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Phase 4 > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

what is bacterial vaginosis?

A

overgrowth of anaerobic bacteria in vagina that causes unusual fishy smelling, grey-ish white thin discharge

Caused by the loss of normal lactobacilli in vagina. Increases risk of STI transmission

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2
Q

what percentage of women with BV have no symptoms?

A

50%

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3
Q

What symtoms are not related to BV?

A

Soreness or itching

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4
Q

What are 4 risk factors for BV?

A

multiple sexual partners
recent Abx
IUD - copper coil
excessive vaginal cleaning

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5
Q

what is the diagnostic criteria for BV?

A

Ansel criteria

thin, white, homogenous discharge
Clue cells
pH >4.5
Whiff test +ve on alkali added

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6
Q

what are 2 complications of BV?

A

small chance of premature birth/miscarriage
Inceased risk of STI

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7
Q

what is discharge like in BV?

A

Thin, grey/white, fishy smelling

pH >4.5

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8
Q

What is the first line antibiotic for BV?

A

1 - Metronidazole 400mg BD 5-7days
OR
2g STAT one off
OR
intravaginal gel 0.75% OD 5 days

SAFE IN PREGNANCY - 2g STAT not safe in pregnancy

2 - Clindamycin gel 2% OD 7 days

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9
Q

What is the healthy bacteria in the vagina?

A

lactobilli - produce lactic acid and reduce pH of vagina (<4.5)

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10
Q

What is the most common pathogenic cause of BV?

A

Gardnerella vaginalis

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11
Q

what are 3 common pathogenic causes of BV?

A

gardnerella vaginalis (most common)
Mycoplasma hominis
prevotella species
ALL ANAEROBIC

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12
Q

What is normal vaginal pH?

A

3.5-4.5

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13
Q

What is the is the gold standard investigation for BV?

A

high or low vaginal swab
should also swab for STIs

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14
Q

What cells are found under a microscope in BV?

A

clue cells

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15
Q

what are 6 complications of BV in pregnancy?

A

Miscarriage
Preterm delivery
PROM
Chorioamnionitis
Low birth weight
post partum endometritis

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16
Q

Which antibiotic should you avoid alcohol whilst on?

A

Metronidazole - causes nausea, vomiting, flushing and sometimes shock

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17
Q

what is the most common cause of vaginal thrush?

A

Candida albicans

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18
Q

What are 4 risk factors for thrush?

A

increased oestrogen (pregnancy)
poorly controlled diabetes
immunosuppresion
Broad spectrum ABx

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19
Q

what are the symptoms of vaginal thrush?

A

thick white discharge
vulva and vaginal itching and irritation

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20
Q

What are 6 complications of vaginal thrush?

A

erythema
fissures
oedema
pain during sex (dyspareunia)
dysuria
excoriation

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21
Q

what is one test that can be used to distiguish between trush and BV/trichomonas?

A

vaginal pH swab
>4.5 in BV and Trichomonas
<4.5 in candidiasis

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22
Q

what swab is used for vaginal MCS?

A

charcoal swab - for BV, candidiasis, gonorrhoea, trichomonas, other bacteria

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23
Q

What is the management for thrush?

A

antifungal cream - clotrimazole 5g 10% single dose
antifungal pessary - clotrimazole 500mg single dose
Oral antifungal - fluconazole 150mg single dose

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24
Q

what is a contraindication to oral antifungals in thrush treatment?

A

pregnancy

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25
Q

what should you tell patients using antifungal creams?

A

can degrade latex condoms and prevent spermacides from working => use other forms of birth control for at least 5 days

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26
Q

what is the management of oral thrush?

A

1 - Miconazole oral gel - 2.5ml QDS

2 - nystatin suspension - 1ml QDS for 7 days

3 - if severe/extensive - fluconazole 50mg OD for 14 days

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27
Q

how is trichomonas spread?

A

sexual activity

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28
Q

what pathogen causes trichomonas?

A

Trichomonas vaginalis
Protozoan

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29
Q

what does trichomonas infection increase risk of?

A

HIV contraction (due to vaginal mucosa damage)
BV
cevical cancer
PID
pregnancy complications

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30
Q

What does the discharge look like in trichomonasis?

A

frothy, yellow-green fishy smelling discharge

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31
Q

on pelvic examination what can be found in someone with trichomoniasis?

A

strawberry cervix (colpitis macularis) caused by inflammation causing tiny haemorrhages on cerviix surface

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32
Q

how is trichomoniasis diagnosed?

A

charcoal microscopy swab from posterior fornix of vagina
vaginal pH >4.5
Urethral or first catch urine in men

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33
Q

What is the treatment for trichomoniasis?

A

refer to GUM for contact tracing
metronidazole 2g single dose
OR
400-500mg TD 5-7days

2g single dose not safe in pregnancy

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34
Q

what are 5 complications of Trichomonas?

A

Prostatitis
Increased risk prostate/cervical cancer
Infertility
PID
Prinatal complications - IUGR, Prem

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35
Q

what are 4 causes of balantitis?

A

Eczema/dermatitis
Bacteria - s.aureus, gonorrhoea
Candida
Lichen Planus
Lichen sclerosis
Penile neoplasm

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36
Q

what are 4 risk factors for balantitis

A

poor hygiene
over washing
HPV
uncircumsised

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37
Q

what are 2 investigations for balantitis?

A

swab for microbiology and PCR
viral swab

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38
Q

What is the management of balanitis?

A

gentle saline washes including under foreskin and 1% hydrocortisone if severe

Treat cause

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39
Q

What bacteria causes chancroid?

A

Haemophilus Ducreyi - coccobacillus

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40
Q

What STI is an important cofactor in HIV transmision?

A

Chancroid

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41
Q

what are 2 symptoms of chancroid?

A

Painful erythematous genital papules that become pustular and erode

Inguinal lymphadenopathy

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42
Q

what are 4 risk factors for chancroid?

A

Geographical location - Africa and Asia more common
Lower socioeconomic stasis
Unprotected sex
Coinfection with other STIs

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43
Q

what STI causes genital ulcers?

A

chancroid

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44
Q

What is the treatment for chancroid?

A

IM azithromycin 1g one off dose

Ceftriaxone or erythromycin in allergy

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45
Q

What bacteria causes chlamydia?

A

Chlamydia trachomatis

gram negative

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46
Q

what is the most common STI in the UK?

A

Chlamydia

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47
Q

what percentage of men and women are asymptomatic with chlamydia?

A

men - 50%
women - 75%

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48
Q

what is nucleic acid amplification test swabbing used for?

A

chlamydia and gonorrhoea

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49
Q

what samples are used in nucleic acid amplification tests?

A

Vulvovaginal/cervical swab
First void urine sample

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50
Q

how long after possible exposure should chlamydia testing take place?

A

2 weeks

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51
Q

what are 5 chlamydia symptoms in women?

A

Abnormal vaginal discharge
pelvic pain
abnormal vaginal bleeding
painful sex
dysuria

52
Q

what are 4 symptoms of chlamydia in men?

A

urethral discharge/discomfort
painful urination
epididymo-orchitis
reactive arthritis

53
Q

what can be found o/e in chlamydia?

A

Pelvic/abdo tenderness
Cervical motion tenderness
Inflamed cervis - cervicitis
Purulent discharge

54
Q

what is the 1st line treatment for chlamydia?

A

Doxycycline 100mg BD 7 days
OR
Azithromycin, 1g STAT then 500mg BD for 2 days

DOXYCYCLINE NOT SAFE IN PREGNANCY!!!

55
Q

what are 8 complications of chlamydia?

A

PID
chronic pelvic pain
infertility
ectopic pregnancy
epididymo-orchitis
conjunctivitis
Lymphogranuloma venereum
reactive arthritis
Fitz-hugh-curtis syndrome

56
Q

what are 5 complication of chlamydia in pregnancy?

A

preterm deliivery
premature rupture of membranes
low birthweight
post partum endometritis
neonatal infection - conjunctivitis and pneumonia

57
Q

when is a test of cure recommended in chlamydia?

A

pregnancy
poor compliance suspected
symptoms persist

58
Q

what is lymphogranuloma venereum?

A

a condition affecting the lymphoid tissue around chlamydia infected sites

most common in MSM and and HIV

59
Q

what are the stages of lymphogranuloma venereum?

A

primary - painless ulcer on genitals
secondary - lymphadenitis
tertiary - inflamation of rectum leading to anal pain, change in bowel, tenesmus and discharge

60
Q

what is the treatment of lymphogranuloma venereum?

A

Doxycycline 100mg BD 21 days

61
Q

What bacteria causes syphilis?

A

Treponema pallidum

spirochete

62
Q

what is the incubation period for syphilis?

A

9-90 days

average 21 days

63
Q

what is the transmission for syphilis?

A

Sexual
Vertical transmission
IV drug use
Blood transfusions and organ transplants

64
Q

what are the 5 stages of syphilis?

A

primary
secondary
latent
tertiary
neurosyphilis

65
Q

what are 2 symptoms of primary syphilis?

A

painless genital ulcer (chancre)
local lymphadenopathy
tends to resolve in 3-8 weeks

66
Q

what are 6 symptoms of secondary syphilis?

A

maculopapular rash - trunks, palms, soles
condylomata lata - grey warts around genitals and anus
low grade fever and lymphadenopathy
oral lesions - snail trail ulcers
alopecia
3-12 weeks long

67
Q

what are 3 symptoms of tertiary syphilis?

A

gummatous lesions - granulomatous lesions on skin, organs and bone
aortic aneurysms
Neurosyphilis
Cardiovascular syphilis

68
Q

what are 8 symptoms of neurosyphilis?

A

headache
altered behaviour
tabes dorsalis - demyelination of posterior columns of spinal cord
ocular syphilis
paralysis
sensory impairment
Argyll-robertson pupil

69
Q

what are 4 featues of cardiovascular syphilis?

A

Aortic aneurysm
Aortic regurgitation
coronary ostia stenosis - angina and heart failure
Conduction defects

70
Q

What is Argyll-Robertson pupil?

A

prostitutes pupil in neurosyphilis

accommodates but does not react to light

71
Q

How do you diagnoses syphilis?

A

Asymptomatic screening - treponemal specific antibody test

Symptomatic - Syphilis serology and dark field microscopy

72
Q

What is the 1st line treatment for syphilis?

A

Deep IM benzathine benzylpenicillin 1.8g single dose in early, 3 doses in late/latent

SAFE IN PREGGOS

ALLERGY - Doxycycline - 100mg BD 14 days early, 28 days late
PLUS PREGNANCY
Erythromycin - 500mg QDS

73
Q

What can trichomoniasis in pregnancy cause?

A

premature birth
low birthweight

74
Q

what can syphilis in pregnancy cause?

A

congenital syphilis
miscarriage
still birth
early death

75
Q

What is the treatment for chlamydia in preggos?

A

Azithromycin 1g once then 500mg OD for 2 days

Erythromycin 500mg QD for 7 days
Amoxicillin 500mg TD 7 days

76
Q

what are the complications of chlamydia during pregnancy?

A

pre-term labour
bleeding in pregnancy
PID + fertility problems
ectopic pregnancy
congenital chlamydia - eye or chest infection

77
Q

what is a complication of spriocete (syphilis) infection after antibiotic treatment?

A

Jarisch-herxheimer reaction - fever, headache, myalgia, tahycardia after 1st dose

No wheeze or hypotension in comparison to anaphylaxis

Can also cause fetal distress and premature labour

also lymes + other spirocetes

78
Q

Which ganglia is genital herpes usually latent in?

A

sacral nerve ganglia

79
Q

what are 5 manifestations of HSV?

A

Cold sores
Genital herpes
aphthous ulcers (in mouth)
herpetic whitlow (painful skin lesions on fingers)
herpes keratitis - inflammation of cornea

80
Q

what are 5 presentations of genital herpes?

A

ulcers
neuropathy
flu like symptoms
dysuria
inguinal lymphadenopathy

81
Q

what is the management of genital herpes?

A

Aciclovir - 200mg 5x daily for 5 days for 1st infection or 800mg TDS for 2 days for recurrence

paracetamol, topical lidocaine and cleaning with warm salt water can also help

82
Q

How is genital herpes managed in pregnancy?

A

if contracted<28 weeks - aciclovir course then prophylactic aciclovir from 36 weeks

> 28 weeks - aciclovir continually till delivery

Recurrence of pre-existing genital herpes - prophylactic aciclovir from 36 weeks

83
Q

what pathogen causes genital warts ?

A

Human papillomavirus
HPV6 and 11 most commonly

84
Q

what is the treatment for genital warts?

A

1 - Topical podophyllum or cryotherapy

2 - imiquimod

85
Q

What bacteria causes gonorrhoea?

A

Neisseria gonorrhoeae
Gram -ve diplococci

86
Q

what are 4 symptoms of gonorrhoea?

A

odourless purulent discharge (can be green/yellow)
Dysuria
pelvic pain
testicular pain

87
Q

How do you diagnose gonorrhoea?

A

Nucleic Acid Amplification Test

endocervical swab or first catch urine sample

88
Q

What is the treatment for gonorrhoea?

A

IM ceftriaxone 1g - safe in pregnancy

Oral Ciprofloxacin 500mg
Single dose if sensitivities are known

89
Q

What are 5 complications of gonorrhoea?

A

PID
Infertility
Prostatitis + epididymo-orchitis
Septic arthritis
Conjunctivitis
Disseminated gonococcal infection
Fitz-hugh-curtis syndrome

90
Q

what should a test of cure be done for gonorrhoea?

A

for everyone due to high abx resistance

72h after treatment for culture in symptomatic patients

7 days after tx RNA NAAT
14 days after Tx DNA NAAT

91
Q

what are 6 presentations of disseminated gonococcal infection?

A

Triad - tenosynovitis, dermatitis, polyarthralgia/arthralgia

Non-specific skin lesions
Migratory
polyarthritis
Systemic symptoms - fever, fatigue

92
Q

which cells does HIV affect?

A

CD4 T-Helper cells

93
Q

what kind of virus is HIV?

A

RNA retrovirus

94
Q

what is the most common type of HIV virus?

A

HIV-1

HIV-2 is found mostly in west Africa

95
Q

what is the transmission of HIV like? 3

A

Unprotected sexual activity - vagina, anal, oral
Vertical transmission
Mucous membrane, blood or open wound exposure to infected blood or bodily fluids

96
Q

What are 4 Aids defining infections occurring with a CD4 count 200-500?

A

HSV
Pulmonary TB
Kaposi sarcoma
Invasive cervical cancer

97
Q

What are 5 Aids defining infections occurring with a CD4 count 100-200?

A

Pneumocystitis pneumonia
Cryptosporidiosis - most common cause of diarrhoea in aids
Histoplasmosis pneumonia
Progressive multifocal leukoencephalopathy
HIV encephalopathy

98
Q

What are 2 Aids defining infections occurring with a CD4 count 50-100?

A

Toxoplasmosis
Oesophagitis - candida, HSV, CMV

99
Q

What are 4 Aids defining infections occurring with a CD4 count <50?

A

CMV retinitis and colitis
Cryptococcal meningitis - fungal cysts visible on indian ink stain of CSF
Mycobacterium avium complex
CNS lymphoma

100
Q

How long after exposure to HIV virus can it take for testing to become positive?

A

45 days

101
Q

what is the normal CD4 count?

A

500-1200 cells

102
Q

what CD4 count puts you at risk of opportunistic infections?

A

<200 cells/mm3

103
Q

What is the treatment of HIV?

A

Antiretroviral therapy (ART)

104
Q

what are 5 classes of antiretroviral therapy?

A

Protease inhibitors
Integrase inhibitors
Nucleoside reverse transcriptase inhibitors (NRTIs)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Entry inhibitors

105
Q

what is the usual antiretroviral starting regime?

A

2 nucleoside reverse transcriptase inhibitors - Tenofovir + emtricitabine
PLUS
3rd agent - Bictegravir

106
Q

what medication can be given people with a very low CD4 count in HIV to prevent pneumocystis jirovecii infection?

A

Prophylactic co-trimoxazole

if CD4 count <200

107
Q

How often do people with HIV get cervical smears?

A

Yearly

108
Q

what are 2 vaccinations that are avoided in HIV?

A

BCG
Typhoid

life attenuated vaccinations

109
Q

how should HIV +ve mothers with a viral load <50 give birth?

A

Normal vaginal delivery

110
Q

how should HIV +ve mothers with a viral load 50-400 give birth?

A

consider pre-labour caesarean section

111
Q

how should a HIV +ve mother with a viral load >400 give birth?

A

pre labour caesarean

112
Q

what is given during labour and delivery in an HIV +ve mother with an unknown/viral load >1000?

A

IV zidovudine

113
Q

what can be given as prophylaxis to the baby of an HIV +ve mother?

A

low risk - zidovudine for 2-4 weeks

High risk - zidovudine, lamivudine, nevirapine for 4 weeks

114
Q

Should HIV +ve mothers breasfeed?

A

It is NOT recommended

115
Q

what can be given as post exposure prophylaxis for HIV?

A

emtricitabine/tenofovir
PLUS Raltegravir

for 28 days

116
Q

what is given as pre-exposure prophylaxis for HIV?

A

Emtrictabine/Tenofovir (Truvada)

117
Q

what are 7 features of HIV seroconversion?

A

typically 3-12 weeks after infection

sore throat
lymphadenopathy
malaise, myalgia, arthralgia
diarrhoea
maculopapular rash
mouth ulcers
meningioencephalitis - rarely

118
Q

what is the presentation of Kaposi’s sarcoma?

A

purple papules or plaques on skin or mucosa

caused by HHV-8

119
Q

what is the investigation pathway for HIV?

A

ELISA - detection of HIV antibodies and p24 antigen
Sensitive 4 weeks post transmission
Repeat at 12 weeks if negative
Confirmatory testing if positive

Western blot or repeat ELISA is used for confirmatory testing

120
Q

what are 4 opportunistic infections that occur in HIV but are not AIDS defining?

A

Oral candida
Hairly leukoplasia - white hairy patch on side of tongue
Shingles
Aspergillosis

121
Q

what are 4 general side effects of nucleoside reverse transcriptase inhibitors?

A

Bone marrow suppression
Lipodystrophy
hepatotoxicity
myalgia

122
Q

what is one general side effect of non-nucleoside reverse transcriptase inhibitors?

A

rashes

123
Q

what are 5 general side effects of protease inhibitors?

A

hypercholesterolaemia
central obesity
diabetes
alopecia
P450 inhibitors

124
Q

what are 3 differences on MRI head of toxoplasmosis and CNS lymphoma?

A

Toxoplasmosis
- multiple lesions
- ring/nodular enhancing
- thallium SPECT negative

Lymphoma
- single lesions
- solid enhancement
- thallium SPECT positive

125
Q

what are 6 signs of congenital syphilis?

A

Blunted upper incisor teeth
Rhagades - linear scars at angle of mouth
Keratitis
Saber shins - deformation of tibia, anterior bowing
saddle nose
deafness

Phase 4 (22 decks)

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