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PHASE 3A > SEXUAL HEALTH > Flashcards

SEXUAL HEALTH Flashcards

1
Q

what organism causes gonorrhoea?

A

Neisseria gonorrhoea

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2
Q

which group of people is gonorrhoea common in ?

A

men who have sex with men

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3
Q

signs and symptoms of gonorrhoea in
a) men
b) women
c) rectal infection

A

a) DYSURIA (often first sign), purulent urethral discharge, epididymal tenderness

b) vaginal discharge (yellow/white), dysuria, dyspareunia, pelvic tenderness, easy bleeding

c) rectal pain, discharge, pruritus

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4
Q

1st line investigation for gonorrhoea - how are samples collected for women and men?

A

nucleic acid amplification test (NAAT)

women - vulvovaginal swab

men - first catch urine

rectal swab if anal sex

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5
Q

investigation for susceptibility testing before initiating abx in gonorrhoea

A

microscopy and culture of specimen e.g. swab, secretions

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6
Q

ddx for gonorrhoea

A
  • chlamydia
  • trichomonas
  • BV
  • UTI
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7
Q

abx management in uncomplicated gonorrhoea if…
a) sensitivities not known
b) sensitivities known

A

a) single dose IM ceftriaxone 1g
b) single dose oral ciprofloxacin 500mg

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8
Q

where should gonorrhoea patients be referred and what advice should be given?

A
  • GUM clinic
  • abstain from sex for 7 days, test and tx other STIs
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9
Q

what is disseminated gonococcal infection? what can it cause?

A

complication of untreated gonococcal infection. can cause
- non-specific lesions
- polyarthralgia
- migratory polyarthritis
- tenosynovitis
- systemic symptoms e.g. fever, fatigue

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10
Q

what organism causes syphilis?

A

spirochete gram-negative bacteria Treponema pallidum

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11
Q

what are the stages of syphilis and what are they characterised by?

A

Primary - painless ulcer at original infection site

Secondary - 6-8w later… systemic sx (skin and mucous membranes), widespread rash, lymphadenopathy, fever, fatigue. resolving after 3-12 weeks

Latent - symptoms disappear, pt asymptomatic but still infected

Tertiary - years after initial infection, gummas (soft non cancerous growths) develop in multiple systems e.g. cardio (aneurysms, valve disease), neurosyphilis

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12
Q

signs and symptoms of primary syphilis

A

painless anogenital ulcer, takes 3-8 weeks to resolve

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13
Q

signs and symptoms of secondary syphilis

A
  • maculopapular rash
  • low grade fever
  • lymphadenopathy
  • alopecia
  • oral lesions
  • grey wart lesions around genitals
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14
Q

signs and symptoms of tertiary syphilis

A

depends on affected organ

  • gummatous lesions
  • aortic aneurysms
  • neurosyphilis
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15
Q

signs and sx of neurosyphilis

A
  • headache
  • altered behaviour
  • dementia
  • paralysis
  • sensory impairment
  • ocular syphilis (eyes)
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16
Q

investigations for syphilis (3)

A
  1. microscopy of chancre fluid
  2. PCR testing of swab
  3. serology (used in screening)
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17
Q

what investigation can be done if neurosyphilis is suspected?

A

lumbar puncture

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18
Q

ddx for syphilis

A

genital herpes

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19
Q

management of syphilis

A
  • referral to GUM
  • screen for other STIs
  • early syphilis = benzathine penicillin IM single dose
  • late syphilis = benzathine penicillin IM, 3 doses as weekly intervals
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20
Q

name and describe the organism that causes Trichomoniasis

A
  • trichomonas vaginalis
  • highly motile, flagellated protozoan parasite
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21
Q

RFs for trichomoniasis

A
  1. <25
  2. new sex partner
  3. > 1 sex partner in past 12m
  4. prev STI
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22
Q

signs and sx of trichomoniasis in women

describe the characteristic discharge

A
  1. DISCHARGE - offensive, yellow-green, frothy
  2. vulvovaginitis - red, sore, itchy
  3. dysuria and dyspareunia
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23
Q

signs and sx of trichomoniasis in men

A

normally asymptomatic - may have balanitis/urethritis

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24
Q

what will be seen on speculum exam in a woman with trichomoniasis?

A

strawberry cervix (cervicitis)

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25
Q

investigations & results for trichomoniasis

what is diagnostic?

A
  1. GUM clinic
  2. pH of vaginal discharge (>4.5)
  3. diagnostic = charcoal swab w microscopy (HVS in women, urethral swab/urine in men)

wet mount microscopy will show motile trophozoites

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26
Q

management of trichomoniasis

abx, advice, other partners

A
  1. refer to GUM specialist for diagnosis, tx and contact tracing
  2. oral metronidazole either 400-500mg for 5-7d or OD 2g
  3. sexual abstinence for 1 week, treat current partner simultaneously and any partners within 4 weeks of presentation
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27
Q

BV vs trichomoniasis (discharge, microscopy, other sx) diffs and similarities

A

DIFFERENCES

BV - thin white discharge, clue cells

trichomoniasis - frothy yellow-green discharge, wet mount motile trophozoites, vulvovaginitis and strawb cervix

SIMILARITIES
offensive discharge, vaginal pH >4.5, tx with metronidazole

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28
Q

complications of trichomoniasis in preg women (4)

A
  1. preterm
  2. postpartum sepsis
  3. PROM
  4. LBW
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29
Q

complications of trichomoniasis in
a) non pregnant women
b) men

A

a) PID, BV, cervical cancer risk, infertility

b) prostatitis, prostate cancer risk, infertility

both increased risk of HIV

30
Q

hyposexual sexual desire disorder - definition and presentation

A

= not interested in sex (no/low sex drive)

don’t respond to partner’s signals, lose desire while having sex, avoid sex

31
Q

what is sexual arousal disorder?

A

having trouble either getting/staying aroused

32
Q

what is orgasm disorder?

A

don’t have orgasms/takes a long time to orgasm/have orgasms less often than you’d like/aren’t as strong as you’d like

33
Q

define erectile dysfunction (ED)

A

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

34
Q

factors of an ED suggesting an organic cause (3)

A
  1. gradual onset sx
  2. lack of tumescence (erection)
  3. NORMAL LIBIDO
35
Q

factors of an ED suggesting a psychogenic cause (7)

A
  1. sudden onset sx
  2. decreased libido
  3. good quality spontaneous or self-stimulated erections
  4. major life events
  5. problems/changes in relationship
  6. previous psych problems
  7. hx of premature ejaculation
36
Q

RFs for ED (4)

A
  1. increased age
  2. CD disease RFs e.g. obesity, diabetes, dyslipidaemia, HTN, smoking
  3. alcohol
  4. drugs/meds
37
Q

which medications are RFs for ED? (2)

A

SSRIs and beta-blockers

38
Q

investigations for ED (2)

A
  1. 10-year cardiovasc risk calculated - measure lipid and fasting serum glucose
  2. free testosterone measured between 9 and 11am
39
Q

1st and 2nd line management for ED

A
  1. PDE-5 inhibitors e.g. sildenafil (viagra)
  2. if can’t/won’t have PDE-5, vacuum erection devices
40
Q

what is vulvodynia?

A

pain in the vulva not caused by infection/other medical problem, lasting > 3 months

41
Q

what is vaginismus?

A

when the vagina tightens when trying to insert something into it, causing pain

42
Q

what is peyronie’s disease?

A

when fibrous scar tissue forms in the deeper tissues of the penis, causing it to curve/bend/lose length or girth

43
Q

symptoms of retrograde ejaculation

A
  • producing no/small amount of semen
  • cloudy urine after sex
44
Q

causes of retrograde ejaculation (5)

A
  1. prostate gland surgery
  2. bladder surgery
  3. diabetes
  4. MS
  5. alpha blockers (e.g. for HTN)
45
Q

what is balanitis? what is balanoposthitis?

A

balanitis - inflammation of the glans penis

balanoposthitis - inflammation of glans penis and foreskin

46
Q

3 common causes of balanitis

A
  1. candidiasis
  2. bacterial - staph aureus
  3. dermatitis - contact/allergic/eczema/psoriasis
47
Q

general signs and sx of balanitis

A
  • swelling
  • redness
  • pruritis
  • red scaly patches
  • discharge (white if candidiasis, yellow if s aureas)
48
Q

what is circinate balanitis?

A

painless erosions on the penis associated with reactive arthritis

49
Q

management of balanitis
a) general
b) candidiasis
c) bacterial
d) eczema

A

a) supportive - hygiene e.g. gentle saline washes

b) topical clotrimazole

c) oral fluclox

d) 1% hydrocortisone

50
Q

what are genital warts? what are they most commonly caused by?

A
  • viral STI, benign epithelial/mucosal outgrowths
  • most common cause is HPV types 6 and 11
51
Q

how is genital warts spread?

A

skin to skin contact

52
Q

presentation of genital warts

A
  • painless, fleshy growths
  • can be soft or hard
  • may be singular/multiple
  • can become irritated
53
Q

most genital warts are managed…

A

with no tx - often resolve spontaneously

54
Q

topical and physical management options for genital warts

A

TOPICAL
- podophyllotoxin for clusters of small
- imiquimod for larger

PHYSICAL
- excision
- cryotherapy (multiple)
- laser surgery (anus)

55
Q

cause of genital herpes

A

HSV 1 or 2 (normally 2)

56
Q

which strains of HPV does the prophylactic vaccine protect against?

A

6, 16, 11, 18

57
Q

presentation of genital herpes, describe the cycle of a genital ulcer

A
  • women commonly get dysuria
  • PAINFUL genital ulcer
  • vesicular lesion > ulceration > crusted lesion
58
Q

genital lesion in syphilis vs herpes

A

syphilis - single painless sore (chancre), firm and round

herpes - painful fluid-filled blisters

59
Q

investigations for genital herpes

A
  • viral culture from lesion
  • HSV PCR
60
Q

tx of genital herpes

A

oral acyclovir 400mg

61
Q

what is a chancroid? what is it caused by?

A

a tropical STI caused by haemophilus ducreyi

62
Q

signs and sx of chancroid

A

RECENT TROPICAL TRAVEL
1. painful genital ulcer/papule - sharply defined, ragged
2. painful inguinal lymph node enlargement (lymphadenitis)
3. dysuria
4. vaginal discharge
5. urethritis

63
Q

unique RF for chancroid

A

sexual contact w sex worker

64
Q

what will show on gram stain in chancroid?

A

‘school of fish’ arrangement of gram -ve coccobacilli/slender bacilli

65
Q

tx of chancroid

A

HIV negative - azithromycin

66
Q

what is lymphogranuloma venereum (LGV)? what is it caused by? who is it most common in?

A

STI caused by chlamydia trachomatis

men who have sex w men

67
Q

symptoms of lymphogranuloma

A

THREE STAGES
1. painless ulcer
2. lymphadenitis (groin)
3. inflammation of rectum (proctitis) and anus

68
Q

ix for lymphogranuloma venereum

A

NAAT test

69
Q

tx of lymphogranuloma venereum

A

doxycycline 100mg for 21 days

70
Q

presentation of pubic lice

A
  1. small insects around penis/vagina
  2. itching, worse at night
  3. small red/blue spots on skin and white/yellow dots attached to hair
71
Q

tx of pubic lice (2)

A
  1. malathion lotion (wash off after 8-12h)
  2. ivermectin (stromectol) - single dose of 2 pills

PHASE 3A (18 decks)

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