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Clinical > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

How does Primary syphilis present?

A

Chancre: round with indurated base lesion located at the site of inoculation by the bacterial spirochete, this usually heals 3-8 weeks later.

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2
Q

How does secondary syphilis present?

A

4-10 weeks after primary, non-itchy symmetrical maculopapular rash appears (palms, soles, face) appears alongside mucosal ulcers, lymphadenopathy, malaise, fevers, hepatitis sx, glomerulonephritis, neurological complications.

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3
Q

What are the features of Tertiary Syphilis?

A

20-40 years after primary infection in untreated pts:
- gummatous disease
- cardiovascular complications (aortitis, arteritis, aortic valve regurg)
- neurological complications (menigovascular syphilis, paresis, dementia, tabes dorsalis, argyll-roberstson pupil)

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4
Q

What are the three components of serological syphilis testing?

A

EIA, RPR, TP-PA.

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5
Q

What does the syphilis serology show for an active syphilis infection?

A

EIA, RPR, and TP-PA reactive.

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6
Q

What does syphilis serology indicate if the EIA and RPR are reactive but TP-PA is not? Or if the EIA is the only reactive?

A

Tests do not agree which indicates:
- Early infection
- Prior syphilis
- False +ve EIA

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7
Q

What does syphilis serology indicate if the EIA and TP-PA are reactive but the RPR is not?

A
  • Previously treated syphilis
  • Early syphilis
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8
Q

What does a higher RPR value (>1:64) mean on Syphilis serology testing?

A

Higher = worse disease
>1:64 = secondary syphilis

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9
Q

Once TPPA is +ve in syphilis serology does it ever change?

A

Once +ve = always +ve = current infection or previous infection.

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10
Q

What is the 1st line management for syphilis?

A

IM Benpen

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11
Q

What is the Jarisch-Herxeimer Reaction?

A

Acute febrile reaction when commencing syphilis treatment due to sudden release of toxins from the killed bacteria.

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12
Q

How long does it take for a chlamydia test to turn +ve?

A

2 weeks

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13
Q

What are the sx of chlamydia?

A

Men: Dysuria, urethral discharge
Women: dysuria, intermenstrual bleeding, urethral discharge, pelvic pain
BOTH CAN BE ASYMPTOMATIC

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14
Q

How do we test for chlamydia?

A

NAAT: vulvovaginal swab, endocervical swab or 1st catch urine (men)

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15
Q

How do we manage chlamydia?

A

Doxycycline 100mg BD for 1 week

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16
Q

What are the complications of untreated chlamydia?

A

Tubal factor infertility, PID, epididymitis, proctitis

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17
Q

What is the presentation of LGV (lymphogranuloma venereum)?

A

Painless ulcer which progresses to inguinal buboes (tender groyne swellings) which elicit the ‘groove’ sign (depression along the superficial veins).

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18
Q

Who is at a higher risk of LGV (lymphogranuloma venereum)?

A

MSM

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19
Q

How does Trichomonas Vaginalis present?

A
  • Frothy yellow discharge with associated fishy odour.
  • Dyspareunia and vulvar irritation in women.
  • Urethritis in men.
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20
Q

What does Trichomonas vaginalis look like under microscopy?

A

Flagellated and unicellular protozoa

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21
Q

How is Trichomonas Vaginalis managed?

A

Metronidazole PO:
- 400-500mg BD for 5-7 days
OR
- Single dose 2g

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22
Q

What type of organism is Neisseria Gonorrhoea?

A

Gram negative intracellular diplococci (bacteria)

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23
Q

How long can it take for a Gonorrhoea test to be +ve after infection?

A

72 hour incubation period

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24
Q

What are some symptoms of Gonorrhoea?

A

Urethral discharge, dysuria, tenderness of inguinal node tenderness, abnormal bleeding (women).
Can be asymptomatic (more commonly in women).

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25
Q

What part of the genital tract does Gonorrhoea infect women?

A

Endocervix - columnar epithelium

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26
Q

Gonorrhoea can cause proctitis - what are the symptoms of this?

A

Rectal pain, bleeding discharge.

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27
Q

What is a complication of Gonorrhoea for women?

A

PID

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28
Q

What is the presentation of disseminated a Gonorrhoea infection? What are the RFs?

A

Small and large joint polyarthritis/swelling, dermatitis, and tenosynovitis.
Recent menstruation, complement deficiency, SLE.

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29
Q

What is the management of Gonorrhoea?

A

Single dose IM ceftriaxone (gent if penicillin allergic).
Do C+S as they have massive antibiotic resistance.
Re-do test 1 week later to ensure it has gone.

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30
Q

How long after gonorrhoea treatment should the pt avoid sexual activity?

A

1 week post treatment.

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31
Q

How does chancroid present?

A

Erythematous papule becomes pustular, and then ulcerates (soft, irregular border with a friable base and a grey-yellow exudate).
Alongside inguinal lymphadenopathy.

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32
Q

What organism is responsible for Chancroid? How does it appear on microscopy?

A

Haemophilus ducreyi (gram -ve rod), an anaerobic bacteria.
‘School of fish’ appearance of microscopy.

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33
Q

How do you manage Chancroid?

A
  • Ceftriaxone, azithromycin, or ciprofloxacin
  • Symptomatic relief ( e.g., drainage of buobes)
34
Q

What are the signs of Mycoplasma Genetalium? How can we test for and treat it?

A

Dysuria, abnormal discharge, abdo pain, dyspareunia, intermenstrual bleeding, bleeding during sex.
CANNOT TEST FOR IT.
Treated alongside gonorrhoea with the 400mg IM ceftriaxone

35
Q

Which HPV strain most commonly causes genital warts?

A

HPV 6+11

36
Q

How are non-keratinised HPV genital warts managed?

A

Podophyllotoxin

37
Q

What are the two categories of HSV infections?

A

Primary (1st exposure = worse sx), non-primary

38
Q

How does HSV present?

A

HSV1: cold sores
HSV 2: Viral prodrome followed by a genital warts.
But can differ.

39
Q

How do you manage genital warts caused by HSV?

A

Acyclovir 400mg TD for 5 days (10 days if sever) OR Valaciclovir 500mg BD for 5 days.
May need some topical lidocaine for pain relief.

40
Q

How long after HSV genital warts can sexual activity be resumed?

A

After wart have gone.

41
Q

How long does HSV stay in your system for?

A

Type 1: less extreme sx, stays in system for 20 years ish.
Type 2: more aggressive, stays in system for 3-5 years.

42
Q

What is the incubation period for Hepatitis B?

A

60-90 days

43
Q

How is Hepatitis B transmitted?

A

Infected blood/bodily fluids: sex, vertical transmission, transfusions

44
Q

Where is Hepatitis B endemic too?

A

Sub-Saharan Africa, Asia, pacific islands

45
Q

How might Hepatitis B present in adults and children?

A

Adults: jaundice, fever, malaise, dark urine, light coloured stools.
Children: only 5% have symptoms so often don’t present in acute phase and therefore 90% progress to chronic.

46
Q

At what point does Hepatitis B become chronic?

A

The body is unable to clear is after 6 months.

47
Q

What are the complications of chronic hepatitis B?

A

Cirrhosis, decompensated liver failure, increased risk of hepatocellular carcinoma.

48
Q

What is seen on liver biopsy of chronic hepatitis B?

A

Ground-glass hepatocytes on light microscopy.

49
Q

In serology of Hepatitis B, what does HBcAB represent?

A

Hepatitis core antibody:
- IgM is +ve in acute infections, IgG is +ve in chronic infections

50
Q

In serology of Hepatitis B, what does Anti-HBc represent?

A

Core antibody is +ve in those who have had an infection at some point.

51
Q

In serology of Hepatitis B, what does HBsAG represent?

A

Surface antigen +ve in active infection, persists >6 months

52
Q

In serology of Hepatitis B, what does Anti-HBs represent?

A

Anti surface antibody is +ve in those who have cleared an infection or had a vaccine.

53
Q

In serology of Hepatitis B, what does HBeAg represent?

A

hepatitis B e antigen indicates viral replication, these are the most infective pts.

54
Q

In serology of Hepatitis B, what does Anti-HBe represent?

A

Low viral viral load/replication.

55
Q

How can we manage Hepatitis B?

A

1st Line: Pegylated interferon alfa 2a.
2nd Line: Tenofovir or Entecavir.
These reduce liver disease: ALT normalisation and improved histology.

56
Q

What type of virus is Hepatitis C? What is the incubation period?

A

RNA virus.
6-9 weeks.

57
Q

How is hepatitis C transmitted?

A

Mostly blood, rarely other bodily fluids.
IVDU, blood transfusion, needlestick injury, sexual transmission (rare but higher rate if also HIV +ve).

58
Q

How does Hepatitis C present?

A

Mostly asymptomatic and therefore 75% go on to develop chronic disease: persistently high LFTs and 25-30% get cirrhosis.

59
Q

How do you test for Hepatitis C? When do you manage it?

A

Test antibody levels, they can remain +ve for months after cleared so if still +e after 2 months then treat.

60
Q

What is the management for Hepatitis C?

A

Nucleoside analogues such as Sofosbuvir and daclatsavir.

61
Q

How does Molloscum contagiosum present?

A

Pink, waxy, umbilicated lumps caused by close contact.

62
Q

If there are >100 Molloscum Contagiosum what should you test for?

A

HIV - may be immunocompromised

63
Q

How is Molloscum Contagiosum managed?

A

Supportively, or can use imiquimod/cryotherapy in immunocompromised pts.

64
Q

What type of virus is HIV? How does it invade cells?

A

Double-stranded RNA virus.
1) Virus uses reverse transcriptase to convert RNA to pro-viral DNA
2) They then use host cell machinery to reproduce using this DNA (targets CD4).

65
Q

What is the incubation period for HIV?

A

Up to 4 weeks.

66
Q

What is the acute retroviral syndrome of HIV?

A

Period following exposure, presents with maculopapular rash, sore throat, lymphadenopathy, fever, mouth ulcers, flu-like illness.

67
Q

How would you manage someone presenting with the acute retroviral syndrome of HIV?

A
  • Investigations: including CD4 count
  • Commence ART
  • Track and trace
68
Q

What are the CDC categories for HIV?

A

CDCA: asymptomatic period
CDC B: some sx/disease (oral candida, peripheral neuropathy, etc)
CDC C: ‘aids defining illness’ (CDC4 usually <250)

69
Q

What causes Kaposi’s Sarcoma? What is it composed of?

A

HHV8, composed of vascular endothelium.

70
Q

Primary CNS Lymphoma and Toxoplasmosis present very similarly in HIV pts, what is this presentation in CT?

A

Ring defining lesions with mass effect and cerebral oedema.

71
Q

How can you diagnose Cryptococcal meningitis?

A

LP: increased opening pressure (6-25 cmH2O).
India Ink Stain: encapsulated yeast organisms.

72
Q

How can you diagnose Toxoplasma? Mx?

A

Ring defining lesions on CT head.
Mx: Pyrimethamine and Sulfadiazine.

73
Q

What causes Progressive Multifocal Leukoencephalopathy (PML) in HIV pts?

A

Human polyomavirus JC (JCV).

74
Q

Which cancers are AIDs defining illnesses?

A

Cervical, NHL, KS

75
Q

What type of organism causes Trichomonas Vaginalis infection? How does it present?

A

Protozoa.
Copious quantities of discharge - may be asymptomatic (especially in men).

76
Q

What are the symptoms of genital candidiasis?

A

Itching, white curdy discharge. sour milk odour, dysuria, superficial dyspareunia.

77
Q

What causes genital candidiasis?

A

Pregnancy, antibiotics, immunosuppression.

78
Q

How can we manage vaginal candidiasis?

A

Oral fluconazole, or vaginal clotrimazole.

79
Q

How is PID managed?

A

Ceftriaxone IM stat, doxycycline , metronidazole

80
Q

Bilateral adnexal tenderness and cervical motion tenderness in a female who is sexually active is likely what?

A

PID

81
Q

What is the triad of Reactive arthritis? Which STI is it most commonly associated with?

A

Can’t see (conjunctivitis), can’t pee (dysuria), can’t climb a tree (arthritis).
Chlamydia.

82
Q
A

Clinical (27 decks)

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