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Phase 3a > Sexual health > Flashcards

Sexual health Flashcards

1
Q

Describe chlamydia infection in women (symptoms, examination, testing)

A
  • Discharge: offensive (normal white/clear colour)
  • Other symptoms: 70% asymptomatic, deep dyspareunia, PCB, can lead to PID
  • Examination findings: vaginal discharge, cervicitis
  • Testing: vulvovaginal swabs for NAAT 14 days after contact (also endocervical or urine but less sensitive)
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2
Q

Describe chlamydia infection in men (symptoms, examination, testing)

A
  • Symptoms: 50% are asymptomatic, dysuria, urethral discharge, urethritis, epididymo-orchitis
  • Examination: epididymal tenderness, mucopurulent discharge
  • Testing: first catch urine specimen, or urethral swab for NAAT (+rectal/pharangeal)
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3
Q

Describe gonorrhoea infection in women (symptoms, examination, testing)

A
  • Discharge: yellow/green, increased amount
  • Other symptoms: 50% asymptomatic, dysuria, IMB, menorrhagia, lower abdominal pain, can lead to PID
  • Examination findings: endocervical discharge, cervicitis and bleeding of endocervix
  • Testing: vulvovaginal swab for NAAT and culture
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4
Q

Describe gonorrhoea infection in men (symptoms, examination, testing)

A
  • Symptoms: urethral discharge (90%), dysuria (50%), asymptomatic (10%)
  • Examination: mucopurulent urethral discharge, epididymal tenderness/swelling, balanitis
  • Testing: first catch urine for NAAT, urethral swabs for microscopy and culture (+rectal/phalangeal swabs)
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5
Q

Describe trichomonas infection in women (symptoms, examination, testing)

A
  • Discharge: yellow/frothy
  • Other symptoms: itching, redness, soreness, dysuria
  • Examination findings: vaginal discharge and inflammation, strawberry cervix
  • Testing: swab for microscopy, pH testing (raised)
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6
Q

Describe trichomonas infection in men (symptoms, examination, testing)

A
  • Symptoms: usually asymptomatic, may have urethritis, discharge, dysuria
  • Examination: often normal
  • Testing: urethral swab and/or first void urine for culture and microscopy
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7
Q

Describe bacterial vaginosis infection in women (symptoms, examination, testing, treatment)

A
  • Discharge: fishy, excessive, white/grey
  • Other symptoms: 50% asymptomatic, sometimes soreness/itching
  • Examination findings: vaginal discharge, normal cervix
  • Testing: swab immediately, pH testing (raised)
  • Treatment: oral metronidazole 400mg BD for 5-7 days, or no treatment if asymptomatic
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8
Q

Describe vaginal candidiasis infection in women (symptoms, examination, testing)

A
  • Discharge: cottage cheese, non-offensive
  • Other symptoms: itching, burning, superficial dyspareunia
  • Examination findings: normal cervix, superficial skin changes
  • Testing: swab immediately, not needed for diagnosis
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9
Q

What antibiotics are the first line treatment for STIs?

A
  • Chlamydia: doxycycline 100mg BD for 7 days
  • Gonorrhoea: ceftriaxone 1g IM (if sensitivity not known), ciprofloxacin 500mg PO (if sensitivity known), as single doses
  • Trichomonas: metronidazole 2g PO single dose, or 400-500mg BD for 5-7 days
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10
Q

Describe genital herpes (cause,symptoms, examination, investigations, treatment)

A
  • Infection caused by HSV-1 or 2, acquired at mucosal surfaces by direct contact (often sexual)
  • Presents with painful genital blisters which burst to leave erosions and ulcers, also dysuria, discharge, malaise, fever
  • Examination: bilateral lesions on external genitalia, perineum, perianal (also vagina, cervix, buttocks, legs), tender bilateral inguinal lymphadenopathy
  • Investigations: swabs for PCR or NAAT
  • Treatment: self care measures, acyclovir 400mg 3 times daily for 5 days
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11
Q

Describe genital warts (cause, symptoms, examination, treatment)

A
  • Caused by HPV infection (types 6 and 11) transmitted sexually
  • Presents with painless lesions, may cause itching, bleeding, dyspareunia, distortion of urinary flow
  • Examination: external genitalia, perineal, speculum
  • Management: treatment not always needed, topical creams, ablative methods
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12
Q

What does a sexual history involve?

A
  • History of presenting complaint
  • Past GU history
  • Past general medical/surgical history
  • Drugs (any antibiotics in last month)
  • Sexual history (last 3-12 months)
    • last sexual intercourse
    • regular/casual partner
    • male/female
    • condom use
    • type of sexual intercourse
  • For females: menstrual, pregnancy, contraception, cervical screening history
  • For males: last voided urine (affects yield of swab)
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13
Q

What does asymptomatic screening for STIs involve?

A
  • Vulvo-vaginal swab (female), or first void urine (male) for gonorrhoea and chlamydia (NAAT)
  • Blood test for syphilis and HIV
  • Additionally for men who have sex with men: pharyngeal and rectal swab for gonorrhoea and chlamydia (NAAT), hep B/C blood tests
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14
Q

What is involved in the symptomatic screening for STIs for females?

A
  • Vulvo-vaginal swab for gonorrhoea and chlamydia (NAAT)
  • High vaginal swab (wet + dry slides) for bacterial vaginosis, trichomonas vaginalis, candida
  • Cervical swab for slide + gonorrhoea culture
  • Urine dipstick (if has dysuria)
  • Bloods for syphilis and HIV
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15
Q

What is involved in the symptomatic screening for STIs for men? (heterosexual and MSM)

A

Heterosexual:
- urethral swab for slide and gonorrhoea culture
- first void urine for gonorrhoea and chlamydia (NAAT)
- dipstick urinalysis (if has dysuria)
- blood tests for syphilis and HIV
Men who have sex with men:
- first void urine, and pharyngeal and rectal swab for gonorrhoea and chlamydia (NAAT)
- urethral and rectal slides
- urethral, rectal, pharyngeal culture plates
- blood tests for syphilis, HIV, hep B/C

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16
Q

What groups of people require hepatitis B screening in sexual health?

A
  • Men who have sex with men
  • Commercial sex workers (+partners)
  • IVDUs (current and past, +partners)
  • People from high risk areas (Africa, Asia, Eastern Europe, +partners)
17
Q

Why is the treatment of partners important in sexual health?

A
  • To prevent re-infection of the index patient
  • To identify and treat asymptomatic infected individuals
  • As a public health measure
18
Q

Describe syphilis (organism, spread, highest rate, types)

A
  • Infection caused by treponema pallidum, mostly sexually transmitted through direct contact, or congenital through vertical transmission
  • Highest rates in men who have sex with men, people of black ethnic background, and in urban hot spots
  • Early syphilis is defined as the first 2 years of infection, categorised as primary, secondary, early latent
  • Late syphilis is defined as more than 2 years after infection, categorised as late latent or tertiary
19
Q

What are the clinical features of primary and secondary syphilis?

A

Primary syphilis:
- primary lesion develops 3 weeks post exposure at site of infection and heals within 2-6 weeks
- chancre is small, painless, papule which forms an ulcer with well defined margin, on genitalia or anal/rectal/oral
- may have painless enlarged regional lymph nodes

Secondary syphilis:
- usually develops 6 weeks - 6 months after primary lesion (but may over lap) in 25% with untreated chancre
- mild systemic symptoms of malaise, fever, aching, generalised painless lymphadenopathy
- generalised symmetrical non-pruritic maculopapular rash affecting palms, soles, face, with condylomata lata (warty lesion) in moist areas
- less common symptoms of alopecia, uveitis, meningism, hepatitis, hepatosplenomegaly

20
Q

What are the clinical features of latent and tertiary syphilis?

A

Latent (early or late):
- asymptomatic (positive serological testing with no current clinical features)
- 25% will have recurrence of secondary disease during early latent stage

Tertiary:
- 15 to 40 years after initial infection
- gummatous (15%): granulomatous fibrous lesions with necrotic core which are locally destructive, commonly affect bone and skin
- cardiovascular (10%): vasculitis and inflammation of the aorta, spread distally from aortic root, manifests as aortic regurgitation, aneurysm, angina, or heart failure
- neurosyphilis (7%): may be asymptomatic with abnormal CSF, or present with general paresis (dementia, psychosis, personality changes), tabes dorsalis (lightening pains, loss of proprioception, vibration, incontinence, and ataxia), or meningovascular involvement (cranial nerve palsies)

21
Q

What investigations are needed for syphilis?

A
  • Screen for other STIs (including HIV as coinfection can lead to treatment failure)
  • Specific treponemal tests (test for previous exposure, remain positive regardless of treatment) e.g. treponemal enzyme immunoassay (EIA), or treponema pallidum particle agglutination assay (TPPA)
  • Non-treponemal tests (indicates disease activity, used for staging and monitoring of treatment) e.g. venereal disease reference laboratory (VDRL)
  • Darker field microscopy: looks for treponema in a sample from visible lesion in primary syphilis
22
Q

What is the management of syphilis?

A
  • Avoidance of all sexual contact (until successful treatment confirmed, or diagnosis excluded)
  • Contact tracing
  • Benzathine benzylpenicillin (single dose in early stage, multiple doses for late stage, alternative in penicillin allergy is doxycycline)
  • Follow up with serological testing after 6-12 months

Phase 3a (10 decks)

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