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Phase 4 Derm, Sexual Health, Breast, Renal, Urology, ENT > Sexual Health > Flashcards

Sexual Health Flashcards

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Dermatology Board Prep flashcards
1
Q

What is Bacterial Vaginosis and what are its features?

A

Overgrowth of predominately anaerobic organisms such as Gardnerella vaginalis. This leads to a consequent fall in lactic acid-producing aerobic lactobacilli resulting in a raised vaginal pH.

Features
- Vaginal discharge: ‘fishy’, offensive
- Asymptomatic in 50%

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2
Q

What are the criteria used for Bacterial Vaginosis?

A

Amsel’s criteria (3/4)

  • Thin, white homogenous discharge
  • Clue cells on microscopy: stippled vaginal epithelial cells
  • Vaginal pH > 4.5
  • Positive whiff test (addition of potassium hydroxide results in fishy odour)
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3
Q

What is the management for Bacterial Vaginosis?

A

Symptomatic
- Oral metronidazole for 5-7 days
- Single oral metronidazole 2g if poor adherence
- Topical metronidazole or topical clindamycin as alternatives
- If pregnant, no stat dose, 5-7 days oral or topical

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4
Q

What is Gonorrhoea and what are its features?

A

Caused by the Gram-negative diplococcus Neisseria gonorrhoea.

Acute infection can occur on any mucous membrane surface, typically the genitourinary, rectum, and pharynx. The incubation period of gonorrhoea is 2-5 days

Features
- Males: urethral discharge, dysuria
- Females: cervicitis e.g. leading to vaginal discharge
- Rectal and pharyngeal infection is usually asymptomatic

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5
Q

What is the management for Gonorrhoea?

A

First-line treatment is a single dose of IM ceftriaxone 1g

If sensitivities are known (and the organism is sensitive to ciprofloxacin) then a single dose of oral ciprofloxacin 500mg should be given

If ceftriaxone is refused (e.g. needle-phobic) then oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose) should be used

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6
Q

What is Trichomonas vaginalis and what are its features?

A

Trichomonas vaginalis is a highly motile, flagellated protozoan parasite. Trichomoniasis is a sexually transmitted infection (STI).

Features
- Vaginal discharge: offensive, yellow/green, frothy
- Vulvovaginitis
- Strawberry cervix
- pH > 4.5

Men (usually asymptomatic but may cause urethritis)

Investigation
microscopy of a wet mount shows motile trophozoites

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7
Q

What is the management of Trichomonas vaginalis?

A

Oral metronidazole for 5-7 days

One-off dose of 2g metronidazole

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8
Q

What is Vaginal candidiasis and what are its features?

A

80% of cases of Candida albicans
20% other candida species.

Features
- ‘cottage cheese’, non-offensive discharge
- Vulvitis: superficial dyspareunia,
- Dysuria
- Itch
- Vulval erythema, fissuring, and satellite lesions may be seen

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9
Q

What is the management of Vaginal candidiasis?

A

First Line: Oral fluconazole 150 mg single dose

Clotrimazole 500 mg intravaginal pessary single dose if oral contraindicated

Vulval symptoms,
- topical imidazole

Pregnant
- Only local treatments (e.g. cream or pessaries) may be used
- Oral treatments are contraindicated

Recurrent vaginal candidiasis (4+ per year)

  • Check compliance
  • Confirm by high vaginal swab for microscopy and culture
  • Consider a blood glucose test to exclude diabetes
  • Exclude differential diagnoses such as lichen sclerosus
  • Consider the use of an induction-maintenance regime
  • Induction: oral fluconazole every 3 days for 3 doses
  • Maintenance: oral fluconazole weekly for 6 months
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10
Q

What is the management for erectile dysfunction?

A

PDE-5 inhibitors (sildenafil)

Vacuum erection devices are recommended for patients who can’t/won’t take a PDE-5 inhibitor.

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11
Q

What are contraindications and side effects of Sildenafil?

A

Contraindications
- Pat`ients taking nitrates and related drugs such as nicorandil
- Hypotension
- Recent stroke or myocardial infarction (NICE recommend waiting 6 months)

Side-effects
- Visual disturbances
- Blue discolouration
- Non-arteritic anterior ischaemic
- Neuropathy
- Nasal congestion
- Flushing
- Gastrointestinal side-effects
- Headache
- Priapism

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12
Q

What is Chancroid?

A

Tropical disease caused by Haemophilus ducreyi.

Painful genital ulcers, sharply defined, ragged, undermined border

Unilateral, painful inguinal lymph node enlargement

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13
Q

What is the management for Chancroid?

A

Azithromycin: 1 gram orally single dose
Ceftriaxone: 250 milligrams (IM) single dose
Erythromycin: 500 milligrams orally TDS for 7 days
Ciprofloxacin: 500 milligrams orally BD for 3 days

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14
Q

What are genital warts and what are their features?

A

Caused by human papillomavirus HPV, especially types 6 & 11.

Features
- Small (2 - 5 mm) fleshy protuberances which are slightly pigmented
- May bleed or itch

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15
Q

What is the management of genital warts?

A

First Line:
- Topical podophyllum (multiple warts) or cryotherapy (solitary wart)

Second Line:
- Imiquimod (Topical Cream)

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16
Q

What is genital herpes and what are its features?

A

Caused by HSV1 and HSV2

Features
- Painful genital ulceration
- May be associated with dysuria and pruritus
- Headache, fever, malaise
- Tender inguinal lymphadenopathy
- Urinary retention may occur

Primary infections are often more severe than recurrent episodes

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17
Q

What is the management of genital herpes?

A

Investigations
- (NAAT)
- HSV serology may be useful in certain situations such as recurrent genital ulceration

Management
- saline bathing
- Analgesia
- Topical anaesthetic agents e.g.
- Lidocaine
- Oral aciclovir

18
Q

What is a Bartholin’s Abscess and what is the management?

A

Infected Bartholin’s gland, painful, with erythema and often gross deformity of the affected side of the vulva

Management:
- Antibiotics
- Insertion of catheter
- Surgical procedure (marsupialization)

19
Q

What is Bartholin’s Cyst and what is the management?

A

Painless and commonly asymptomatic cyst on Bartholin’s Gland. Unilateral and 1-3cm

Management:
- Insertion of catheter
- Surgical procedure (marsupialization)

20
Q

What is Chlamydia and what are its features?

A

Caused by chlamydia trachomatis

Features

  • Asymptomatic in70% of women and 50% of men
  • Women: cervicitis (discharge, bleeding), dysuria
  • Men: urethral discharge, dysuria
21
Q

What are the complications of chlamydia?

A
  • Epididymitis
  • PID
  • Endometritis
  • Increased incidence of ectopic pregnancies
  • Infertility
  • Reactive arthritis
  • Perihepatitis (Fitz-Hugh-Curtis syndrome)
22
Q

What is the management for chlamydia?

A

First Line
- Doxycycline 7 days

Second Line
- Azithromycin (1g od for one day, then 500mg od for two days)

Pregnant
- Azithromycin, erythromycin or amoxicillin

23
Q

What is the investigation of choice for chlamydia?

A

Women: the vulvovaginal swab

Men: the urine test
Can also use NAAT

24
Q

What are the primary features of Syphilis?

A

Chancre - painless ulcer at the site of sexual contact

Local non-tender lymphadenopathy

25
Q

What are the secondary features of Syphilis?

A

Occurs 6-10 weeks after primary infection

Systemic symptoms:
- fevers, lymphadenopathy

Rash on the trunk, palms and soles

Buccal ‘snail track’ ulcers (30%)

Condylomata lata (painless, warty lesions on the genitalia)

26
Q

What are the Tertiary features of Syphilis?

A

Gummas (granulomatous lesions of the
skin and bones)

Ascending aortic aneurysms

General paralysis of the insane

Tabes dorsalis

Argyll-Robertson pupil

27
Q

What are the features of congenital Syphilis?

A

Blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars

Rhagades (linear scars at the angle of the mouth)

Keratitis

Saber shins

Saddle nose

Deafness

28
Q

What are the investigations for syphilis?

A

Mainly based on clinical features but can use 2 types of serological tests?

Non-treponemal tests
- not specific for syphilis, therefore may result in false positives
- RPR, VDRL
- Becomes negative after treatment

Treponemal-specific tests
- Specific for syphilis
- TP-EIA, TPHA

EG:

Active syphilis infection
- Positive non-treponemal test + positive treponemal test

False positive syphilis infection
- Positive non-treponemal test + negative treponemal test

Successfully treated syphilis
- Negative non-treponemal test + positive treponemal test :

29
Q

What are some causes of false positives for non-treponemal tests (syphilis)?

A

Pregnancy
SLE, anti-phospholipid syndrome
Tuberculosis
Leprosy
Malaria
HIV

30
Q

What is the management for syphilis?

A

First Line:
- Benzathine penicillin (IM)

Alternative:
- Doxycycline (RPR and VDRL should be assessed after)

The Jarisch-Herxheimer reaction is sometimes seen following treatment
fever, rash, tachycardia after the first dose of antibiotic within a few hours of treatment

No treatment is needed other than antipyretics if required

31
Q

What is Balantitis and what is it caused by?

A

Inflammation of the glans penis that sometimes extends to the underside of the foreskin which is known as balanoposthitis.

Candidiasis
Dermatitis (contact or allergic)
Dermatitis (eczema or psoriasis)
Bacterial
Lichen Planus
Lichen Sclerosis
Plasma cell balanitis of Zoon
Circinate balanitis

32
Q

What is the management of Balanitis?

A

General treatment:
- Gentle saline washes
- Wash properly under the foreskin,
- Severe irritation and discomfort then 1% hydrocortisone can be used for a short period.

Specific treatment:

  • Candidiasis: topical clotrimazole (2 weeks)
  • Bacterial balanitis (Staphylococcus spp. or Group B Streptococcus spp)
  • Oral flucloxacillin or clarithromycin

Anaerobic balanitis
- Saline washing
- Topical or oral metronidazole if not settling

Dermatitis and circinate balanitis:
- Mild-potency topical corticosteroids (e.g. hydrocortisone)

Lichen sclerosus and plasma cell balanitis of Zoon
- High-potency topical steroids (e.g. clobetasol).
Circumcision can help in the case of lichen sclerosus.

33
Q

What is Lymphogranuloma venereum (LGV) and what are its features and risk factors?

A

Caused by Chlamydia trachomatis serovars L1, L2 and L3*.

Stage 1:
- small painless pustule which later forms an ulcer
Stage 2:
- painful inguinal lymphadenopathy
- may occasionally form fistulating buboes
Stage 3:
- proctocolitis

Risk factors
- Gay men
- HIV
- Tropical Climate

34
Q

What is the management of Lymphogranuloma venereum (LGV)?

A

Doxycycline

35
Q

What is the management of pubic lice?

A

Permethrin 5% cream

Malathion 0.5% aqueous solution

36
Q

What is HIV and what are its features?

A

Glandular fever type illness. Increased symptomatic severity is associated with poorer long-term prognosis. It typically occurs 3-12 weeks after infection

Features
- Sore throat
- Lymphadenopathy
- Malaise, myalgia, arthralgia
- Diarrhoea
- Maculopapular rash
- Mouth ulcers
- Rarely meningoencephalitis

37
Q

What are the diagnostic factors for HIV?

A

HIV antibodies
- May not be present in early infection, but
- Develop antibodies to HIV at 4-6 weeks
- ELISA test and Western Blot Assay

p24 antigen
- 1 week to 3/4 weeks after infection
- Combination tests (HIV p24 antigen and HIV antibody) are now standard for the diagnosis and screening of HIV

Combined test
- Repeat if positive
- Test the viral load (HIV RNA levels)

Testing for HIV in asymptomatic patients should be done at 4 weeks after possible exposure

After an initial negative result when testing for HIV in an asymptomatic patient, offer a repeat test at 12 weeks

38
Q

What is the management of HIV?

A

Antiretroviral therapy (ART)
- typically 2 NRTI and either a PI or NNRTI

Entry Inhibitors
- Maraviroc and Enfuvirtide

NRTIs
- Zidovudine (AZT), Abacavir, Emtricitabine, Didanosine, Lamivudine, Stavudine, Zalcitabine, Tenofovir

NNRTIs
- Nevirapine, Efavirenz

PIs
- Indinavir, Nelfinavir, Ritonavir, Saquinavir

Integrase Inhibitors
- Raltegravir, Elvitegravir, Dolutegravir

39
Q

What are the side effects of NRTIs?

A

Tenofovir: renal impairment and osteoporosis

Zidovudine: anaemia, myopathy, black nails

Didanosine: pancreatitis

40
Q

What are the side effects of NNRTIs?

A

P450 enzyme interaction (nevirapine induces)

Rashes

41
Q

What are the side effects of PIs?

A

Diabetes, hyperlipidaemia, buffalo hump, central obesity, P450 enzyme inhibition

Indinavir: renal stones, asymptomatic hyperbilirubinaemia

Ritonavir: a potent inhibitor of the P450 system

Phase 4 Derm, Sexual Health, Breast, Renal, Urology, ENT (5 decks)

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