Sexual health Flashcards
What are some risk factors for STIs (8)?
- < 25 years
- UPSI
- IVDU
- Immunosuppression
- Men who have sex with men (MSM)
- Lower socioeconomic status
- Multiple partners
- Sexually active
What are the important STIs to how about (9)?
- Chlamydia
- Gonorrhoea
- Trichomonas vaginalis
- HSV
- HPV
- Syphilis
- Mycoplasma genitalium
- HIV
- Chancroid
What investigations are typically done to investigate for STIs in men (3)?
- Men = first catch urine + MC&S = usually first line
- Urethral swab
- Bloods
What investigations are typically done to investigate for STIs in women (4)?
- Vulvovaginal swab (done by themselves) = usually first line
- Endocervical or high vaginal swabs
- First catch urine
- Bloods
What are the different types of swab that can be used to investigate STIs and what are they for (2)?
- Charcoal swab = MC&S
- Nucleic acid and amplification test (NAAT) swab = identification of DNA/ RNA
Who is eligible for the sexual health screening programme?
Sexually active 16-24 year olds
How frequently should 16-24 year olds be screened for STIs?
Annually or when they change partner
What is typically tested for if someone attends a GUM clinic for an STI screen (4)?
- Chlamydia
- Gonorrhoea
- Syphilis (blood)
- HIV (blood)
How far back should the contacts of those with chlamydia and gonorrhoea be traced and what should they be offered?
- Chlamydia = 6 months
- Gonorrhoea = 2 months
offer them tests
What is the most common STI in the UK?
Chlamydia
What is the full name for chlamydia?
Chlamydia trachomatis
What type of bacteria is chlamydia trachomatis?
Gram negative cocci
What are the signs/ symptoms of chlamydia (4)?
- Dysuria
- Purulent (pus) discharge
- Abnormal vaginal bleeding
- Proctitis - discomfort, discharge, bleeding (inflam in rectum)
often asymptomatic in women
How is chlamydia diagnosed?
NAAT
first catch urine or vulvovaginal swab
What are some examination finding of those with chlamydia (3)?
- Pelvic/ abdo pain
- Cervical motion tenderness
- Purulent discharge
What additional swabs should be taken considered for chlamydia in certain patient groups (2)?
- Rectal
- Pharyngeal
How should chlamydia be treated?
100mg doxycycline BD for 7 days
What are some contraindications to doxycycline (2)?
- Pregnant
- Breastfeeding
What does doxycycline do if a pregnant woman takes it?
Can cause foetal teeth discolouration
How should chlamydia be treated in pregnancy/ breastfeeding?
Azithromycin 1g stat, then 500mg OD for 2 days
What are some complications of chlamydia (6)?
- PID
- Lymphogranuloma venereum
- Infertility
- Reactive arthritis
- Neonatal infection (conjunctivitis/ pneumonia)
- Pregnancy comp (low birth weight, pre-term, ectopic, PROM)
What is lymphogranuloma venereum?
Ulceration of genital area due to chlamydia infection
What are the signs/ symptoms of lymphogranuloma venereum (3)?
- Ulceration of genital area
- Proctitis (inflame of rectum)
- Inguinal lymphadenopathy
Where else in the body does chlamydia commonly infect?
The eye causing conjunctivitis
What is the full name for gonorrhoea?
Neiserria gonorrhoea
What type of bacteria is neiserria gonorrhoea?
Gram -ve diplococci
What are the signs/ symptoms of gonorrhoea (4)?
- Dysuria
- Odourless green discharge
- Pelvic pain
- Epididymo-orchitis
How is gonorrhoea diagnosed?
First catch urine or vulvovaginal NAAT
What is important to do before commencing antibiotics for gonorrhoea?
Charcoal swab (urethral or endocervical) for MC&S
to determine Abx resistance
How is gonorrhoea typically managed if the sensitivities are not known?
IM ceftriaxone 1g stat
What are some complications of gonorrhoea (5)?
- Reactive arthritis or septic arthritis
- Disseminated gonococcal infection
- Conjunctivitis
- Neonatal infections (ophthalmia neonatorum)
- Infection of nearby organs (proctitis, prostatitis, epididymo-orchitis)
Does chlamydia or gonorrhoea more commonly cause reactive and septic arthritis?
- Chlamydia = reactive
- Gonorrhoea = septic
What is ophthalmia neonatorum and how is it managed?
Neonatal conjunctivitis
it is a medical emergency when caused by gonorrhoea and can lead to blindness
What are the signs/ symptoms of disseminated gonococcal infection (3)?
- Polyarthralgia (migratory)
- Systemic Sx e.g. fever, fatigue
- Various non-specific skin lesions
What is the most common STI worldwide?
Trichomonas vaginalis
What sort of organism is trichomonas vaginalis?
Flagellated protazoa
What are the signs/ symptoms of trichomonas vaginalis (5)?
- Dysuria
- Yellow frothy offensive discharge
- Itching
- Strawberry cervix
- Balantitis (inflammation of penis glans)
How is trichomonas vaginalis diagnosed (2)?
- Charcoal high vagina swab + microscopy
- Men = first catch urine + microscopy
What is an additional finding in women with trichomonas vaginalis?
High vaginal pH
like in BV
How is trichomonas vaginalis managed?
Metronidazole
What else is important to do/ tell in those diagnosed with trichomonas vaginalis (2)?
- Do not drink alcohol - reacts with metronidazole and can induce hypotension
- Contact trace
What can cause ulcers in the genital region?
HSV 2
How is HSV 2 diagnosed?
NAAT (swab)
How is HSV 2 treated?
Aciclovir
What causes genital warts?
HPV 6 and 11
What is the presentation of genital warts?
Painless warts on genitals
How can genital warts be prevented?
HPV vaccines
How are genital warts treated?
Podophyllotoxin cream/ imiquimod cream
What bacteria causes syphilis?
Treponema pallidum
What type of bacteria is treponema pallidum?
-ve spirochete
What are the stages of syphilis (4)?
- Primary syphilis
- Secondary syphilis
- Latent syphilis
- Tertiary syphilis
How long is syphilis incubation period?
21 days
What is the presentation of primary syphilis?
Painless ulcer at infection site (chancre)
