SEXUAL HEALTH Flashcards
what organism causes gonorrhoea?
Neisseria gonorrhoea
which group of people is gonorrhoea common in ?
men who have sex with men
signs and symptoms of gonorrhoea in
a) men
b) women
c) rectal infection
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
1st line investigation for gonorrhoea - how are samples collected for women and men?
nucleic acid amplification test (NAAT)
women - vulvovaginal swab
men - first catch urine
rectal swab if anal sex
investigation for susceptibility testing before initiating abx in gonorrhoea
microscopy and culture of specimen e.g. swab, secretions
ddx for gonorrhoea
- chlamydia
- trichomonas
- BV
- UTI
abx management in uncomplicated gonorrhoea if…
a) sensitivities not known
b) sensitivities known
a) single dose IM ceftriaxone 1g
b) single dose oral ciprofloxacin 500mg
where should gonorrhoea patients be referred and what advice should be given?
- GUM clinic
- abstain from sex for 7 days, test and tx other STIs
what is disseminated gonococcal infection? what can it cause?
complication of untreated gonococcal infection. can cause
- non-specific lesions
- polyarthralgia
- migratory polyarthritis
- tenosynovitis
- systemic symptoms e.g. fever, fatigue
what organism causes syphilis?
spirochete gram-negative bacteria Treponema pallidum
what are the stages of syphilis and what are they characterised by?
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
signs and symptoms of primary syphilis
painless anogenital ulcer, takes 3-8 weeks to resolve
signs and symptoms of secondary syphilis
- maculopapular rash
- low grade fever
- lymphadenopathy
- alopecia
- oral lesions
- grey wart lesions around genitals
signs and symptoms of tertiary syphilis
depends on affected organ
- gummatous lesions
- aortic aneurysms
- neurosyphilis
signs and sx of neurosyphilis
- headache
- altered behaviour
- dementia
- paralysis
- sensory impairment
- ocular syphilis (eyes)
investigations for syphilis (3)
- microscopy of chancre fluid
- PCR testing of swab
- serology (used in screening)
what investigation can be done if neurosyphilis is suspected?
lumbar puncture
ddx for syphilis
genital herpes
management of syphilis
- referral to GUM
- screen for other STIs
- early syphilis = benzathine penicillin IM single dose
- late syphilis = benzathine penicillin IM, 3 doses as weekly intervals
name and describe the organism that causes Trichomoniasis
- trichomonas vaginalis
- highly motile, flagellated protozoan parasite
RFs for trichomoniasis
- <25
- new sex partner
- > 1 sex partner in past 12m
- prev STI
signs and sx of trichomoniasis in women
describe the characteristic discharge
- DISCHARGE - offensive, yellow-green, frothy
- vulvovaginitis - red, sore, itchy
- dysuria and dyspareunia
signs and sx of trichomoniasis in men
normally asymptomatic - may have balanitis/urethritis
what will be seen on speculum exam in a woman with trichomoniasis?
strawberry cervix (cervicitis)
investigations & results for trichomoniasis
what is diagnostic?
- GUM clinic
- pH of vaginal discharge (>4.5)
- diagnostic = charcoal swab w microscopy (HVS in women, urethral swab/urine in men)
wet mount microscopy will show motile trophozoites
management of trichomoniasis
abx, advice, other partners
- refer to GUM specialist for diagnosis, tx and contact tracing
- oral metronidazole either 400-500mg for 5-7d or OD 2g
- sexual abstinence for 1 week, treat current partner simultaneously and any partners within 4 weeks of presentation
BV vs trichomoniasis (discharge, microscopy, other sx) diffs and similarities
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
complications of trichomoniasis in preg women (4)
- preterm
- postpartum sepsis
- PROM
- LBW
complications of trichomoniasis in
a) non pregnant women
b) men
a) PID, BV, cervical cancer risk, infertility
b) prostatitis, prostate cancer risk, infertility
both increased risk of HIV
hyposexual sexual desire disorder - definition and presentation
= not interested in sex (no/low sex drive)
don’t respond to partner’s signals, lose desire while having sex, avoid sex
what is sexual arousal disorder?
having trouble either getting/staying aroused
what is orgasm disorder?
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
define erectile dysfunction (ED)
persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance
factors of an ED suggesting an organic cause (3)
- gradual onset sx
- lack of tumescence (erection)
- NORMAL LIBIDO
factors of an ED suggesting a psychogenic cause (7)
- sudden onset sx
- decreased libido
- good quality spontaneous or self-stimulated erections
- major life events
- problems/changes in relationship
- previous psych problems
- hx of premature ejaculation
RFs for ED (4)
- increased age
- CD disease RFs e.g. obesity, diabetes, dyslipidaemia, HTN, smoking
- alcohol
- drugs/meds
which medications are RFs for ED? (2)
SSRIs and beta-blockers
investigations for ED (2)
- 10-year cardiovasc risk calculated - measure lipid and fasting serum glucose
- free testosterone measured between 9 and 11am
1st and 2nd line management for ED
- PDE-5 inhibitors e.g. sildenafil (viagra)
- if can’t/won’t have PDE-5, vacuum erection devices
what is vulvodynia?
pain in the vulva not caused by infection/other medical problem, lasting > 3 months
what is vaginismus?
when the vagina tightens when trying to insert something into it, causing pain
what is peyronie’s disease?
when fibrous scar tissue forms in the deeper tissues of the penis, causing it to curve/bend/lose length or girth
symptoms of retrograde ejaculation
- producing no/small amount of semen
- cloudy urine after sex
causes of retrograde ejaculation (5)
- prostate gland surgery
- bladder surgery
- diabetes
- MS
- alpha blockers (e.g. for HTN)
what is balanitis? what is balanoposthitis?
balanitis - inflammation of the glans penis
balanoposthitis - inflammation of glans penis and foreskin
3 common causes of balanitis
- candidiasis
- bacterial - staph aureus
- dermatitis - contact/allergic/eczema/psoriasis
general signs and sx of balanitis
- swelling
- redness
- pruritis
- red scaly patches
- discharge (white if candidiasis, yellow if s aureas)
what is circinate balanitis?
painless erosions on the penis associated with reactive arthritis
management of balanitis
a) general
b) candidiasis
c) bacterial
d) eczema
a) supportive - hygiene e.g. gentle saline washes
b) topical clotrimazole
c) oral fluclox
d) 1% hydrocortisone
what are genital warts? what are they most commonly caused by?
- viral STI, benign epithelial/mucosal outgrowths
- most common cause is HPV types 6 and 11
how is genital warts spread?
skin to skin contact
presentation of genital warts
- painless, fleshy growths
- can be soft or hard
- may be singular/multiple
- can become irritated
most genital warts are managed…
with no tx - often resolve spontaneously
topical and physical management options for genital warts
TOPICAL
- podophyllotoxin for clusters of small
- imiquimod for larger
PHYSICAL
- excision
- cryotherapy (multiple)
- laser surgery (anus)
cause of genital herpes
HSV 1 or 2 (normally 2)
which strains of HPV does the prophylactic vaccine protect against?
6, 16, 11, 18
presentation of genital herpes, describe the cycle of a genital ulcer
- women commonly get dysuria
- PAINFUL genital ulcer
- vesicular lesion > ulceration > crusted lesion
genital lesion in syphilis vs herpes
syphilis - single painless sore (chancre), firm and round
herpes - painful fluid-filled blisters
investigations for genital herpes
- viral culture from lesion
- HSV PCR
tx of genital herpes
oral acyclovir 400mg
what is a chancroid? what is it caused by?
a tropical STI caused by haemophilus ducreyi
signs and sx of chancroid
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
unique RF for chancroid
sexual contact w sex worker
what will show on gram stain in chancroid?
‘school of fish’ arrangement of gram -ve coccobacilli/slender bacilli
tx of chancroid
HIV negative - azithromycin
what is lymphogranuloma venereum (LGV)? what is it caused by? who is it most common in?
STI caused by chlamydia trachomatis
men who have sex w men
symptoms of lymphogranuloma
THREE STAGES
1. painless ulcer
2. lymphadenitis (groin)
3. inflammation of rectum (proctitis) and anus
ix for lymphogranuloma venereum
NAAT test
tx of lymphogranuloma venereum
doxycycline 100mg for 21 days
presentation of pubic lice
- small insects around penis/vagina
- itching, worse at night
- small red/blue spots on skin and white/yellow dots attached to hair
tx of pubic lice (2)
- malathion lotion (wash off after 8-12h)
- ivermectin (stromectol) - single dose of 2 pills
