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Phase 3a > Sexual Health > Flashcards

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

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
Q

What are the side effects of the NRTI zidovudine?

A

Anaemia
Myopathy
Black nails

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26
Q

What are the side effects of the NRTI didanosine?

A

Pancreatitis

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27
Q

What are some examples of NNRTIs used in ART?

A

Nevirapine
Efavirenz

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28
Q

What are the side effects of the NNRTI nevirapine?

A

P450 enzyme interaction and rashes

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29
Q

What is the side effect of efavirenz?

A

Rashes

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30
Q

What are some examples of protease inhibitors used in ART?

A

Indinavir
Nelfinavir
Ritonavir
Saquinavir

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31
Q

What are the side effects of protease inhibitors used in ART?

A

Diabetes
Hyperlipidaemia
Buffalo hump
Central obesity
P450 enzyme inhibition

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32
Q

What are the side effects of the protease inhibitor indinavir?

A

Renal stones
Asymptomatic hyperbilirubinaemia

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33
Q

What are the side effects of the protease inhibitor ritonavir?

A

A potent inhibitor of the P450 system

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34
Q

What is the mechanism of action of integrase inhibitors for ART?

A

Block the action of integrase, a viral enzyme that inserts the viral genome into the DNA of the host cell

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35
Q

What are some examples of integrase inhibitors used in ART?

A

Raltegravir
Elvitegravir
Dolutegravir

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36
Q

What is the investigation for HIV infection?

A

Combination tests (HIV p24 antigen and HIV antibody)
If the combined test is positive it should be repeated to confirm the diagnosis

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37
Q

When should a HIV test be performed after possible exposure?

A

4 weeks and a repeat test at 12 weeks if negative.

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38
Q

What organism most commonly causes septic arthritis in young adults?

A

Neisseria gonorrhoeae

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39
Q

What would a positive non-treponemal test + positive treponemal test indicate for potential syphilis infection?

A

Consistent with active syphilis infection

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40
Q

What would a positive non-treponemal test + negative treponemal test indicate for potential syphilis infection?

A

Consistent with a false-positive syphilis result e.g. due to pregnancy or SLE

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41
Q

What would a negative non-treponemal test + positive treponemal test indicate for potential syphilis infection

A

Consistent with successfully treated syphilis

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42
Q

What is the first line management for syphilis?

A

Intramuscular benzathine penicillin is the first-line management

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43
Q

What is the second-line management for syphilis?

A

Doxycycline

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44
Q

What can sometimes be seen following treatment for syphilis? What is the management?

A

Jarisch-Herxheimer reaction
No treatment is needed other than antipyretics if required

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45
Q

What is chancroid?

A

Chancroid is a tropical disease caused by Haemophilus ducreyi.

46
Q

What are the features of chancroid?

A

Painful genital ulcers - sharply defined, ragged, undermined borders.
Associated with unilateral, painful inguinal lymph node enlargement.

47
Q

What is the causative organism of gonorrhoea?

A

Neisseria gonorrhoeae

48
Q

What is the incubation period of gonorrhoea?

A

2-5 days

49
Q

What type of bacterium is neisseria gonorrhoeae?

A

Gram-negative diplococcus

50
Q

What are the classical features of gonorrhoeae in males?

A

Urethral discharge and dysuria

51
Q

What are the classical features of gonorrhoea in females?

A

Cervicitis e.g. leading to vaginal discharge

52
Q

What is the first line management for gonorrhoea infection?

A

IM ceftriaxone 1g

53
Q

What is the first line management for gonorrhoea infection if there is a known resistance?

A

Oral ciprofloxacin 500mg

54
Q

What is the management for gonorrhoea if IM injection is refused?

A

Oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose)

55
Q

What are key features of disseminated gonococcal infection?

A

Tenosynovitis
Migratory polyarthritis
Dermatitis (lesions can be maculopapular or vesicular)

56
Q

What is the causative organism of bacterial vaginosis?

A

Gardnerella vaginalis

57
Q

What disease can gardnerella vaginalis cause?

A

Bacterial vaginosis

58
Q

Describe the pathophysiology behind bacterial vaginosis?

A

An overgrowth of predominately anaerobic organisms leading to a consequent fall in lactic acid producing aerobic lactobacilli resulting in a raised vaginal pH.

59
Q

What are the classical features of bacterial vaginosis?

A

Vaginal discharge: ‘fishy’, offensive
Asymptomatic in 50% of patients

60
Q

What criteria is used for the diagnosis of 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)

61
Q

What is the management of bacterial vaginosis in an asymptomatic patient?

A

If the woman is asymptomatic, treatment is not usually required
Exceptions include if the patient is undergoing termination of pregnancy

62
Q

What is the first line management of bacterial vaginosis in a symptomatic patient?

A

Oral metronidazole for 5-7 days
Single oral dose of 2g may be used if adherence is an issue

63
Q

What are the alternative management options for bacterial vaginosis?

A

Topical metronidazole or topical clindamycin

64
Q

What is the causative organism of trichomoniasis?

A

Trichomonas vaginalis

65
Q

What type of organism is trichomonas vaginalis?

A

A highly motile, flagellated protozoan parasite

66
Q

What are the features of trichomoniasis in females?

A

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

67
Q

What are the features of trichomoniasis in males?

A

Usually asymptomatic but may cause urethritis

68
Q

What is the investigation of choice for trichomoniasis?

A

Microscopy of a wet mount shows motile trophozoites

69
Q

What is the first line management for trichomoniasis?

A

Oral metronidazole for 5-7 days
2g metronidazole single dose can also be used.

70
Q

What organism is lymphogranuloma venereum caused by?

A

Chlamydia trachomatis serovars L1, L2 and L3

71
Q

What disease does chlamydia trachomatis serovars L1, L2 and L3 cause?

A

Lymphogranuloma venereum

72
Q

What are the three stages of lymphogranuloma venereum infection?

A

Stage 1 - Small painless pustule which later forms an ulcer
Stage 2 - Painful inguinal lymphadenopathy (may occasionally form fistulating buboes)
Stage 3 - Proctocolitis

73
Q

What is the management for lymphogranuloma venereum?

A

Doxycycline.

74
Q

What organism causes chlamydia?

A

Chlamydia trachomatis serovars D through K

75
Q

Chlamydia trachomatis serovars D through K causes which STI?

A

Chlamydia

76
Q

What is the incubation period of chlamydia?

A

The incubation period is around 7-21 days

77
Q

What percentage of men and women who have chlamydia are asymptomatic?

A

70% of women and 50% of men

78
Q

What are the features of chlamydia in women?

A

Cervicitis (discharge, bleeding)
Dysuria

79
Q

What are the features of chlamydia in men?

A

Urethral discharge
Dysuria

80
Q

What is the investigation of choice for chlamydia in men and women?

A

Nuclear acid amplification tests (NAATs) are now the investigation of choice.
Women: vulvovaginal swab is first-line
Men: urine test is first-line

81
Q

What type of organism is chlamydia?

A

Gram-negative, anaerobic bacterium

82
Q

What is the first line management for chlamydia?

A

Doxycycline (7 day course)

83
Q

What is the alternative management for chlamydia in patients who are pregnant?

A

Azithromycin, erythromycin or amoxicillin may be used
Azithromycin (1g od for one day, then 500mg od for two days)

84
Q

What is the most common cause of oesophagitis in patients with HIV?

A

Oesophageal candidiasis

85
Q

What are the features of HIV seroconversion?

A

Sore throat
Lymphadenopathy
Malaise, myalgia, arthralgia
Diarrhoea
Maculopapular rash
Mouth ulcers

86
Q

What are the classic features of genital herpes?

A

Painful genital ulceration
Tender inguinal lymphadenopathy
Urinary retention may occur

87
Q

What is the difference in features between primary and recurrent episodes of genital herpes?

A

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
Q

What is the investigation of choice for suspected genital herpes?

A

Nucleic acid amplification test

89
Q

What is the pharmacological management of genital herpes?

A

Oral aciclovir

90
Q

What is the general management for genital herpes?

A

Saline bathing
Analgesia
Topical anaesthetic agents e.g. lidocaine

91
Q

What is the advise surrounding genital herpes and pregnancy?

A

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
Q

What is the most common opportunistic infection in AIDS?

A

Pneumocystis jiroveci is an unicellular eukaryote

93
Q

What should happen if a patient with HIV has a CD4 count of < 200/mm³?

A

All patients with a CD4 count < 200/mm³ should receive PCP prophylaxis

94
Q

What is the management of pneumocystis jiroveci?

A

Co-trimoxazole (trimethoprim and sulfamethoxazole)
IV pentamidine in severe cases

95
Q

What HPV strains cause genital warts?

A

Types 6 and 11

96
Q

What is the first line management for genital warts?

A

Topical podophyllum - when multiple and non-keratinised
Cryotherapy - when solitary and keratinised

97
Q

What is the second line management for genital warts?

A

Imiquimod which is a topical cream

98
Q

What should happen if a patient with HIV has a CD4 count of < 50/mm³?

A

All patients with a CD4 count < 50/mm³ should receive mycobacterium avium complex prophylaxis

99
Q

What is the pharmacological prophylaxis management for mycobacterium avian complex?

A

Azithromycin

100
Q

What are the causes of infertility?

A

Male factor 30%
Unexplained 20%
Ovulation failure 20%
Tubal damage 15%
Other causes 15%

101
Q

What is the investigation for infertility in males?

A

Semen analysis

102
Q

What is the investigation for infertility in females?

A

Serum progesterone 7 days prior to expected next period.

Day 21 for 28 day period

103
Q

How would you interpret a serum progesterone in females for infertility?

A

< 16 nmol/l - Repeat, if consistently low refer to specialist
16 - 30 nmol/l - Repeat
> 30 nmol/l - Confirms ovulation

104
Q

What are the key counselling points for infertility?

A

Folic acid
Aim for BMI 20-25
Advise regular sexual intercourse every 2 to 3 days
Smoking/drinking advice

105
Q

Define premature ejactulation?

A

Premature ejaculation is a common male sexual disorder characterised by brief ejaculatory latency, loss of control, and psychological distress

106
Q

What are the non-drug management strategies for premature ejaculation?

A

Psychosexual counselling
Education
Behavioural treatments

107
Q

What is the pharmacological management for premature ejaculation?

A

SSRI - Dapoxetine PRN
Topical anaesthetics

108
Q

Define molluscum contagiosum?

A

A common skin infection caused by molluscum contagiosum virus (MCV), a member of the Poxviridae family.

109
Q

How is molluscum contagiosum spread?

A

Transmission occurs directly by close personal contact, or indirectly via fomites (contaminated surfaces) such as shared towels and flannels

110
Q

What are the classic features of molluscum contagiosum?

A

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
Q

What is the management for molluscum contagiosum?

A

Treatment is not usually recommended
Cryotherapy can be used or simple trauma

Phase 3a (7 decks)

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