the eye
What can chalymdia during pregnancy cause?
Preterm labour
PROM
Low birth weight
What is chalmydia in pregnancy treated with?
Erythromycin 500mg BD for 10-14 days
What is lymphogranuloma venereum?
STI caused by a strain of chlamydia that attacks lymph nodes
What are some causes of lymphogranuloma venereum?
Chemsex
Group sex
Fisting
Sharing unwashed sex toys
Unprotected sex - anal, oral, vaginal
What is the presentation of lymphogranuloma venereum?
Asymptomatic
Swollen groin lymph glands
Ulcer on penis, vagina or around anus
Blood/ pus from anus
Constipation
Painful straining
Loose stools
Tenesmus
What is the treatment for lymphogranuloma venerum?
Doxycycline BD 3 weeks
What is syphilis caused by?
Treponema pallidum
What is primary syphilis?
Painless ulcer (chancre) at original infection site - usually genitals
What is secondary syphilis?
Systemic symptoms particularly of skin and mucous membranes
What is latent syphilis?
Asymptomatic despite infection
What is neurosyphilis?
Infection moves to CNS
What is the presentation of neurosyphilis?
Dementia
Headache
Altered behaviour
Ocular syphilis
Paralysis
What is an argyll-robertson pupil?
Seen in neurosyphilis where there is a constricted pupil that accommodates when focussing on a near object but doesn’t react to light and are often irregularly shaped
What is tabes dorsalis?
Demyelination affecting spinal cord posterior columns
What is the treatment for syphilis?
Single deep IM dose of benzathine benzylpenicillin
What is HSV-1 associated with?
Cold sores
What is HSV-2 associated with?
Genital herpes
What nerve is cold sores associated with?
Trigeminal
What nerve is genital herpes associated with?
Sacral
What is the treatment for genital herpes?
Aciclovir
What is genital warts caused by?
HPV-6 and 11 in most
What sort of bacteria is gonorrhoea?
Gram negative diplococcus
How does gonorrhoea spread?
Mucous secretions
What is the treatment for gonorrhoea?
Ciprofloxacin
What is AIDS?
HIV when CD4 count drops below 200
Give 4 AIDS defining illnesses
Kaposi’s sarcoma
PCP
CMV
TB
Candidiasis
What is 1st line treatment for HIV?
2 NRTIs plus a 3rd agent
What is given to all those with CD4 under 200?
Prophylactic co-trimoxazole to protect against PCP
Delivery of baby with HIV viral load under 50 copies?
Normal vaginal
Delivery of baby with HIV viral load over 400 copies?
Pre-labour C-section
What is given during labour in HIV?
IV zidovudine
What is PEP?
Used after HIV exposure to reduce transmission risk
What is PrEP?
Take before exposure to HIV to reduce transmission risk
