Sexual health Flashcards
Vulvovaginal candidiasis:
- Definition
- Risk factors
- Symptoms + signs
- Investigations
- Management
Vulvovaginal candidiasis:
- Definition: candida albicans yeast
- Risk factors : abx, preg, diabetes, steroids, immunosuppression
- Symptoms + signs: itching, white odourless discharge, satellite lesions, ph<4
- Investigations : charcoal swab mc+s
- Management : oral fluconazole, if preg pessary clotrimazole. If recurrent >4 year check with mc+s + BGC then induction oral fluconazole every 3 days for 3 doses then weekly for 6 months
Bacterial vaginosis:
- Definition
- Risk factors
- Symptoms + signs
- Amsel criteria
- Investigations
- Management
- Complications
Bacterial vaginosis:
- Definition: gardnerella vaginalis when depleted lactobacilli
- Risk factors: douching, perfumed products, iud, abx
- Symptoms + signs: fishy smell, thin homogenous grey discharge
- Amsel criteria: clue cells, >4.5 ph, odour with KOH, symptoms
- Investigations: high vag swab charcoal
- Management : metronidazole 7 days, if assymp no treatment unless aborting
- Complications : prematurity, chorioamn
Trichomonas vaginalis:
- Definition
- Symptoms + signs
- Investigations
- Management
- Complications
Trichomonas vaginalis:
- Definition : protozoan parasite
- Symptoms + signs: frothy green yellow discharge, strawberry cervix, vulvovaginitis
- Investigations: wet mound shows motile trophozoites , ph>4/5, post fornix charcoal swab
- Management : metronidazole 7 days
- Complications
Mycoplasma genitalium:
- Causes
- Investigations
- Management
Mycoplasma genitalium:
- Causes : urethritis, cervicitis, pid, epidymoorchitis, proctitis
- Investigations : urine sample first morning men, vulvovag naat fem
- Management : 1 week doxy, then 2 days azithromycin (or 7 days moxyflucloxacillin if macrolide resistant). then test of cute after treatment
Non specific urethritis:
- Definition
- Investigations
- Management
Non specific urethritis:
- Definition : inflammation (dysuria, discharge) without identifiable gonococcal - usually due to chla, myco genit, trich, ecoli
- Investigations : swab mc+s shows neuts (5+ polymorphonuclear leucocytes) only
- Management: oral doxy, contact tracing
Chlamydia:
- Definition
- Symptoms and signs
- Investigations
- Management
- Complications - normal, when pregnant
Chlamydia:
- Definition: chlamydia trachomatis
- Symptoms and signs : assymp, cervicitis, dysuria, discharge
- Investigations : vulvovag swab or urine for NAAT 2 weeks post exposure
- Management : 1 week doxy (if preg azith), contact trace 6 months, no sex
- Complications - normal, when pregnant : pid, epidid, endomet, infertility, reactive arthritis, inc risk ectopic preg
Gonorrhoea:
- Definition
- Symptoms + signs
- Investigations
- Management
- Complications
Gonorrhoea:
- Definition: gram - diplococci neisseria gonorrhoeae
- Symptoms + signs: 2-5 days post thin yellow discharge, dysparinea, cervical bleeding
- Investigations : endocervical swab or first pass for NAAT
- Management : IM ceftriaxone. then test of cure
- Complications : PID, urethral strictures, epididymoorch, disseminated infection (tenosynovitis, polyarthritis, dermatitis, septic arthritis, endocarditis, fitz hugh)
Genital warts:
- Definition
- Symptoms
- Management
- DD
Genital warts:
- Definition : hpv 6 + 11
- Symptoms : small fleshy lesions may bleed/itch
- Management : topical podophyllum or imiquimod if multiple non keratinised. if keratinised solitary or pregnant then cryotherapy.
- DD: molluscum contag, condylomata lata, malig
Syphilis:
- Definition
- Symptoms
- Investigations
- Management
Syphilis:
- Definition: treponema pallidum 9-90 day incubation period
- Symptoms: primary chancre which is a painless ulcer + non tender lymph then secondary 6-10 weeks systemic lymphad, fever, rash maculopap not itchy on trunk/soles/palms and condylomata lata. Then tertiary where gummas, aortitis, tabis dorsalis, neurosyphilis, argyl robertson pupil
- Investigations : dark ground microscopy (spirochetes), bloods treponemal enzyme immunoassay for ab
- Management: IM benzylpenicillin (3x if tertiary), no sex 2 weeks post inj then condoms until rechecked at 3 months, check partners
Herpes:
- Definition
- Symptoms: primary + secondary
- Signs
- Investigations
- Management
Herpes:
- Definition: hsv 1/2
- Symptoms: primary + secondary: painful ulcer dysuria/pruritis,and headache, fever, malaise
- Signs: ing lymphad, retention
- Investigations : NAAT
- Management: saline bath, analgesia, lidocaine topical, oral aciclovir. If preg elective c section if >28 weeks + aciclovir
HIV:
- Needlestick injury: management
- Definition
- Risk factors
- Transmission
- Symptoms + stages (4)
- Aids: cd4 count, diseases
- Investigations
- Management - medical, pregnancy, further
- PrEP vs PEP
Human immunodeficiency virus:
- Definition: rna virus infects cd4 t helper + mO cells
- Symptoms: flu symptoms within first few weeks (sore throat/lymphad, diarr, maculopap rash, ulcers), assymp until immunocomp/aids
- kaposis sarcoma (hhv8, brown spots + resp involvement), tb, cerebral lymphomas (single lesion on ct assoc with ebv - steroids, chemo), cytomegalovirus, pneumocytitis jirovecci pneumonia (fungus causing dry cough, desat on exercise, pneumothorax, hepatomeg - cxr shows bilat pul infiltrates - needs cotrim + steroids), toxoplasmosis (ring enhancing lesions on ct, needs sulfadiazine + pyrimethamine), cryptosporidium (diarrhoea), oesoph candidiasis, hairy leukoplakia
- Transmission: unp sex, needles, vertical
- Investigations for newly diagnosed patients: hiv ab test but takes 4-6 weeks to develop ab, hiv ab + p24 ag (4th gen enzyme assay ) can be detected 2-3 weeks post so now first line, hiv viral load, cd4 count (500-1200, when <300 then aids). Test at 4 weeks if assymp, if neg repeat at 12
- Management:
2 nucleoside reverse transcriptase inhibitors (peripheral neuropathy) (tenofovir) and either: non nucleos (efavirenz), integrase (raltegravir) or protease inhibitor (atazanavir) (diab, hyperlipid) (fever, headaches, nausea, insomnia, need to monitor fbc/lfts/u+es)
If cd4<200 cotrimoxazole
If <50 azithromycin for MAI + dilated fundoscopy
Yearly smears
preg: antiviral therapy antenatal. if <50 load can deliver vaginally. If high load iiv zidovudine during birth, Post birth avoid breast feeding unless undetectable. baby needs antivirals 4 weeks post and hiv test 48 hours/12 weeks/18 months
- Post exp: 1/300, test patient ag + test recipient + run under water + bleed, nnrts + raltegravir 28 days if <72 hours post exposure
-Prep: nnrti
Hep B:
- Transmission + incubation period
- Symptoms
- Investigations
- Management - medical, pregnancy
- complications
- serology
Hep C:
- Transmission
- Investigations
- Management
Hep B:
- Transmission + incubation period: dna virus via blood/vertical/sexual where 6-20 days incubation period
- Symptoms : initial flu/malaise/fatigue / jaundice/hepatomeg/ruq pain/itch then becomes chronic liver disease
- Investigations : lfts (inc bili, alt, alp ), hep b serology, viral load
- Management - medical, pregnancy: self limiting, notifiable, if chronic interferon antiviral. Hibg if recent exposure. if preg antivirals interferon and vaccinate neonate within 24 hours birth
- complications: chronic hepatitis, liveer failure, hepatocell carcinoma, glomerulonephritis
- hep serology:
hbsAg: first marker to appear and implies acute disease (if >6 months then chronic)
Then hbeAg indicates highly infective
Then hbcAb implies previous or current infection (igM in acute and lasts for 6 months, igG persists even if cleared)
then anti HBs implies immunity (post exposure or immunised)
Hep C:
- Transmission: rna virus where mostly vertical/blood transmission (low sexual)
- Symptoms: 6 week incubation period where acute transient rise in aminotransfer/jaundice/fatigue/arthralgia. 80 % develop chronic where leads to cirrhosis
- Investigations : hcv rna
- Management : depends on hcv genotype/cirrhosis presence/u+es- protease inhib +/- ribavirin 8-12 weeks
