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3a Women's health > Sexual health > Flashcards

Sexual health Flashcards

1
Q

Describe the microbiology of chlamydia trachomatis

A

intracellular gram-negative bacteria

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2
Q

How is chlamydia transmitted

A

vertical transmission`
sexual contact

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3
Q

Give 3 RFs for chlamydia

A
  • under 25
  • new/multiple sexual partners
  • not using condoms
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4
Q

Give 4 ways chlamydia may present in women

A

asymptomatic (70%)
* abnormal vaginal discharge - cloudy/ yellow
* pelvic pain
* dysuria
* post coital/intermenstrual bleeding

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5
Q

Give 4 ways chlamydia may present in men

A

asymptomatic (50%)
* urethral discharge
* dysuria
* testicular pain

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6
Q

How is chlamydia diagnosed

A
  • nucelic acid amplification test (NAAT) - first catch urine (men) and vulvovaginal swab (women)
  • test for lymphogranuloma venereum in MSM with rectal chlamydia
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7
Q

How is chlamydia managed in men and non pregnant women

A
  • doxycycline 100mg orally BD for 7d
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8
Q

How is chlamydia managed in a pregnant woman

A

Any of:
* azithromycin 1g stat then 500mg oral OD for 2 days
* erythromycin
* amoxicillin 500mg oral TDS for 7d

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9
Q

What advice should be given to patients with chlamydia

A
  • no sex for 1 week
  • refer to GUM for contact tracing
  • leaflet on condition
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10
Q

Give 5 complications of chlamydia

A
  • epididymo-orchitis
  • ectopic pregnancy
  • reactive arthritis
  • pelvic inflammatory disease
  • infertility
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11
Q

When should a test of cure be done for chlamydia

A

after 6 weeks if pregnant or rectal infection

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12
Q

What type of bacteria is neisseria gonorrhoea

A

gram negative diplococcus

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13
Q

3 ways gonorrhoea may present in females

A
  • odourless mucopurulent discharge (50%)
  • pelvic pain
  • dysuria
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14
Q

2 ways gonorrhoea may present in males

A
  • mucopurulent discharge (80%)
  • dysuria
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15
Q

2 investigations done for gonorrhoea

A
  • NAAT
  • charcoal swab for culture, microscopy and antibiotic sensitivities
  • swabs in women should be taken from the vulvo-vaginal area
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16
Q

How is gonorrhoea managed

A

depends on whether antibiotic sensitivities are known
* first line: Single dose IM ceftriaxone 1g
* sensitive: single dose oral ciprofloxacin 500mg
Alternative: single dose oral cefixime + azithromycin

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17
Q

When is test of cure done for gonorrhoea

A

after a week for all people who have been treated

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18
Q

What is the most common cause of vaginal discharge in women of reproductive age

A

bacterial vaginosis

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19
Q

What is bacterial vaginosis

A

overgrowth of predominately anaerobic bacteria in the vagina

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20
Q

Describe the pathophysiology of bacterial vaginosis

A
  • lactobacilli are the main component of the healthy vaginal flora
  • lactobacilli produce lactic acid that keep the vag ph low (<4.5)
  • loss of lactobacilli results in a raised vaginal pH which enables anaerobic bacteria to multiply
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21
Q

Give an example of an anaerobic bacteria associated with bacterial vaginosis

A

Gardnerella vaginalis

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22
Q

Give 4 RFs for bacterial vaginosis

A
  • multiple sexual partners
  • excessive vaginal cleaning - douching, cleaning products
  • recent antibiotics
  • smoking
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23
Q

Describe the presentation of bacterial vaginosis

A
  • half of women are asymptomatic
  • grey-white discharge with characteristic fishy odour
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24
Q

How is bacterial vaginosis diagnosed

A
  • vaginal pH >4.5
  • positive whiff test(addition of KOH = fishy odour)
  • thin,white homogenous discharge
  • clue cells on microscopy
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25
Q

How is bacterial vaginosis managed

A
  • asymptomatic: don’t usually require treatment unless undergoing termination
  • symptomatic: oral metronidazole for 5-7 days or topical clindamycin
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26
Q

What advice should be given to patients when prescribing metronidazole and why

A

avoid alcohol for duration of treatment as together they can cause a disulfiram-like reaction
* N+V,flushing and in severe cases shock

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27
Q

What are 4 complications of bacterial vaginosis

A
  • preterm labour
  • chorioamnionitis
  • late miscarriage
  • STIs
28
Q

What is vaginal candidiasis

A

aka thrush
* vaginal infection with a yeast of the candida family

29
Q

Which species of candida is the most common in vaginal candidiasis

A

candida albicans

30
Q

Give 4 RFs for vaginal candidiasis

A
  • pregnancy
  • Poorly controlled diabetes
  • Immunosuppression (e.g. using corticosteroids)
  • Broad-spectrum antibiotics
31
Q

Give 4 ways vaginal candidiasis may present

A
  • thick, white, non-offensive discharge (‘cottage cheese’)
  • itching
  • superficial dyspareunia and dysuria
  • vulval erythema
32
Q

How is vaginal candidiasis investigated

A
  • pH < 4.5 (normal)
  • high vaginal swab for culture and microscopy
  • Investigations are not routinely indicated if clinical features are consistent with candidiasis
33
Q

How is vaginal candidiasis managed

A
  • oral antifungal - fluconazole 150mg as single dose
  • antifungal pessary - clotrimazole as single dose
  • topical antifungal - clotrimazole
  • if pregnant only manage with creams/ pessaries.
34
Q

How are recurrent vaginal candidiasis defined and managed

A
  • 4 or more episodes in a year
  • consider blood glucose test to exclude diabetes
  • confirm diagnosis with HVS
  • induction-maintenance regime of oral fluconazole for 6 months
35
Q

What is the most common cause of genital warts

A

human papillomavirus 6 and 11

36
Q

Give 3 clinical features of genital warts

A
  • most asymptomatic
  • painless non-ulcerative lesion
  • may itch
37
Q

How are genital warts managed

A

first-line treatments depend on the location and type of lesion
* multiple, non-keratinised warts are generally best treated with topical podophyllum/ podophyllotoxin
* solitary, keratinised warts respond better to cryotherapy
* topical imiquimod is 2nd line

38
Q

What causes genital herpes

A

herpes simplex virus 1 and/or 2

39
Q

How may genital herpes present

A
  • asymptomatic
  • multiple painful genital ulcers
  • dysuria and itching
  • primary infections may have systemic features e.g. fever and headache
  • the primary episode is often more severe than recurrent episodes
40
Q

What occurs after an initial infection with herpes simplex virus

A

following primary infection, virus becomes latent in sensory ganglia, periodically reactivating to cause symptomatic lesions or asymptomatic viral shedding

41
Q

How is genital herpes investigated

A

NAAT: HSV DNA detection by PCR
* sample base of ulcer

42
Q

How is genital herpes managed

A
  • primary herpes: oral aciclovir 400mg TDS for 5d
  • Recurrences of herpes – Aciclovir 800mg TDS for 2 days
  • If >6 outbreaks a year consider suppressive therapy with Aciclovir 400mg BD for 12 months
  • advice: saline bathing, analgesia
43
Q

What is syphilis

A

STI caused by treponema pallidum (gram -ve spirochete)

44
Q

How is syphilis transmitted

A
  • sexual contact
  • vertically
  • IVDU
45
Q

Give 2 features of primary syphilis

A
  • painless genital ulcer (chancre) at site of invasion
  • local non-tender lymphadenopathy
46
Q

Give 5 features of secondary syphilis

A
  • non-itchy maculopapular rash on trunk, palms and soles
  • systemic: lymphadenopathy, fever, headache
  • condylomata lata - painless, grey warty lesions on genitalia
  • buccal ‘snail track’ ulcers
47
Q

Give 2 features of tertiary syphilis

A
  • gummatous in skin and bones - Chronic painless nodules that break down into ulcers which heal slowly
  • aortic aneurysms
48
Q

At what stages can neurosyphilis occur, and how does it develop?

A

Neurosyphilis can occur at any stage of syphilis if the infection reaches the central nervous system

49
Q

Give 5 symptoms of neurosyphilis

A
  • meningitis
  • optic neuritis
  • sensorineural hearing loss
  • Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
  • Argyll-Robertson pupil - constricted pupil that accommodates when focusing on a near object but does not react to light
50
Q

How is syphilis investigated

A
  • Dark ground microscopy from the primary chancre
    Serology:
  • Treponemal-specific test: e.g. T.pallidum enzyme immunoassay (TP-EIA)
  • Non-specific tests: rapid plasma reagin (RPR) and venereal disease research laboratory (VDRL) tests. used to measure response to treatment
51
Q

How is syphilis managed

A
  • IM benzathine penicillin stat
  • late syphilis (>2y) - IM benzathine penicillin weekly for 3 doses
  • follow up 3,6 and 12m
  • A sustained four-fold or greater increase in the VDRL titre suggests re-infection or treatment failure
52
Q

What is Trichomonas vaginalis

A

highly motile flagellated protozoan parasite

53
Q

How is Trichomonas vaginalis transmitted

A

sexual contact

54
Q

Give 5 clinical features of Trichomonas vaginalis

A

50% asymptomatic
* vaginal discharge: offensive, yellow/green, frothy
* dysuria
* itching
* strawberry cervix
* pH > 4.5
* may cause urethritis in men

55
Q

How is Trichomonas vaginalis investigated

A
  • microscopy of wet slide from posterior fornix of vagina
  • urethral swab/ first catch urine in men
56
Q

How is trichomonas vaginalis treated

A

oral metronidazole for 5-7 day

57
Q

What advice should be given to people with trichomonas vaginalis

A
  • no sexual contact for 1 week after patient and partner treated
  • patient information leaflet
  • See health advisor for contact tracing
58
Q

What type of virus is the human immunodeficiency virus and what is the most common type

A

RNA retrovirus
HIV-1

59
Q

How is HIV transmitted

A
  • sexual contact
  • needle sharing
  • vertical
  • needle stick injury
  • blood transfusion
60
Q

Describe the stages of HIV

A
  1. Acute infection: often asymptomatic
  2. seroconversion (3-12 weeks after exposure): myalgia, fever, rash, severe sore throat
  3. Asymptomatic phase: loss of CD4 cells, persistent generalised lymphadenopathy (30%)
  4. AIDS: CD4 count <200 x 106/L, fatal if untreated
61
Q

How is HIV investigated

A
  • HIV antibody: ELISA (enzyme linked immune-sorbent assay) and confirmatory western blot assay
  • combined tests: HIV antibody and HIV p24 antigen
  • if a combined HIV test is +ve, repeat to confirm diagnosis
  • Serum HIV rapid test - point of care test
62
Q

How should HIV be tested for in asymptomatic patients

A
  • testing should be done at 4 weeks after possible exposure
  • after an initial negative result, offer a repeat test at 12 weeks
63
Q

How is HIV monitored

A
  • CD4 count (normal= 500-1200 cells/mm3)
  • testing for HIV RNA per ml of blood indicates viral load - aim for undetectable
64
Q

How is HIV managed

A

highly active anti-retroviral therapy (HAART) at diagnosis
* Nucleoside reverse transcriptase inhibitors (NRTI)
* Non-nucleoside reverse transcriptase inhibitors (NNRTI)
* Protease inhibitors (ritonavir)
* Integrase inhibitors (raltegravir)
* entry inhibitors (e.g. fuzeon)

65
Q

Give 3 examples of Nucleoside analogue reverse transcriptase inhibitors (NRTI)

A
  • zidovudine
  • tenofovir
  • emtricitabine
  • didanosine
66
Q

Give 4 AIDS defining illnesses

A
  • Kaposi’s sarcoma
  • Pneumocystis jirovecii pneumonia (PCP)
  • Cytomegalovirus infection
  • Candidiasis (oesophageal or bronchial)
  • Hodgkin’s Lymphomas
  • Tuberculosis
67
Q

What is the prophylaxis for HIV

A
  • post exposure prophylaxis (PEP): used within 72hrs of exposure to reduce risk of transmission - emtricitabine/tenofovir (Truvada) and raltegravir for 28 days
  • Pre-exposure prophylaxis (PrEP): ART for those at high risk of transmission - co-formulation of emtricitabine/tenofovir

3a Women's health (12 decks)

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