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Sexual Health Flashcards

1
Q

What organism causes syphilis?

A

The spirochaete Treponema pallidum

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2
Q

The spirochaete Treponema pallidum causes which STI?

A

Syphilis

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3
Q

What are the primary features of Syphilis?

A

Chancre - painless ulcer at the site of sexual contact
Local non-tender lymphadenopathy
Often not seen in women (the lesion may be on the cervix)

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4
Q

How long is the incubation period of syphilis?

A

9-90 days

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5
Q

How long after primary infection does it take for secondary features of syphilis to develop?

A

Occurs 6-10 weeks after primary infection

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6
Q

What are the secondary features of syphilis?

A

Systemic symptoms: fevers, lymphadenopathy
Rash on trunk, palms and soles
Buccal ‘snail track’ ulcers (30%)
Condylomata lata (painless, warty lesions on the genitalia )

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7
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

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8
Q

What are some 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

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9
Q

What are the features of vaginal candidiasis?

A

‘Cottage cheese’, non-offensive discharge
Vulvitis: superficial dyspareunia, dysuria
Itch
Vulval erythema, fissuring, satellite lesions may be seen

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10
Q

What factors make vaginal candidiasis more likely to develop?

A

Diabetes mellitus
Drugs; antibiotics and steroids
Pregnancy
Immunosuppression: HIV

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11
Q

What are the investigations for vaginal candidiasis?

A

A high vaginal swab is not routinely indicated if the clinical features are consistent with candidiasis

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12
Q

What is the first line management for vaginal candidiasis?

A

Oral fluconazole 150 mg as a single dose first-line

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13
Q

What is the second line management for vaginal candidiasis? What would be an indication for this?

A

Clotrimazole 500 mg intravaginal pessary as a single dose
Oral treatments are contraindicated

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14
Q

What would be considered recurrent vaginal candidiasis?

A

BASHH define recurrent vaginal candidiasis as 4 or more episodes per year

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15
Q

What should be checked if a patient has recurrent vaginal candidiasis?

A

Compliance with previous treatment should be checked
High vaginal swab for microscopy and culture
Consider a blood glucose test to exclude diabetes

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16
Q

What would an induction-maintenance regime be for recurrent vaginal candidiasis?

A

Induction: oral fluconazole every 3 days for 3 doses
Maintenance: oral fluconazole weekly for 6 months

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17
Q

What does ART for HIV entail?

A

A combination of at least three drugs, typically two nucleoside reverse transcriptase inhibitors (NRTI) and either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI).

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18
Q

When should ART be commenced for patients with HIV?

A

Following the 2015 BHIVA guidelines it is now recommended that patients start ART as soon as they have been diagnosed with HIV, rather than waiting until a particular CD4 count, as was previously advocated.

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19
Q

Give some examples of entry inhibitors used in ART? How do they work?

A

Maraviroc
Enfuvirtide

Prevent HIV-1 from entering and infecting cells.

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20
Q

What is the mechanism of action of the entry inhibitor Maraviroc?

A

Binds to CCR5, preventing an interaction with gp41

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21
Q

What is the mechanism of action of the entry inhibitor Enfuvirtide?

A

Binds to gp41, also known as a ‘fusion inhibitor’

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22
Q

Give some examples of NRTIs used in ART?

A

‘vu’ in the middle or ‘vir’ at the end

Zidovudine (AZT)
Abacavir
Emtricitabine
Didanosine
Lamivudine
Stavudine
Zalcitabine
Tenofovir

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23
Q

What are the general side effects of NRTIs?

A

Peripheral neuropathy

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24
Q

What are the side effects of the NRTI tenofovir?

A

Renal impairment
Ostesoporosis

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25
What are the side effects of the NRTI zidovudine?
Anaemia Myopathy Black nails
26
What are the side effects of the NRTI didanosine?
Pancreatitis
27
What are some examples of NNRTIs used in ART?
'vir' in the middle Nevirapine Efavirenz
28
What are the side effects of the NNRTI nevirapine?
P450 enzyme interaction and rashes
29
What is the side effect of efavirenz?
Rashes
30
What are some examples of protease inhibitors used in ART?
All end in 'navir' Indinavir Nelfinavir Ritonavir Saquinavir
31
What are the side effects of protease inhibitors used in ART?
Diabetes Hyperlipidaemia Buffalo hump Central obesity P450 enzyme inhibition
32
What are the side effects of the protease inhibitor indinavir?
Renal stones Asymptomatic hyperbilirubinaemia
33
What are the side effects of the protease inhibitor ritonavir?
A potent inhibitor of the P450 system
34
What is the mechanism of action of integrase inhibitors for ART?
Block the action of integrase, a viral enzyme that inserts the viral genome into the DNA of the host cell
35
What are some examples of integrase inhibitors used in ART?
'tegra' in the middle Raltegravir Elvitegravir Dolutegravir
36
What is the investigation for HIV infection?
Combination tests (HIV p24 antigen and HIV antibody) If the combined test is positive it should be repeated to confirm the diagnosis
37
When should a HIV test be performed after possible exposure?
4 weeks and a repeat test at 12 weeks if negative.
38
What organism most commonly causes septic arthritis in young adults?
Neisseria gonorrhoeae
39
What would a positive non-treponemal test + positive treponemal test indicate for potential syphilis infection?
Consistent with active syphilis infection
40
What would a positive non-treponemal test + negative treponemal test indicate for potential syphilis infection?
Consistent with a false-positive syphilis result e.g. due to pregnancy or SLE
41
What would a negative non-treponemal test + positive treponemal test indicate for potential syphilis infection
Consistent with successfully treated syphilis
42
What is the first line management for syphilis?
Intramuscular benzathine penicillin is the first-line management
43
What is the second-line management for syphilis?
Doxycycline
44
What can sometimes be seen following treatment for syphilis? What is the management?
Jarisch-Herxheimer reaction No treatment is needed other than antipyretics if required
45
What is chancroid?
Chancroid is a tropical disease caused by Haemophilus ducreyi.
46
What are the features of chancroid?
Painful genital ulcers - sharply defined, ragged, undermined borders. Associated with unilateral, painful inguinal lymph node enlargement.
47
What is the causative organism of gonorrhoea?
Neisseria gonorrhoeae
48
What is the incubation period of gonorrhoea?
2-5 days
49
What type of bacterium is neisseria gonorrhoeae?
Gram-negative diplococcus
50
What are the classical features of gonorrhoeae in males?
Urethral discharge and dysuria
51
What are the classical features of gonorrhoea in females?
Cervicitis e.g. leading to vaginal discharge
52
What is the first line management for gonorrhoea infection?
IM ceftriaxone 1g
53
What is the first line management for gonorrhoea infection if there is a known resistance?
Oral ciprofloxacin 500mg
54
What is the management for gonorrhoea if IM injection is refused?
Oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose)
55
What are key features of disseminated gonococcal infection?
Tenosynovitis Migratory polyarthritis Dermatitis (lesions can be maculopapular or vesicular)
56
What is the causative organism of bacterial vaginosis?
Gardnerella vaginalis
57
What disease can gardnerella vaginalis cause?
Bacterial vaginosis
58
Describe the pathophysiology behind bacterial vaginosis?
An overgrowth of predominately anaerobic organisms leading to a consequent fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH.
59
What are the classical features of bacterial vaginosis?
Vaginal discharge: 'fishy', offensive Asymptomatic in 50% of patients
60
What criteria is used for the diagnosis of bacterial vaginosis?
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)
61
What is the management of bacterial vaginosis in an asymptomatic patient?
If the woman is asymptomatic, treatment is not usually required Exceptions include if the patient is undergoing termination of pregnancy
62
What is the first line management of bacterial vaginosis in a symptomatic patient?
Oral metronidazole for 5-7 days Single oral dose of 2g may be used if adherence is an issue
63
What are the alternative management options for bacterial vaginosis?
Topical metronidazole or topical clindamycin
64
What is the causative organism of trichomoniasis?
Trichomonas vaginalis
65
What type of organism is trichomonas vaginalis?
A highly motile, flagellated protozoan parasite
66
What are the features of trichomoniasis in females?
Vaginal discharge: offensive, yellow/green, frothy Vulvovaginitis Strawberry cervix pH > 4.5
67
What are the features of trichomoniasis in males?
Usually asymptomatic but may cause urethritis
68
What is the investigation of choice for trichomoniasis?
Microscopy of a wet mount shows motile trophozoites
69
What is the first line management for trichomoniasis?
Oral metronidazole for 5-7 days 2g metronidazole single dose can also be used.
70
What organism is lymphogranuloma venereum caused by?
Chlamydia trachomatis serovars L1, L2 and L3
71
What disease does chlamydia trachomatis serovars L1, L2 and L3 cause?
Lymphogranuloma venereum
72
What are the three stages of lymphogranuloma venereum infection?
Stage 1 - Small painless pustule which later forms an ulcer Stage 2 - Painful inguinal lymphadenopathy (may occasionally form fistulating buboes) Stage 3 - Proctocolitis
73
What is the management for lymphogranuloma venereum?
Doxycycline.
74
What organism causes chlamydia?
Chlamydia trachomatis serovars D through K
75
Chlamydia trachomatis serovars D through K causes which STI?
Chlamydia
76
What is the incubation period of chlamydia?
The incubation period is around 7-21 days
77
What percentage of men and women who have chlamydia are asymptomatic?
70% of women and 50% of men
78
What are the features of chlamydia in women?
Cervicitis (discharge, bleeding) Dysuria
79
What are the features of chlamydia in men?
Urethral discharge Dysuria
80
What is the investigation of choice for chlamydia in men and women?
Nuclear acid amplification tests (NAATs) are now the investigation of choice. Women: vulvovaginal swab is first-line Men: urine test is first-line
81
What type of organism is chlamydia?
Gram-negative, anaerobic bacterium
82
What is the first line management for chlamydia?
Doxycycline (7 day course)
83
What is the alternative management for chlamydia in patients who are pregnant?
Azithromycin, erythromycin or amoxicillin may be used Azithromycin (1g od for one day, then 500mg od for two days)
84
What is the most common cause of oesophagitis in patients with HIV?
Oesophageal candidiasis
85
What are the features of HIV seroconversion?
Sore throat Lymphadenopathy Malaise, myalgia, arthralgia Diarrhoea Maculopapular rash Mouth ulcers
86
What are the classic features of genital herpes?
Painful genital ulceration Tender inguinal lymphadenopathy Urinary retention may occur
87
What is the difference in features between primary and recurrent episodes of genital herpes?
The primary infection is often more severe than recurrent episodes - systemic features such as headache, fever and malaise are more common in primary episodes
88
What is the investigation of choice for suspected genital herpes?
Nucleic acid amplification test
89
What is the pharmacological management of genital herpes?
Oral aciclovir
90
What is the general management for genital herpes?
Saline bathing Analgesia Topical anaesthetic agents e.g. lidocaine
91
What is the advise surrounding genital herpes and pregnancy?
Elective caesarean section at term is advised if a primary attack of herpes occurs during pregnancy at greater than 28 weeks gestation Women with recurrent herpes who are pregnant should be treated with suppressive therapy and be advised that the risk of transmission to their baby is low
92
What is the most common opportunistic infection in AIDS?
Pneumocystis jiroveci is an unicellular eukaryote
93
What should happen if a patient with HIV has a CD4 count of < 200/mm³?
All patients with a CD4 count < 200/mm³ should receive PCP prophylaxis
94
What is the management of pneumocystis jiroveci?
Co-trimoxazole (trimethoprim and sulfamethoxazole) IV pentamidine in severe cases
95
What HPV strains cause genital warts?
Types 6 and 11
96
What is the first line management for genital warts?
Topical podophyllum - when multiple and non-keratinised Cryotherapy - when solitary and keratinised
97
What is the second line management for genital warts?
Imiquimod which is a topical cream
98
What should happen if a patient with HIV has a CD4 count of < 50/mm³?
All patients with a CD4 count < 50/mm³ should receive mycobacterium avium complex prophylaxis
99
What is the pharmacological prophylaxis management for mycobacterium avian complex?
Azithromycin
100
What are the causes of infertility?
Male factor 30% Unexplained 20% Ovulation failure 20% Tubal damage 15% Other causes 15%
101
What is the investigation for infertility in males?
Semen analysis
102
What is the investigation for infertility in females?
Serum progesterone 7 days prior to expected next period. Day 21 for 28 day period
103
How would you interpret a serum progesterone in females for infertility?
< 16 nmol/l - Repeat, if consistently low refer to specialist 16 - 30 nmol/l - Repeat > 30 nmol/l - Confirms ovulation
104
What are the key counselling points for infertility?
Folic acid Aim for BMI 20-25 Advise regular sexual intercourse every 2 to 3 days Smoking/drinking advice
105
Define premature ejactulation?
Premature ejaculation is a common male sexual disorder characterised by brief ejaculatory latency, loss of control, and psychological distress
106
What are the non-drug management strategies for premature ejaculation?
Psychosexual counselling Education Behavioural treatments
107
What is the pharmacological management for premature ejaculation?
SSRI - Dapoxetine PRN Topical anaesthetics
108
Define molluscum contagiosum?
A common skin infection caused by molluscum contagiosum virus (MCV), a member of the Poxviridae family.
109
How is molluscum contagiosum spread?
Transmission occurs directly by close personal contact, or indirectly via fomites (contaminated surfaces) such as shared towels and flannels
110
What are the classic features of molluscum contagiosum?
Pinkish or pearly white papules with a central umbilication 5mm in diameter Children - typically trunk and flexures Adults - Genitalia, pubis, thighs, and lower abdomen
111
What is the management for molluscum contagiosum?
Treatment is not usually recommended Cryotherapy can be used or simple trauma
112
Define balanitis?
Inflammation of the glans penis and sometimes extends to the underside of the foreskin which is known as balanoposthitis
113
What is the investigation for balanitis?
Clinical diagnosis
114
What is balanitis xerotica obliterans?
Lichen sclerosus
115
What is the management for bacterial balanitis?
Oral flucloxacillin Clarithromycin if penicillin allergic
116
What organism most often causes bacterial balanitis?
Staphylococcus spp. or Group B Streptococcus spp
117
What is the management for anaerobic balanitis?
Topical or oral metronidazole
118
What is the management for dermatitis and circinate balanitis?
Mild potency topical corticosteroids (e.g. hydrocortisone)
119
What is the management for lichen sclerosus and plasma cell balanitis of Zoon?
High potency topical steroids (e.g. clobetasol) Circumcision can also help with lichen sclerosus

Phase 3a (8 decks)

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