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Phase 3a Finals > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

What is bacterial vaginosis?

A

overgrowth of predominately anaerobic organisms such as :
GARDNERELLA VAGINALIS..

leads to fall in lactic acid producing aerobic lactobacilli (friendly bacteria in vagina) = raised vaginal ph.

not STI

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2
Q

features of bacterial vaginosis

A

vaginal discharge: fishy offensive

asx in 50%

no itching irritation or pain.

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3
Q

what is the criteria for bacterial vaginosis?

A

amsels criteria

3 of 4 needed

thwin white homogenous discharge

clue cells on microscopy: stippled vaginal epithelial cells

vaginal ph over 4.5

positive whiff test (addition of potassium hydroxide = fishy odour)

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4
Q

how would you manage bacterial vaginosis?

A

if asx: no tx unless if women undergoing termination of pregnancy

if sx:
oral metronidazole 5-7 days.
70-80% initial cure but relapse over 50% within 3 months

if adherence issue: single oral dose metronidazole 2g

topical metronidazole or topical clindamycin alternative

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5
Q

in pregnancy how can bacterial vaginosis affect it?

A

increased risk of preterm labour,

low birth weight

chorioamnionitis,

late miscarriage

postpartum endometritis

premature rupture of membranes

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6
Q

how to tx bacterial vaginosis in pregnancy?

A

oral metronidazole

if asx: discuss if needed

if sx: oral metro 5-7 or topical metro/clinda

NOT STAT DOSE OF METRO

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7
Q

examples of anaerobic bacteria associated with BV

A

gardnerella vaginalis -= mc

mycoplasma hominis

prevotella

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8
Q

risk factors of bv

A

multiple sex partners but not sti

smoking
recent abx
copper coil
excessive vaginal cleaning - douching - cleaning products, vaginal washes

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9
Q

what examination could be done to confirm bv

normal vaginal ph

A

speculum exam

confirm typical discharge.

high vaginal swab - exclude others.

vaginal ph : swab and ph paper.

normal vaginal ph - 3.5-4.5

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10
Q

what to avoid whilst bv tx and why?

A

alcohol.

alcoholl + metro = disulfiram like raction = nausea and vomiting, flushing

sometimes severe sx of shock and angioedema

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11
Q

comps of bv

A

increase the risk of catching sti like chlamydia gonorrhoea and hiv

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12
Q

what is trichomonas vaginalis?

trichomoniasis

A

highly motile flagellated protozoan parasite.

trichomoniasis - STI

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13
Q

features of trichomoniasis?

A

vaginal discharge: offensive, yellow/green, frothy

itching
dysuria
dyspareunia
balanitis - men

vulvovaginitis

strawberry cervix

ph over 4.5

men asx but could be urethritis

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14
Q

how would you investigate trichmoniasis?

A

miscropy of wet mount: motile trophozoites

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15
Q

how would you manage trichomoniasis?

A

oral metro 5-7 days

or one off dose of 2g metron

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16
Q

how would you diagnose trichomoniasis?

take swab from where?

and for men ?

A

standard charcoal swab with microscopy

swab taken from posterior fornix of vagina (behind cervix)

self taken low vaginal swab alternative

urethral swab/first catch urine : men

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17
Q

trichomonas can increase the risk of?

A

contracting hiv - because it damages vaginal mucosa

bv
cervical cancer
pelvic inflammatory idsease

pregnancy related comps: preterm delivery

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18
Q

how is trichomonas spread?

A

lives in urethra of men and women
vagina of women

sexual activity

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19
Q

what is vaginal candidasis? - thrush ?

mc yeast.

when can it happen?

A

vaginal infection with yeast from candida family.

mc : candida albicans

can colonise without sx.

can progress to infection during like pregnancy or after tx with broad spec abx that alter vaginal flora

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20
Q

risk factors of vaginal candidiasis?

A

increase oestrogen - pregnancy m lower prepuberty, post menopause

poorly controlled diabetes

immunosupression - using corticosteroids

broad spec abx - alter vaginal flora

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21
Q

features of vaginal candidiasis/

A

cottage cheese - non offensive discharge

vulvitis; superficial dysparenia, dysuria

itch

vulval eryhthema, fissuring, satellite lesions
excoriation

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22
Q

how would you investigate for vaginal candidiasis?

A

test vaginal ph : swab and ph paper. - ph under 4.5

charcoal swab with microscopy - to confirm

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23
Q

how would you manage vaginal candidiasis?

A

oral fluconazole 150 mg - single dose - 1st line

clotrimazole 500mg intravaginal pessary- single dose - if oral ci;d

if vulval sx: add topical imidazole as adjunct

if pregnant: only local tx cream or pessary used.

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24
Q

what would be considered reucrrent vaginal candidiasis?

tx

A

4 or more a yr

check compliance

high vaginal swab for microscopy and culture

do bg test exclude dm

exclude diff like lichen sclerosus

consider induction-maintenance regime:

induction - oral fluconazole - every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 weeks

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25
Q

what is chancroid?

causative organism

tx

A

tropical disease
STI

haemophilus ducreyi.

painful genital ulcers

unilateral painful inguinal lymph node enlargement.

ulcerS:
sharply defined, ragged, undermined border

Azithromycin: A single oral dose of 1 gram

Ciprofloxacin: An alternative is 500 mg orally twice daily for 3 days.

Ceftriaxone: IM single 250 mg

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26
Q

what is lymphogranuloma venerum?

A

STI

caused by chlamydia trachomatis serovars L1,L2 and L3

affect lymphoid tissue around site of infection with chlamydia.

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27
Q

risk factors of lymphogranuloma venereum

A

men sex men

most have hiv (if HIV+ PROCTITIS THINK THIS)

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28
Q

3 STAGES of infection of lymphogranuloma venererum

A

1: small painless pustule later forms ulcer. penis men. vaginal wall women or rectum after anal.

2: painful inguinal lymphadenopathy - poss form fistulating buboes. lymphadenitis.

3: proctocolitis - anal pain, change in bowel habit, tenesmus, discharge.

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29
Q

how would you treat lymphogranuloma venereum?

A

doxycycline

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30
Q

chlamydia resulting in urethritis and pelvic inflammatory disease is caused by which serovars

A

chlamydia trachomatris serovars d-k.

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31
Q

What is balanitis?

most common causes

A

inflammation of glans penis

can extend to underside of foreskin: balanoposthitis.

infective - bacterial and candidal

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32
Q

how would you investigate for balanitis

A

clinically

swab for microscopy and culture: bacteria or candida albicans

if doubt: biopsy

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33
Q

how would you treat balanitis?

non specific
specific
bacterial
anaerobic
dermatitis/circinate
lichen schlerosus

A

gentle saline wash, wash under foreskin, 1% hydrocortisone for short period.

specific:
- topical clotrimazole - 2 weeks.

bacterial balanitis: due to staphylococcus or group b strept - oral flucloxacillin or clarithromycin if penicillin allergic.

anaerobic balanitis: saline wash and topical/oral metro if not settle

dermatitis and circinate balanitis: mild potency topic corticosteroids - eg hydrocortisone

lichen sclerosus and plasma cell balanitis of zoon : high potency topical steroid - clobetasol.

circumcision: lichen sclerosus

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34
Q

explain candidiasis as a cause of balanitis

A

very common

acute

after intercourse

itching
white non urethral discharge

both children and adults

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35
Q

explain dermatitis - contact or allergic as a cause of balanitis

A

very common
acute

itchy , poss painful

occasionally associated with clear non-urethral ldischarge.

no other body area affected

both children and adults

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36
Q

explain bacterial cause of balanitis

A

common

acute

painful
itchy
yellow non-urethral discharge

most often due to staphylococcus spp

both kids and adult

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37
Q

explain anaerobic cause of balanitis

A

common

acute

itchy
very offensive yellow non urethral discharge

both kids and adults

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38
Q

explain lichen planus as a cause of balanitis

A

uncommon

acute and chronic

itchy
diagnostic feature: wickhams striae and violaceous papules

more commonly adults

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39
Q

explain lichen sclerosus as a cause of balanitis - balanitis xerotica obliterans

A

rare

chronic

itchy
white plaques
scarring

both kids and adults

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40
Q

explain plasma cell balanitis of zoon as a cause of balanitis

A

rare

chronic

itchy with clearly circumscribed areas of inflammation

both kids and adults

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41
Q

explain circinate balanitis as a cause of balanitis

A

uncommon

both acute and chronic

not itchy
no discharge

painless erosions

associated with reactive arthritis

adults

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42
Q

What is chlamydia?

incubation period

A

most prevalent sti in uk

caused by chlamydia trachomatis.

obligate intracellular pathogen.

incubation period: 7-21 days.

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43
Q

features of chlamydia

A

asx in around 70% of women and 50% of men

women: cervicitis (discharge, bleeding), dysuria

men: urethral discharge, dysuria, epididymo-orchitis

dyspareunia

vaginal bleeding can be intermenstrual or postcoital

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44
Q

potential complications of chlamydia

A

epididymitis

pelvic inflammatory disease

endometritis

increased incidence of ectopic pregnancy

infertility

reactive arthritis

perihepatitis - fitz hugh curtis syndrome

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45
Q

how would you investigate chlamydia

A

nuclear acid amplification test- NAATs

urine - first void urine sample , vulvovaginal swab, cervical swab - test these using NAAT technique

for women : vulvovaginal swab - 1st line

for men : urine test - 1st line

chlamydia testing - carry out 2 weeks after possible exposure

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46
Q

screening for chlamydia

A

men and women 15-24

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47
Q

how to manage chlamydia

A

doxycycline - 7 days - 1st line

if ci’d
either azithromycin - 1g od for 1 day then 500mg od for 2 days.

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48
Q

why in chlamydia should you use doxycycline and not azithromycin ?

A

concerns about mycoplasma genitalium.

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49
Q

how to treat chlamydia if pregnant?

A

azithromycin 1g stat then 500mg once day for 2 days erythromycin 500mg 4 time day for 7 days or 500mg twice day for 14 days

or amoxicillin 500mg 3 times day for 7 days

azithro 1g stat.

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50
Q

how to let know about chlamydia - contact tracing

A

men with urethral sx: all contacts since and 4 weeks prior

for women and asx men : last 6 months or most recent sexual partner

contacts of confirmed chlamydia should be offered tx before results of ix being known.

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51
Q

sti screening at a minimum is for which conditions

A

chlamydia
gonorrhoea
syphilis - blood test
hiv - blood test

52
Q

what is a charcoal swab?

A

allow for microscopy , culture and sensitivies.

long cotton bud into tube with black transport medium at end.

amies transport medium.
keeps microorganisms alive during transport.

53
Q

what can charcoal swabs confirm?

A

bv
candidiasis
gonorrhoea - endocervical swab

trichonmonas - posterior fornix swab

group b strept

54
Q

pt with anal or oral sex suspected chlamydia what to do

A

rectal and pharyngeal NAAT swab

55
Q

i examined someone with chlamydia. what are my findings?

A

pelvic/abdo tenderness

cervical motion tenderness

inflamed cervix

purulent discharge

56
Q

pregnancy related comps of chlamydia

A

preterm delivery

premature rupture of membranes

low birth weight

postpartum endometritis

neonatal infection - conjunctivitis and pneumonia

57
Q

general comps of chlamydia

A

pelvic inflammatory disease
chronic pelvic pain
infertility

ectopic

epididymo-orchitis
conjuncitivitis

lymphogranuloma venererum

reactive arthritis

58
Q

What is Syphilis?

caused by?

A

STI caused by spirochete Treponema Pallidum.

3 stages:
primary
secondary
tertiary

9-90 days - incubation period

59
Q

Different Stages of Disease - Syphillis

A

Primary - painless genital ulcer (Chancre). resolves over 3-8 weeks. local non-tender lymphadenopathy. (not seen in women mostly bc lesion could be on cervix)

Secondary - 6-10 weeks after primary infection.
- systemic sx: fevers, lymphadenopathy
- rash on trunk,palms and soles
- buccal “snail track” ulcers (30%)
condylomata late (painless, warty lesions on genitalia)
- alopecia
- maculopapular rash

Tertiary -
- gummatous lesions (granulomatous lesions that affect skin,organs and bones)
-aortic aneurysms
-neursyphillis
- general paralysis of the insane
-tabes dorsalis
-argyll-robertson pupil

Neurosyphillis - occur at any stage if infection reaches cns :

Headache
Altered behaviour
Dementia
Tabes dorsalis (demyelination affecting the spinal cord posterior columns)
Ocular syphilis (affecting the eyes)
Paralysis
Sensory impairment

60
Q

explain argyll robertson pupil to me

A

neurosyphillis

constricted pupil accomodates when focusing on a near object but doesnt react to light.

irregular shaped.

61
Q

features of congenital syphillis

A

blunted upper incisor teeth (hutchinson teeth) - “mulberry” molars

rhagades - linear scars at angle of mouth

keratitis
saber shins
saddle nose
deafness

62
Q

how would you investigate for syphillis?

A

non-treponemal tests: not specific, can have false positives.

assess quantity of antibodies being produced

rapid plasma reagin(RPR) and venereal disease research laboratory (VDRL)

treponemal- specific tests
- generally more complex and expensive but specific for syphilis
- qualititive

eg: TP-EIA, TPHA

take samples from site of infection to confirm presence of t pallidum with :
dark field microscopy
PCR

63
Q

causes of false positive non-treponemal (cardiolipin) tests

A

pregnancy

sle , anti-phospholipid syndrome
tb
leprosy
malaria
hiv

64
Q

example of test results for syphilis and what they might mean?

A

positive non treponemal test+ positive treponemal test : active syphilis

positive non-treponemal test + negative treponemal tesT: false-positive syphilis : due to pregnancy or sle

negative non-treponemal test+ positive treponemal test: sucessfully treated syphilis

65
Q

How to manage for syphilis?

A

im benzathine penicciline - 1st line

alternative: doxycycline

monitor nontreponemal rpr/vdrl titres.

66
Q

complication of syphilis treatment.

symptoms.

tx?

A

jarisch-herxheimer reaction.

fever, rash tachy after 1st dose of abx

release endotoxins following bactrial death- within few hours of treatment.

no tx - antipyretics if required.

67
Q

What is Genital Herpes?

A

hsv1 and hsv 2

after initial infection virus becomes latent in sensory nerve ganglia (trigeminal nerve ganglion with cold sores and sacral nerve ganglia with
genital herpes)

hsc 1 - cold sores - childhood before 5.- dormant in trigeminal nerve ganglion. genital herpes caused by hsv1 contracted via oro-genital sex- virus spreads from persion with oral infection to the person that gets genital infection.
hsv 2 - genital herpes. - sti - lesions in mouth

68
Q

how is herpes simplex virus spread?

A

direct contact with affected mucous membrane or viral shredding in mucous secretions.

can be contracted from asx pts. - more common in 1st 12 mnths of infection.

69
Q

features of genital herpes

how long do they last.

A

painful genital ulceration - poss dysuria and pruritis

primary infection more severe than recurrent episodes: systemic features:
headache
fever
malaise

tender inguinal lymphadenopathy
urinary retention poss
neuropathic type pain - tingling burning shooting

sx can last 3 weeks in primary infection. recurrent milder and resolve quicker

70
Q

how to investigate for genital herpes?

A

nucleic acid amplification test (NAAT) - ix of choice.

hsv serology - if recurrent genital ulceration of unknown cause

viral pcr swab from a lesion - confirm causative organism

71
Q

how would you manage genital herpes

A

general:
saline bathing
analgesia
topic anaesthetic agent: lidocaine

oral acyclovir

topical lidocaine - 2% gel
wear loose clothing

72
Q

main issue with genital herpes during pregnancy

A

neonatal herpes simplex infection contracted during labour and delivery.

high morbidity and mortality.

73
Q

pregnancy and baby immune to genital herpes?

A

woman develops antibodies to virus.

cross placenta into fetus.

passive immunity.

aiclovir not harmful in pregnancy

74
Q

how to treat genital herpes during pregnancy?

A

primary genital herpes - before 28 weeks gestation - aciclovir. - then give regular prophylactic aciclovir from 36 weeks gestation onwards.

if sx present : csection

normal delivery if no sx and more than 6 weeks from initial infection.

primary genital herpes contracted after 28 weeks gestation: aciclovir follow immediately by regular prophylactic aciclovir. - c section recommended.

recurrent genital herpes : low risk of neonatal infection even if lesions are present during delivery. - give prophylactic aciclovir from 36 weeks gestation.

75
Q

What are genital warts?

A

condylomata accuminata

caused by human papillomavirus hpv - types 6 and 11.

76
Q

which types of hpv predispose to cervical cancer

A

16 18 33

77
Q

features of genital warts

A

small - 2-5 mm - fleshy protuberances slightly pigmented

may bleed or itch

78
Q

how would you manage genital warts?

A

topical podophyllum or cryotherapy - 1st line

depending on location/type of lesion:
- multiple, non-keratinised waters: topical agent

solitary keratinised warts: cyrotherapy

imiquimod - topic cream - 2nd line

genital warts - resistant to tx and recurrence is common - most anogenital infection with hpv clear without intervention within 1-2 years.

79
Q

What is gonorrhoea?

causative bacteria?

what does it infect?

how does it spread?

A

neisseria gonorrhoea - gram negative diplococcus bacteria.

sti.

infects mucous membrane with columnar epithelium like endocervix in women, urethra, rectum, conjunctiva, pharynx.

spreads via contact with mucous secretions from infected areas.

80
Q

risk factors for gonorrhorea

A

young sexually active
multiple partners

other stis like chlamydia hiv

81
Q

abx resistance for gonorhea - tell me?

A

usualy ciprofloxacin and azithromycin were used to treat it but now theres high levels of resistance for these

82
Q

how would you diagnose gonnorrhoea?

A

naat - detect rna/dna of gonorrhoea.
do endocervical,vulvovaginal or urethral swab - or first catch urine swab.

rectal and pharyngeal swab recommend in men sex men.

standard charcoal endocervical swab take for microscopy, culture and abx sensitivities before initiating abx.

83
Q

feautures of gonorrhoea

local comps:

A

males: urethral discharge, dysuria

females: cervicitis : leading to vaginal discharge

rectal and pharyngeal infection : asx

local comps:
- urethral strcitures
epididymitis
salpingitis - poss lead to infertility

84
Q

is immunisation possible for gonorrhoea?

why?

A

no

reinfection common: antigenic variation of type 4 pili (proteins which adhere to surfaces)

and opa proteins (surface proteins that bind to receptors on immune cells)

85
Q

how would you manage gonorrhoea?

A

cephalosporins.

1st line : single dose of im ceftriaxone 1g.

if sensitivities known : single dose of oral ciprofloxacin 500mg

if ceftriaxone refused: oral cefixime 400 mg - single dose + oral azithromycin 2g single dose used

86
Q

what is the test of cure for gonorrhoea?

recommendations to pt

A

follow up.
naat testing if pt asx.

72 hrs after tx for culture
7 days after tx for RNA NAAT
14 days after tx for DNA NAAT

no sex for 7 days of tx
advice about ways to prevent future infection.

87
Q

complications of gonorhoea

A

pelvic inflammatory disease
infertility
chronic pelvic pain
conjunctivitis
urethral strictures
skin lesions
septic arthritis
endocarditis
disseminated gonococcal infection
prostatitis - in men
epididymo-orchitis (men)

firz hugh curis syndrome

88
Q

key complication of gonorrhoea in a neonate?

A

gonococcal conjunctivitis.

when contracted from mother during birth.

opthalmia neonatorum

med emergency:
associated with sepsis perforation of eye and blindness

89
Q

what is disseminated gonococcal infection

A

comp of untx gonococcal infection where bacteria spread to skin and joints.

poss due to haematogenous spread from mucosal infection.

causes pt to have:
dermatitis: non specific skin lesiosn
tenosynovitis
systemic: fever fatigue
migratory polyarthritis: arthritis that moves between joints
polyarthralgia: joint aches and pains

later comps:

endocarditis, perihepatitis(fitz-hugh curtis), septic arthritis

90
Q

mc cause of septic arthritis in young adults

A

gonococcal infection

91
Q

what is hiv?

what happens?

A

rna retrovirus.

hiv-1 mc
hiv-2 west africa.

virus enters and destroys the cd4 T-helper cells of immune system.

initial seroconversion flu like illness within few weeks of infection. then asx until conditions leads to immunodeficiency.
can be years after

92
Q

transmission of hiv

A

not through day to day activities like kissing

its through:

unprotected anal, vaginal or oral sex

mother to child at any stage of pregnancy, birth or breastfeeding (vertical transmission)

mucous membrane, blood or open wound exposure to infected blood or bodily fluids (sharing needles, needle-stick injuries or blood splashed in an eye)

93
Q

what is aids?

A

if hiv not treated
and the person becomes immunodeficient.

leads to opportunistic infections and aids defining illness

94
Q

aids defining illnesses

A

where cd4 count dropped to a level that allows for unusual opportunistic infections and malignnacies.

kaposi sarcoma
pneumocystic jiroveci pneumonia
cytomegalovirus infection
candidiasis (oesophageal or bronchial)
lymphomas
tb

95
Q

cd4 count is between 200-500 cells/mm3

what can happen in hiv pts

A

oral thrush - secondary to candida albicans

shingles - secondary to herpes zoster

hairy leukoplakia - secondary to ebv

kaposi sarcoma - secondary to hhv-8

96
Q

cd4 count 50-100 cells/mm3 - what can happen in hiv pts

A

aspergillosis - secondary to aspergillus fumigatus

oesophageal candidiasis - secondary to candida albicans

cryptococcal meningitis

primary CNS lymphoma - secondary to EBV

96
Q

cd4 count is 100-200 cells/mm3 - what can happen in hiv pts

A

cryptosporidiosis - self-limiting

cerebral toxoplsmosis

progressive multifocal leukoencephalopathy - secondary to JC virus

pneumocystic jirovecii pneumonia

hiv dementia

97
Q

cd4 count under 50 cells/mm3

A

cytomegalovirus retinitis - affects 30-40% of pts with cd4 under 50 cells/mm3

mycobacterium avium-intracellulare infection

98
Q

possible causes of diarrhoea in hiv patients

most common
incubation
staining
tx

A

cryptosporidium + other protozoa

cytomegalovirus

mycobacterium avium intracellulare

giardia

crypto- mc
intracellular protozoa
incubation: 7 days.
mild-severe diarhoea.
modified ziehl-neelsen stain - red cysts of cryptosporidium.
tx: supportive

99
Q

tell me about mycobacterium avium intracellulare

  • hiv

cd4 count
sx
ix
tx

A

atypical mycobactria

cd4 below 50

fever sweats abdo pain and diarhoea.

hepatomegaly poss and deranged lfts.

blood cultures
bm examination.

mx:
rifabutin
ethambutol
clarithromycin

100
Q

screening for hiv

A

can take bloods for hiv in emergency department.

4th gen lab test for hiv checks for antibodies and p24 antigen. window period of 45 days - can take upto 45 days after exposure to the virus for test to turn positive. - negative result within 45 days of exposure is unrealiable. over 45 days after exposure, negative reuslt is reliable.

point of care tests for hiv antibodies: result within minutes. 90 day window period.

home testing kit:
self-sampling - poste dto lab - fourth gen test for antibodies and p24 antigen

point of care test - antibodies only

101
Q

how to monitor for hiv

A

test cd4 count- number of cd4 cells in blood. cells destroyed by the virus.

lower the count higher the risk of opportunistic infection:

500-1200 cells/mm3 is normal

under 200 cells/mm3 - pt at high risk of opportunistic infections

test for hiv rna per ml of blood: tells you viral load.
undetectable viral load means level below recordable range (usually 20 copies/ml). viral load can be in hundreds of thousands in untreated hiv

102
Q

Investigations for HIV

A

1st - HIV antibody test - false negative for 3 months post exposure

if negative - repeat in 3 months

confirmatory: repeat p24 or use western blot (p24, gp120, gp41)

103
Q

How does HIV present?

A

acute (cd4>500)
- flu like symptoms

chronic/latent (cd4 500-200)
-fever
-persistent lymphadenoapthy
-opportunistic infections like ebv causing hairy leukoplakia or oral candidiasis
- tb can reactivate

aids defining
-persistent fever,fatigue, weight loss, diarrhoea, visual loss

104
Q

How would you manage HIV

A

Antiretrovirals, aim to increase cd4 count and reduce viral load

-2 nucleoside reverse transcriptase inhibitors (nrti) + protease inhibitor or on nucleoside reverse transcriptse inhibitor

eg: tenofovir, emtricitabine and bictegravir

105
Q

How would birth be managed in a women with hiv?

A

viral load
<50 copies/ml - normal delivery
>50 copies - consider c section
over 400 - pre-labour c section

IV zidovudine if viral load high/unknown during labour. (4 hrs before starting c section)

106
Q

factors in hiv which reduce vertical transmission (from 25-30% to 2 %)

A

maternal antiretroviral therapy

mode of delivery - c section

neonatal antiretroviral therapy

infant feeding - bottle feeding

107
Q

what neonatal antiretroviral therapy is given in hiv?

A

zidovudine - orally to neonate if maternal viral load is under 50 copies/ml.

otherwise triple ART.
4-6 weeks

108
Q

What is mycoplasma genitalium?

A

non-gonoccocal urethritis sti

presents similar to chlamydia, often co infected.

urethritis key feature

increasing abx resistance, especially to azithromycin

109
Q

how is mycoplasma investigated?

A

naat
-first urine sample in men
-vaginal swab for women

macrolide resistance and test of cure needed

110
Q

mx of mycoplasma genitalum

A

doxycycline 100mg 2*day/7 days

2nd:
-azithromycin 1g stat then 500mg 1*day/2days

111
Q

possible complications of mycoplasma

A

urethritis
epididymitis
cervicitis
PID
reactive arthritis
preterm delivery in pregnancy

112
Q

Explain the Hypothalamic-Pituitary-Gonadal axis in women

A

Hypothalamus releases GnRH (gonadotrophin releasing hormone)

GnRH stimulates anterior pituitary to release LH and FSH

LH and FSH stimulate follicle development in ovaries, causing theca granulosa cells to secrete oestrogen, which negatively feeds back to Hypothalamus and AP, reducing LH and FSH levels.

113
Q

What is oestrogen and what does it stimulate

A

Steroid sex hormone (17-beta oestradiol is main active version).

Breast tissue development

Growth and development of female sex organs (vulva, vagina, uterus) at puberty

Blood vessel development in uterus

Development of endometrium

114
Q

What is progesterone and what does it stimulate

A

Steroid sex hormone produced by corpus luteum after ovulation. In pregnancy, it is produced by placenta from 10 weeks gestation onwards. Acts on tissues previously stimulated by oestrogen.

Thickens and maintains endometrium

Thickens cervical mucus

Increases body temperature

115
Q

What age does puberty occur in girls, how long does it last and in what sequence do changes occur? Also why does low weight delay puberty.

What staging is used

A

8-14 years

4 years

Growth spurt/breast buds, pubic hair, menarche

Aromatase found in adipose tissue helps create oestrogen. More aromatase (fat) = earlier puberty. Low birth weight, chronic disease/ED, athletic hence can cause delays

Tanner staging (under 10, no pubic hair or breasts = 1)

116
Q

What are the 2 phases of menstrual cycle

A

Follicular phase (start of menstruation -> ovulation) - first 14 days
Luteal phase (ovulation -> start of menstruation) - final 14 days

117
Q

What are ovarian follicles

A

oocytes are cells that have potential to develop into eggs. These are surrounded by granulosa cells, forming follicles.

Primary follicles are always maturing into primary and secondary follicles. When they reach secondary, they grow FSH receptors, which when stimulated, cause granulosa cells to secrete oestradiol (oestrogen).

118
Q

Describe the follicular phase

A

Low oestrogen and progesterone causes endometrium shedding and bleeding.

FSH stimulates secondary follicles, causing them to grow, and for surrounding granulosa cells to secrete oestrogen. This reduces LH and FSH production (negative feedback). Rising oestrogen also causes cervical mucus to become more permeable, allowing sperm to penetrate cervix around ovulation.

One follicle will develop more than the rest (dominant follicle) LH spike causes dominant follicle to release an ovum. Ovulation occurs 14 days before end of cycle.

Overall: FSH stimulates oestrogen, which spikes ~day 12. There is an LH spike right before ovulation causing an ovum to release.

119
Q

Describe the luteal phase

A

The follicle that released the ovum collapses, becoming the corpus luteum. This secretes progesterone, maintaining the endometrial lining. It also causes the cervical mucus to become thick.

If pregnancy: the syncytiotrophoblast of the embryo secretes Human Chorionic Gonadotrophin (HCG), maintaining the corpus luteum.

Without fertilisation the corpus luteum degenerates and stops producing oestrogen and progesterone. This fall causes breakdown of the endometrium and menstruation. The stromal cells in the endometrium release prostaglandins, causing uterus contractions. The fall in Oestrogen and Progesterone causes an increase in LH and FSH, restarting the cycle.

Menstruation marks day 1 of the menstrual cycle.

120
Q

What is amenorrhoea? Give primary and secondary causes

A

Failure to establish menstruation at 15 with normal sexual development and 13 without.

Primary
- Gonadal dysgenesis (e.g. Turners)
- Hypogonadotrophic hypogonadism (deficiency of LH and FSH), Hypergonadotrophic hypogonadism (lack of response to LH and FSH by gonads)
- Pregnancy

Secondary - 3-6 months amenorrhoea when previously normal
- Hypothalamic (secondary stress, excessive exercise)
- PCOS
- Thyroid disease
- Hyperprolactinaemia

121
Q

What is erectile dysfunction?

2 main causes

A

persistent inability to attain/maintain an erection sufficient to permit satisfactory sexual performance.

organic - gradual onset sx, lack of tumescence, normal libido

psychogenic cause: sudden onset of sx, decreased libido, good quality spontaneous/self-stimulated erections, major life events, problems/changes in relationship, previous psychological problems, hx of premature ejaculation

122
Q

risk factors of ed

A

cv disease: obesity, dm, dyslipidemia, met syndrome, htn, smoking

alcohol

drugs: ssri beta blockers

123
Q

ix for ed

A

10 yr cv risk - measure lipid and fasting glucose serum levels

free testosterone - between 9 and 11am. - if low/borderline repeat with fsh,lh,prolactin.

124
Q

how to manage ed

A

pde-5 inhibitor: sildenafil

vacuum erection: 1st line if wont take pde-5 inhibitor

stop cycling if cycline for more than 3 hrs per week

Phase 3a Finals (25 decks)

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