Sexual Health Flashcards
1
Q
What is Bacterial Vaginosis
A
an overgrowth of bacteria in the vagina, specifically anaerobic bacteria
2
Q
What causes Bacterial Vaginosis
A
overgrowth of predominately anaerobic organisms such as Gardnerella vaginalis
–> fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH.
3
Q
What anaerobic bacteria is associated with Bacterial Vaginosis
A
Gardnerella vaginalis (most common)
Mycoplasma hominis
Prevotella species
4
Q
What risk factors are associated with Bacterial Vaginosis
A
- Multiple sexual partners
- Excessive vaginal cleaning
- Recent antibiotics
- Smoking
- Copper coil
5
Q
How does BV present
A
thin, white homogenous discharge
‘fishy’ smell
asymptomatic in 50%
vaginal swab and exclude other causes of symptom
6
Q
How is BV investigated?
A
clue cells on microscopy
Vaginal pH > 4.5
7
Q
How is BV managed
A
oral metronidazole for 5-7 days
8
Q
WHat advice should be given with metronidazole prescription and why
A
avoid alcohol
can cause a “disulfiram-like reaction”, with nausea and vomiting, flushing and sometimes severe symptoms of shock and angioedema.
9
Q
What are complication of BV
A
- increase the risk of catching sexually transmitted infections
10
Q
What are complication of BV in pregnant women
A
Miscarriage
Preterm delivery
Premature rupture of membranes
Chorioamnionitis
Low birth weight
Postpartum endometritis
11
Q
What is candidiasis
A
thrush
vaginal infectuin with yeast if candida family
mc:candida albicans
12
Q
What are risk factors of thrust
A
Increased oestrogen (higher in pregnancy, lower pre-puberty and post-menopause)
Poorly controlled diabetes
Immunosuppression (e.g. using corticosteroids)
Broad-spectrum antibiotics
13
Q
How does thrust commonly present
A
Thick, white discharge that does not typically smell
Vulval and vaginal itching, irritation or discomfort
14
Q
What can severe thrush lead to
A
Erythema
Fissures
Oedema
Pain during sex (dyspareunia)
Dysuria
Excoriation
15
Q
How is thrush investigated
A
often Tx started empirically based on presentation
vaginal pH swab
charcoal swab w microscopy to confirm
16
Q
What is the vaginal pH of thrust
A
< 4.5
17
Q
What is the vaginal pH of BV and trichomonas
A
> 4.5
18
Q
How can thrust treatment be delivered
A
- Antifungal cream (i.e. clotrimazole) inserted into the vagina with an applicator
- Antifungal pessary (i.e. clotrimazole)
- Oral antifungal tablets (i.e. fluconazole)
19
Q
How is thrust treated
A
- A single dose of intravaginal clotrimazole cream (5g of 10% cream) at night
- A single dose of clotrimazole pessary (500mg) at night
- Three doses of clotrimazole pessaries (200mg) over three nights
- A single dose of fluconazole (150mg)
20
Q
What is the name of the standard over the counter thursh treatment
A
Canesten Duo
contains a single fluconazole tablet and clotrimazole cream for vuvla symptoms
21
Q
what should sexually active women keep in mind when using antifugal treatment
A
antifungal creams and pessaries can damage latex condoms and prevent spermicides from working
alternative contraceptive is required for at least five days after use.
22
Q
What is Trichomonas vaginalis
A
a type of parasite spread through sexual intercourse
23
Q
how is Trichomonas classed
A
protozoan, and is a single-celled organism with flagella
four flagella at the front and a single flagellum at the back
24
Q
Where does Trichomonas live
A
lives in the urethra of men and women and the vagina of women.
25
What can Trichomonas increase the risk of
Contracting HIV by damaging the vaginal mucosa
Bacterial vaginosis
Cervical cancer
Pelvic inflammatory disease
Pregnancy-related complications such as preterm delivery.
26
How does Trichomonas vaginalis present
50% asymptomatic
Vaginal discharge
Itching
Dysuria (painful urination)
Dyspareunia (painful sex)
Balanitis (inflammation to the glans penis)
27
What is the characteristic description of Trichomonas vaginalis vaginal discharge
frothy and yellow-green
may have a fishy smell
28
What does Trichomonas vaginalis show on cervical examination
characteristic “strawberry cervix” (also called colpitis macularis)
caused by inflammation
tiny haemorrhages across the surface
29
How is Trichomonas vaginalis diagnosed
charcoal swab with microscopy
- Swabs should be taken from the posterior fornix of the vagina
- A urethral swab or first-catch urine is used in men.
30
how is Trichomonas vaginalis treated
metronidazole 500mg twice daily for 5-7 days
contact tracing needed
full sexual health screen.
sexual intercourse avoided til treated
31
What is a complication of trichomoniasis in pregnancy
An increased risk of premature rupture of membranes and preterm birth.
32
What is Chlamydia
gram-negative bacteria
intracellular organism
MC STI
significant cause of infertility
33
what is a intracellular organism
enters and replicates within cells before rupturing the cell and spreading to others
34
Is there a screening program for chlamydia
yes, National Chlamydia Screening Programme (NCSP)
screen every sexually active person under 25 years of age for chlamydia annually or when they change their sexual partner
those who test positive should have a re-test three months after treatment.
35
What STIs are tested in an STI screen as minimum
Chlamydia
Gonorrhoea
Syphilis (blood test)
HIV (blood test)
36
What two types of swabs are used in sexual health
Charcoal swabs
Nucleic acid amplification test (NAAT) swabs
37
What are Charcoal swabs used for
microscopy
culture
sensitivities
38
What is the trasnport medium for charcoal medium
Amies transport medium
39
What are locations of swabs for charcoal swabs in womne
endocervical swabs
high vaginal swabs (HVS).
40
What can charocal swabs confirm
Bacterial vaginosis
Candidiasis
Gonorrhoeae (specifically endocervical swab)
Trichomonas vaginalis (specifically a swab from the posterior fornix)
Other bacteria, such as group B streptococcus (GBS)
41
What does NAAT look at
DNA or RNA of the organism.
42
What is NAAT used to test for
chlamydia and gonorrhoea
&
Mycoplasma genitalium
43
What types samples are used for NAAT testing
endocervical
vulvovaginal (self taken)
and then urine
44
how does chlamydia present in women
majority asymptomatic
Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding (intermenstrual or postcoital)
Painful sex (dyspareunia)
Painful urination (dysuria)
45
How does chlamydia present in men
Urethral discharge or discomfort
Painful urination (dysuria)
Epididymo-orchitis
Reactive arthritis
46
What are symptoms of rectal chlamydia and lymphogranuloma venereum
anorectal symptoms
such as discomfort, discharge, bleeding and change in bowel habits.
47
What findings would you see on examination for chlamydia
Pelvic or abdominal tenderness
Cervical motion tenderness (cervical excitation)
Inflamed cervix (cervicitis)
Purulent discharge
48
How is chlamydia diagnosed
NAAT
Vulvovaginal swab
Endocervical swab
First-catch urine sample (in women or men)
Urethral swab in men
Rectal swab (after anal sex)
Pharyngeal swab (after oral sex)
49
What is 1st line management for uncomplicated chlamydia
doxycycline 100mg twice a day for 7 days.
50
What is management for chlamydia in pregnancy or breastfeeding
Azithromycin 1g stat then 500mg once a day for 2 days
or
Erythromycin 500mg four times daily for 7 days
51
Name an Abx contraindicated in pregnancy
doxycycline
52
Other factors to consider in chlamydia treatment
Abstain from sex for seven days of treatment
Refer all patients to genitourinary medicine (GUM) for contact tracing and notification of sexual partners
Test for and treat any other
Provide advice about ways to prevent future infection
Consider safeguarding issues and sexual abuse
53
Name 3 complications of chlamydia
Pelvic inflammatory disease
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Lymphogranuloma venereum
Reactive arthritis
54
Name three pregnancy complications of chlamydia
Preterm delivery
Premature rupture of membranes
Low birth weight
Postpartum endometritis
Neonatal infection (conjunctivitis and pneumonia)
55
What is Lymphogranuloma Venereum (LGV)
A sexually transmitted disease caused by L1–3 serovars of Chlamydia trachomatis
affecting the lymphoid tissue around the site of infection
56
What primary stage LGV
a painless ulcer (primary lesion). This typically occurs on the penis in men, vaginal wall in women or rectum after anal sex
57
who does LGV typically affect
men who have sex with men (MSM)
58
What is secondary stage LGV
lymphadenitis. This is swelling, inflammation and pain in the lymph nodes infected with the bacteria
inguinal or femoral lymph nodes
59
What is tertiary stage LGV
inflammation of the rectum (proctitis) and anus. Proctocolitis leads to anal pain, change in bowel habit, tenesmus and discharge.
60
What is tenesmus
feeling of needing to empty the bowels
61
How is LGV treated
Doxycycline 100mg twice daily for 21 days
alt abx = Erythromycin, azithromycin and ofloxacin
62
What is gonorrhoea
Neisseria gonorrhoeae
gram-negative diplococcus bacteria
63
What type of tissue does gonorrhoea infect
mucous membranes with a columnar epithelium
such as the endocervix in women, urethra, rectum, conjunctiva and pharynx.
64
What increases risk of having gonorrhoea
Young, sexually active and having multiple partners
Having other sexually transmitted infections,
65
What ABx does gonorrhoea have resistance to
ciprofloxacin or azithromycin
66
How does gonorrhoea present in women
50% of women are symptomatic
Odourless purulent discharge, possibly green or yellow
Dysuria
Pelvic pain
67
How does gonorrhoea present in men
90% of men are symptomatic
Odourless purulent discharge, possibly green or yellow
Dysuria
Testicular pain or swelling (epididymo-orchitis)
68
How does Prostatitis present
perineal pain, urinary symptoms and prostate tenderness on examination
69
How does gonorrhoea rectal infection present
anal or rectal discomfort and discharge, but is often asymptomatic.
70
How is gonorrhoea diagnosed
NAAT
endocervical, vulvovaginal or urethral swabs, or in a first-catch urine
Rectal and pharyngeal swab for MSM
71
What other testing should be done before treatment is started
A standard charcoal endocervical swab should be taken for microscopy, culture and antibiotic sensitivities before initiating antibiotics
72
How is gonorrhoea managed
referred to GUM clinics to coordinate testing, treatment and contact tracing
73
How is uncomplicated gonorrhoea treated if the sensitivities are NOT known
A single dose of intramuscular ceftriaxone 1g
74
How is uncomplicated gonorrhoea treated if the sensitivities ARE known
A single dose of oral ciprofloxacin 500mg
75
How is complicated gonorrhoea treated most of the time
single dose of intramuscular ceftriaxone
76
What test should be done after treatment for gonorrhoea
follow-up “test of cure” given the high antibiotic resistance
77
When should a “test of cure” be done for gonorrhoea
72 hours after treatment for culture
7 days after treatment for RNA NAAT
14 days after treatment for DNA NAAT
78
What other factors should be considered for gonorrhoea management
Abstain from sex for seven days of treatment of all partners to reduce the risk of re-infection
Test for and treat any other sexually transmitted infections
Provide advice about ways to prevent future infection
Consider safeguarding issues and sexual abuse in children and young people
79
Name 5 complications of gonorrhoea
* Disseminated gonococcal infection
* Conjunctivitis
* Pelvic inflammatory disease
* Chronic pelvic pain
* Infertility
* Epididymo-orchitis (men)
* Prostatitis (men)
* Urethral strictures
* Skin lesions
* Fitz-Hugh-Curtis syndrome
* Septic arthritis
* Endocarditis
80
What is a key gonorrhoea complciation in neonate
gonococcal conjunctivitis in neonate
81
What is gonococcal conjunctivitis
ophthalmia neonatorum
a medical emergency and is associated with sepsis, perforation of the eye and blindness.
82
What is disseminated gonococcal infection
a complication of untreated gonococcal infection, where the bacteria spreads to the skin and joints
83
What does disseminated gonococcal cause (symptoms)
Various non-specific skin lesions
Polyarthralgia (joint aches and pains)
Migratory polyarthritis (arthritis that moves between joints)
Tenosynovitis
Systemic symptoms such as fever and fatigue
84
What is syphilis
caused by bacteria called Treponema pallidum
spirochete, a spiral-shaped bacteria
85
How long is the incubation period of syphilis between the initial infection and symptoms
21 days
86
How is syphilis transmitted
- Oral, vaginal or anal sex involving direct contact with an infected area
- Vertical transmission from mother to baby during pregnancy
- Intravenous drug use
- Blood transfusions and other transplants (although this is rare due to screening of blood products)
87
What is primary syphilis
a painless ulcer called a chancre at the original site of infection (usually on the genitals).
88
what is secondary syphilis
systemic symptoms, particularly of the skin and mucous membranes. These symptoms can resolve after 3 – 12 weeks
89
What is latent syphilis
symptoms disappear and the patient becomes asymptomatic despite still being infected.
90
when does early latent syphilis occur
within two years of the initial infection
91
when does late latent syphilis occur
occurs from two years after the initial infection onwards.
92
what is tertiary syphilis
can occur many years after the initial infection and affect many organs of the body, particularly with the development of gummas and cardiovascular and neurological complications.
93
what is neurosyphilis
occurs if the infection involves the central nervous system, presenting with neurological symptoms
94
How does primary syphilis present
A painless genital ulcer (chancre). This tends to resolve over 3 – 8 weeks.
Local lymphadenopathy
95
How does secondary syphilis present
starts after the chancre has healed with symptoms of
- Maculopapular rash
- Condylomata lata (grey wart-like lesions around the genitals and anus)
- Low-grade fever
- Lymphadenopathy
- Alopecia (localised hair loss)
- Oral lesions
96
How does tertiary syphilis present
- Gummatous lesions (gummas are granulomatous lesions that can affect the skin, organs and bones)
- Aortic aneurysms
- Neurosyphilis
97
How does neurosyphilis present
can occur at any stage if the infection reaches
Headache
Altered behaviour
Dementia
Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
Ocular syphilis (affecting the eyes)
Paralysis
Sensory impairment
98
What is Argyll-Robertson pupil
specific finding in neurosyphilis
a constricted pupil that accommodates when focusing on a near object but does not react to light
prostitutes pupil
it accommodates but does not react
99
What is the screening test for syphilis.
Antibody testing for antibodies to the T. pallidum
100
how are samples from site of syphilis infection tested to confirm the presence of T. pallidum
Dark field microscopy and Polymerase chain reaction (PCR)
101
What test is used to assess for active syphilis infection (can be used to monitor response to treatment) and name an issue with this test
rapid plasma reagin (RPR) and venereal disease research laboratory (VDRL)
the tests are non-specific, meaning they often produce false-positive
102
what is medical management of syphilis
A single deep intramuscular dose of benzathine benzylpenicillin (penicillin)
late latentm = IM penicillin for 3 weeks + 3 days steroids
neuropsyphilis = IM penicillin for 2 weeks = oral probenecid + 3 days steroids
103
how is syphilis managed
managed and followed up by a specialist service, such as GUM
Full screening for other STIs
Advice about avoiding sexual activity until treated
Contact tracing
Prevention of future infections
104
how is early syphilis managed in pregnancy
In early syphilis, the treatment is a single dose penicillin in the first and second trimesters or 2 doses if diagnosed in the third trimester.
105
how is late latent syphilis and neurosyphilis managed in pregnancy
the first line treatment is the same during pregnancy as it is normally.
106
What is jarisch-Herxheimer reaction
reaction to syphilis treatment.
acute febrile illness, presenting with headache, myalgia, chills and rigours
in pregnancy can cause contractions, fetal heart rate abnormalities and stillbirth
107
What is is the causative agent of herpes simplex virus
HSV-1 and HSV-2
108
How is herpes simplex virus transmitted
double-stranded DNA viruses transmitted through mucosal surfaces or broken skin.
109
what are the clinical features of herpes simplex virus
can be asymptomatic
blisters which progress to painful ulcers
dysuria, discharge and inguinal lymphadenopath
110
When do herpes simplex virus patients develop symptoms
33% symptomatic at time of infection
lifelong infection with periods of reactivation and symptoms.
111
Where does herpes simplex virus lay dormant
within local sensory ganglia
lifelong infection with periods of reactivation and symptoms.
112
What herpes strain is more likely to cause recurrent symptoms
HSV-2 is around four times more likely than HSV-1 to cause recurrent symptoms.
113
how is herpes simplex virus investigated
diagnosed using PCR
the lesion should be burst and a swab taken from the base of the ulcer.
no lesion = no test
114
how is herpes simplex virus managed
Symptomatic episodes can be treated with aciclovir 400mg orally TDS for five days
full sexual health screen
115
What are complications of herpes simplex virus
* Urinary retention: may require catheterisation
* HSV keratitis: dendritic lesion on the cornea
* Aseptic meningitis
* Herpes proctitis
* Neonatal HSV: an increased risk if the mother becomes infected in the third trimester
* Herpetic whitlow
116
What sexual health advice should be given to those with herpes
full sexual health screen
no requirement for contact tracing
refrain from intercourse when they have lesions
Condoms
117
What is the causative agent of genital warts
Human papillomavirus (HPV) 6 and 11 (in most cases)
118
How is genital warts transmitted
double-stranded DNA virus is mainly transmitted via direct skin-to-skin contact
rarely perinatally
119
how long is the incubation period from exposure to infection for genital warts
up to 8 months.
120
What are the clinical feature of genital warts
textured, soft growths.
Anogenital warts can be keratinised (hard surface) or non-keratinised (soft surface).
121
Where can gential warts affect
anogenital area
anus, cervix and urethral meatus can all be affected
122
how are genital warts investigated
clinical, based on characteristic examination findings.
123
What should be done if gential wart appear atypical or suspicious
a biopsy should be performed to exclude an oncogenic HPV virus type.
124
what are topical treatment for genital warts
Topical podophyllotoxin (Warticon® and Condyline®)
Topical imiquimod (patients should be made aware that this damages condoms)
125
what are physical ablation therapy options for genital warts
Cryotherapy
Surgical excision
126
what increases the risk of gential wart recurrence
smoking
127
What are complications of genital warts
Ano-genital cancer
Scarring following treatment
128
What is HIV
human immunodeficiency virus (HIV)
RNA retrovirus
129
What is AIDS
Acquired immunodeficiency syndrome (AIDS) occurs when HIV is not treated
Immunodeficiency leads to opportunistic infections and AIDS-defining illnesses.
130
What is mc type of HIV
HIV-1
HIV-2 is mainly found in West Africa
131
What does HIV destroy
enters and destroys the CD4 T-helper cells of the immune system.
132
What is the disease progression of HIV
An initial seroconversion flu-like illness occurs within a few weeks of infection.
infection is then asymptomatic until the condition progresses to immunodeficiency (might be several years)
133
How is HIV transmitted
Unprotected anal, vaginal or oral sexual activity
mother to child
Mucous membrane, blood or open wound exposure to infected blood or bodily fluids
134
what is vertical transmission
Mother to child at any stage of pregnancy, birth or breastfeedin
135
name 3 AIDS defining illnesses
Kaposi’s sarcoma
Pneumocystis jirovecii pneumonia (PCP)
Cytomegalovirus infection
Candidiasis (oesophageal or bronchial)
Lymphomas
Tuberculosis
136
What are fourth-generation laboratory test for HIV
checks for antibodies to HIV and the p24 antigen
window period of 45 days
**First line test**
137
What is a window period
it can take up to X days after exposure to the virus for the test to turn positive
138
When do most people develop antibodies to HIV
4-6 weeks but 99% do by 3 months
139
What are point of care tests for HIV
tests for HIV antibodies give a result within minutes.
90-day window period.
140
What medication therapy regimen is used to treat HIV regardless of viral load of CD4 count
antiretroviral therapy (ART)
141
Name three classes of antiretroviral therapy
- Protease inhibitors (PI)
- Integrase inhibitors (II)
- Nucleoside reverse transcriptase inhibitors (NRTI)
- Non-nucleoside reverse transcriptase inhibitors (NNRTI)
- Entry inhibitors (EI)
142
What is the usual starting medication regime for HIV
two NRTIs (e.g., tenofovir plus emtricitabine)
plus a third agent (e.g., bictegravir)
143
What is the treatment aim for HIV
a normal CD4 count and undetectable viral load
144
What additional medication is given to HIV patients with CD count under 200/mm3 and why
Prophylactic co-trimoxazole
to protect against pneumocystis jirovecii pneumonia (PCP).
145
What appears to prevent the spread of HIV even during unprotected sex
Effective treatment combined with an undetectable viral load
146
What mode of delivery is indicated in a HIV+ mother with viral load of under 50 copies/ml
Normal vaginal delivery
147
What mode of delivery is indicated in a HIV+ mother with viral load of over 50 copies/ml
Consider a pre-labour caesarean section
148
What mode of delivery is indicated in a HIV+ mother with viral load of over 400 copies/ml
Pre-labour caesarean section is recommended
149
What medication is given during labor and delivery in a HIV+ mother if the viral load is unknown or above 1000 copies/ml
IV zidovudine
150
What prophylaxis is given to low risk babies to HIV+ mothers
zidovudine for 2-4 weeks
151
What prophylaxis is given to high risk babies to HIV+ mothers
zidovudine, lamivudine and nevirapine for four weeks
152
what viral load is considered low risk for HIV
Under 50 copies per ml
153
What window must Post-exposure prophylaxis (PEP) be started with
72 hours
sooner the better
154
What medication regime is included in PEP for HIV
emtricitabine/tenofovir (Truvada) and raltegravir for 28 days.
155
What is the usual choice for Pre-exposure prophylaxis (PrEP)
emtricitabine/tenofovir (Truvada).
156
What is adive for HIV+ mother breast feeding
in the UK all women should be advised NOT to breast feed
157
What is balanitis
inflammation of the glans penis and sometimes extends to the underside of the foreskin (balanoposthitis)
158
What is the mc cause of balanitis
infective (both bacterial and candidal)
159
What is the main treatment for balanitis
Simple hygiene is a key part of the treatment of balanitis
160
what can make balanitis worse
improper washing under the foreskin and the presence of a tight foreskin
161
How is balanitis diagnoses
made clinically based on the history and examination
162
What key features are importatnt to note with balanitis
itching or discharge
163
how is staphylococcus spp. or Group B Streptococcus spp. balanitis treated
oral flucloxacillin or clarithromycin if penicillin allergic
164
how is candidiasis balanitis treated
topical clotrimazole for two weeks
165
What is Chancroid
tropical disease caused by Haemophilus ducreyi.
166
how does chancroid present
painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement
167
how do chancroid ulcers appear on examination
sharply defined, ragged, undermined border.
