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3a mehdi > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

What is subfertility?

A

Diminished ability for a couple to conceive a child

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2
Q

What is the difference between primary and secondary infertility?

A

Primary) Never had children
Secondary) Struggling for subsequent children

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3
Q

How can a couple increase the chance of conception?

A
  • Regular sex (3-4 times/week)
  • No use of contraception
  • Trying for 1+ years
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4
Q

What are the risk factors for subfertility?

A
  • Increased Age
  • Obesity
  • Smoking and Alcohol
  • Tight Underwear (Men)
  • Anabolic Steroids
  • Illicit Drug use
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5
Q

What are the phsyiological causes of infertility?

A

Genetics (Turner’s and Kleinfelter’s)
Ovulation/Endocrine Disorder
Tubal Abnormalities
Uterine Abnormalities
Cervical Abnormalities
Testicular Disorders
Ejaculatory Disorders

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6
Q

What are the genetic causes of infertiltiy?

A

Turner’s Syndrome (XO)
Kleinfelter’s Syndrome (XXY)

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7
Q

What are the Ovulation/ Endocrine causes of Infertility?

A

PCOS
Sheehan’s (Post Partrum Pituitary Necrosis)
Premature Ovarian Fail
Pituitary Adenoma/ Cushing’s
Hyperprolactinaemia

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8
Q

What Tubal Abnormalities can cause infertility?

A

Congenital
Pelvic Inflammatory Adhesions (Chlamydia/ Gonorrhea)

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9
Q

What are the Uterine abnormalities affecting infertility?

A

Bicornate Uterus
Fibroids
Asherman’s (Adhesions)
Endometriosis

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10
Q

What are the Cervical causes of Infertility?

A

Post Biopsy Damage
Post LLETZ Procedure damage

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11
Q

What testicular disorders affect Infertility?

A

Cryptorchidism
Varcicole
Testicular Cancer
Congenital Defects

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12
Q

What Ejaculatory Disorders affect Infertility?

A

Obstruction
Retrograde Ejaculation
Premature Ejaculation

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13
Q

How would you investigate infertility in women?

A

Bedside
History
Speculum and Bimanual
STI Screen

Bloods
Serum Progesterone (7 Days before end of cycle)
Prolactin
LH and FSH and TFT
Anti Mullerian Hormone

Imaging
TV USS
Hystersosalpingography (Tubal Patency)
Laproscopy w/ Dye (Tubal Patency w/ Co-morbidities)

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14
Q

How would you investigate male infertiltiy?

A

Bedside
History w/ Past Pregnancies
Testicular Exam
Semen Analysis

Bloods
Serum Testosterone
LH/FSH and TFT

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15
Q

When and why is serum progesterone tested in infertiltiy?

A
  • 7 Days before end of cycle
  • A rise suggests corpus luteum has formed and ovulation is initiated
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16
Q

What does a semen analysis evaluate?

A

Sperm Count
Motility
Morphology

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17
Q

What should happen if a semen analysis is abnormal?

A

Repeat in 3 months

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18
Q

How is Infertility managed?

A

Conservative
- Weight loss
- Smoking cessation
- Alcohol Reduction
- Stress reduction
- Manage Underlying Causes

Medical
- 1st) Clomiphene
- LH/ FSH Injections
- GnRH and Dopamine Agonists

Surgical
- IVF w/ BhCG
- Intracytoplasmic sperm injection

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19
Q

What is Clomiphene and its side effects?

A

Oestrogen Modulator
- Inhibit HPG = Negative Feedback
- Increases GnRH, FSH/LH and Ovulation

Side Effects
- Flushing
- Mittelzhmer’s (Ovulatory Pain)
- Blurred Vision

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20
Q

What are the complications of IVF?

A

Twin Pregnancy
Ectopic Pregnancy
Ovarian Hyperstimulation Syndrome

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21
Q

What is Ovarian Hyperstimulation Syndrome?

A

Raised BhCG = Raised VGEF
Causes Ascites, Oliguria, Diarrhoea and Vomiting due to >10cm Ovaries

Management
- ABCDE
- IV Colloid w/ LMWH and Urine Output

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22
Q

What are the Risk factors for STI?

A

<25 years
Unprotected Sex
Sexually Active
IV Drug Use
Partner w/ STI
Multiple Partners
Partner w/ Multiple Partners
Immunosuppresion
Low Socioeconomic Status
MSM/Anal Sex

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23
Q

How do you Investigate STI?

A

Male
- First Catch Urine MC+S

Female
- Triple Swab (High Vag NAAT, Endocervical NAAT and Charcoal)

Sexual Health Screen
Chlamydia? 6 month Contact Trace
Gonorrhea? 2 month Contract Trace

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24
Q

What is Chlamydia?

A

Negative Cocci
Obligate Intracellular Bacterium

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25
Q

What is the epidemiology of Chalmydia?

A

Most Common STI in UK
15-24 Prevalence

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26
Q

Presentation of Chlamydia

A

Asymptomatic
Men? Urethral Discharge, Proctitis and Dysuria
Women? Vaginal discharge, Cervicitis, Dysuria and Intermenstrual Bleeding
MSM? Anal Discharge/ Anorectal Discomfort
Neonate? Pneumonia/ Conjunctivitis

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27
Q

Why may a neonate present with Pneumonia/ Conjunctivitis from Chlamydia?

A

Exposed to bacterium during delivery form infected mother

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28
Q

How do you investigate Chlamydia infection?

A

Men
- Urine/ Urethral Swab w/ NAAT

Women
- Vulvovaginal/Endocervical Swab w/ NAAT

MSM/Anal
- Anal swab w/ NAAT

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29
Q

How do you manage Chlamydia infection?

A

Twice daily Oral Doxycylcine (7 Days)

Pregnant? 1g Azithromycin

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30
Q

When is Doxycycline contraindicated?

A

Breast Feeding - Causes Fetal Teeth Discolouration

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31
Q

What is Gonorrhea

A

Gram Negative Diplococcus

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32
Q

What is the presentation of Gonorrhea?

A

Men
- Discharge
- Dysuria
- Tender Inguinal Nodes

Women
- Discharge (Cervical OS/ Bartholin’s or Skene’s Gland)
- Dysuria
- Abnormal Bleeding

Extragenital
- Pharyngitis
- Conjunctivitis
- Rectal Pain/Discharge
- Septic Arthritis
- Disseminated Infection

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33
Q

What are the extragenital manifestations of Gonorrhea?

A
  • Pharyngitis
  • Conjunctivitis
  • Rectal Pain/Discharge
  • Septic Arthritis
  • Disseminated Infection
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34
Q

How do you investigate Gonorrhea?

A

Men
First pass urine/ Penile Swab w/ MCUS and NAAT

Women
Vulvovaginal/ Endocervical Swab w/ MCUS and NAAT

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35
Q

What might you see on microscopy of Gonorrhea?

A

Gram Negative Diplococci
Polymorphonuclear Leukocytes

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36
Q

How do you manage Gonorrhea Infection?

A

All patients = Referral, Partner notification and Screening
Unwell = Admission

1st = IM Ceftriaxone
Other = IM Gentamycin/ Oral Cefixime w/ Oral Azithromycin

After Treatment = Test of Cure

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37
Q

What are the complications of Gonorrhea?

A

Infertility
Men - Epididymitis
Women - Pelvic Inflammatory Disease
Reactive Arthritis
Disseminated Infection
Skin and Joint (Rash/Pain)
HIV
Opthalmia Neonatorum
- Requires Emergency Eye care <48hrs

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38
Q

What is Trichomonas Vaginalis?

A

Flagellated Protazoan Parasite
Most common Non Viral STI

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39
Q

Presentations of Trichomonas Vaginalis

A

Women
- Profuse, Frothy Yellow Discharge
- Vulval Irritation
- Dyspaerunia
- “Strawberry Cervix”

Men
- Non Gonococcal urethritis

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40
Q

Investigating Trichomonas Vaginalis

A

Triple Swab (Wet Mount) and
Direct Microscopy w/ Culture

Vaginal pH can be raised

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41
Q

Management for Trichomonas Vaginalis

A

1) Oral Metronidazole 400mg BD 7 days
2) Abstain from sex >7 days and Alcohol
3) Contact Tracing and Screening

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42
Q

What is genital herpes?

A

Painful sores and ulcers on the genitals caused by HSV 1/2

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43
Q

Describe the symptom disribution between HSV-1 and HSV-2

A

HSV-1 = Traditionally oral but now the most common genital
HSV-2 = Recurrent anogenital symptoms

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44
Q

Presentations of Genital Herpes

A

Asymptomatic
Multiple painful ulcers
Dysuria and Discharge
Crusting/ Lesion Healing
Fever, Malaise, Headcahe and Urine Retention

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45
Q

Investigating Genital Herpes

A

1) History and Exam
2) Ulcer Base Swab w/ NAAT

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46
Q

Managing Genital herpes

A

Oral Antivirals <5 days for 5 days
- Aciclovir 400mg TD
- Aciclovir 200mg PD
- Valaciclovir 500mg BD
- Famciclovir 250mg TD

Other
- Analgesia
- Topical Lidocaine

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47
Q

How is Genital Herpes Manged in Pregnancy

A

1) GUM Referral w/ Aciclovir 400mg TD

Neonatal Herpes risk is low even w/ lesions at delivery

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48
Q

What are some differentials for genital ulcers?

A

Genital Herpes
- Painful w/ Dysuria and Discharge

Syphillis
- Painless w/ rash and systemic signs

Chancroid
- Painful w/ Inguinal Lymphadenopathy

Lymphogranuloma Venereum
- Painless w/ Painful Inguinal Lymphadenopathy

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49
Q

What can cause Painless genital/anogenital warts?

A

Low risk HPV 6/11

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50
Q

Presentations of Genital warts

A

Painless Lumps
Keratinised or Non Keratinised

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51
Q

Investigating Genital Warts

A

Clinical and History
Unsure? Biopsy

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52
Q

Managing Genital Warts

A

Podophyllotoxin
- Plant based antiviral destorys wart tissue

Imiquimod
- Immune response modifier (Enhances immune system)

Cryotherapy
- Liquid Nitrogen freezing

Tricloroacetic Acid
- Chemical Burning

53
Q

What is Syphillis?

A

STI caused by Spirochet bacterium Treponema Pallidum

54
Q

How is Syphillis transmission different?

A

It is transmitted by direct contact with syphillis sores during sex or during baby delivery

55
Q

Describe the stages of Syphillis

A

Primary
Single painless lesion (Chancre) It is self limiiting <8 weeks and can present w/ Painless Lymphadenopathy

Secondary
Symmetrical maculopapaular rash <10 weeks of Primary. Can present with mucosal ulcers, lymphadenopathy and general systemic symptoms

Tertiary
Gummatous disease, CV Complications and neurological complications <40 years after Primary

Congenital
Transmission of Treponema Pallidum from infected mother during pregnancy

56
Q

What are the presentations of Syphillis?

A

Primary
- Single Painless Chancre(Lesion)
- Painless regional lymphadenopathy
- Spontatenous healing <8 weeks

Secondary
- Symmetrical Maculopapular rash
- Mucosal Ulcers and Lymohadenopathy
- Glomerulonephritis and Systemic Signs
- Develops <10 weeks of Primary

Tertiary
- Gummatous Disease
- Cardiovascular (Aortitis/Arteritis)
- Neurovascular (Argyll-Robinson, Dementia, Meningovacular Syphillis)
- Develops <40 years after Primary

Congenital
- Rash (Palms, Soles, Mouth and Genitals)
- Hepatosplenomegaly and Anaemia
- Saber Shins and Neurological Sequalae

57
Q

Presentations of Primary Syphillis

A
  • Single Painless Chancre(Lesion)
  • Painless regional lymphadenopathy
  • Spontatenous healing <8 weeks
58
Q

Presentations of Secondary Syphillis

A
  • Symmetrical Maculopapular rash
  • Mucosal Ulcers and Lymohadenopathy
  • Glomerulonephritis and Systemic Signs
  • Develops <10 weeks of Primary
59
Q

Presentations of Tetiary Syphillis

A
  • Gummatous Disease
  • Cardiovascular (Aortitis/Arteritis)
  • Neurovascular (Argyll-Robinson, Dementia, Meningovacular Syphillis)
  • Develops <40 years after Primary
60
Q

Presentations of Congenital Syphillis

A
  • Rash (Palms, Soles, Mouth and Genitals)
  • Hepatosplenomegaly and Anaemia
  • Saber Shins and Neurological Sequalae
61
Q

Investigating Syphillis

A

Primary
Dark Field MIcroscopy
- Lesion sample (Genital)

PCR Testing
- Oral Lesion sample

Secondary/ Tertiary
Tropenemal Test
- Enzyme Immunoassays
- Chemiluminescent Assay

Other
- Virology and STI Screen
- CSF Examination (Tertiary)

Monitoring Treatment
Non Tropenemal test
- Veneral Diseas Research Lab

62
Q

How would you monitor treatment efficacy in Syphillis?

A

Venereal Disease Research Lab

63
Q

Why may False Negatives occur in Syphillis?

A
  • Early Presentation
  • HIV infection
64
Q

Why may False positives occur in Syphillis?

A

With Non Tropenemal Test
- Viral Infection
- Malignancy
- Autoimmunity
- Older Age
- Pregnancy

65
Q

Managing Syphillis

A

GUM referral and Partner screening

1st) One dose IM Penicillin G (Benzathine benzylpenicillin)
Late Syphillis) <3 weeks IM Penicilin G
Neurosyphillis) IV Penicillin G

Jarisch Herxheimer Reaction
- Acute fever <24hrs after treatment
- Rx w/ Antipyretics

66
Q

What is Bacterial Vaginosis?

A

Imbalance of the vaginal microbiome due to anaerobic bacterial overgrowth and loss of lactobacilli

67
Q

Causes of Bacterial Vaginosis?

A

Overgrowth of Gardenerella Vaginalis
Multiple Sexual Partners
Douching (Direct Cleaning)
Lack of Conistent Condom use
Hormonal Changes

68
Q

Presentations of Bacterial Vaginosis

A

Vaginal Discharge (Grey/White)
Fishy Smelling Discharge
Vaginal Irritation

69
Q

Investigating Bacterial Vaginosis

A

Amsel Criteria (3+ features)
- Vaginal pH >4.5
- Grey Milky Discharge
- Positive Whiff test
- Clue Cells on Wet mount

70
Q

What is a positive Whiff test?

A

Adding 10% Potassium Hydroxide = Fishy Smell

71
Q

Managing Bacterial Vaginosis

A

1st ) Oral/ Vaginal Metronidazole/ Clindamycin

Prevention
- Avoid Smoking
- Avoid Vaginal Douching
- Avoid Bubble baths

72
Q

Pregnancy and Vaginosis

A

Pregnancy increases risk of BV
BV Increases risk of premature babies and low birth weight
Rx = Metronidazole and Antenatal Care

73
Q

What is Vulvovaginal Candidiasis?

A

“Yeast Infection” caused by Candida Albicans overgrowth

74
Q

Risk Factors for Vaginal Candidiasis

A

Pregnancy
Antibiotics
Immunosuppresion

75
Q

Presentations of Candidiasis

A

Women
- Itching and Burning
- White Lumpy Discharge
- Sour Milk Odour
- Dysuria and Dyspaerunia

Men
- Soreness, Pruritis and Redness

76
Q

Investigating Candidiasis

A

1) Clinical Exam
Women
- Redness, Fissures, Thick White Discharge

Men
- Dry, Dull, Red glazed plaques and papules

2) High Vaginal Swab for MCS
M = Blastophores, Pseudohypae and Neutrophils

77
Q

Managing Candidiasis

A

1s) Single Dose “Azole”
- Oral Fluconazole/Itraconazole
- Vaginal /Topical Clotrimazole

Recurrent?
Induction = PO Fluconazole 150 every 3 days
Maintenanance = PO Fluconazole 150mg weekly

78
Q

Considerations for treatment of Candidiasis

A

Avoid Oral
- Pregnancy/ Breastfeeding

Avoid IV/Topical
- Integrity of Condom
- Integrity of Diaphragms

79
Q

What is Pelvic Inflammatory Disease?

A

Infection spreads from the vagina to the cervix, and subsequently to the upper genital tract

80
Q

Causes of Pelvic infallamtory disease

A

Sexual Contact
Non Sexual
Gonorrhea and chlamydia

81
Q

Presentations of Pelvic Inflammatory Disease

A
  • Bilateral Abdominal Pain
  • Vaginal Discharge
  • Post coital bleeding
  • Adnexal/ Cervical Motion Tenderness
  • Fever
  • Fitz-Hugh-Curtis Syndrome
82
Q

What is Fitz Hugh Curtis Syndrome?

A

Adhesions form between anteriot liver capsule and anterior abdominal wall
Can form Perihepatic Abscess
Px = RUQ pain w/ PID Px
Dx = Abdominal USS then Laporoscopy
Rx = Antibiotics and Laparosocpic Adhesion Lysis

83
Q

How is Pelvic Inflammatory Disease Investigated?

A

Bedside
Bimanual - Cervical Motion tenderness
Pregnancy Test
High Vag Swab (STI or urinary NAAT)

Bloods
FBC and CRP

Imaging
Transvaginal USS

84
Q

Mangaing Pelvic Inflammatory Disease

A

1st) IM Ceftriaxone + PO Doxycycline + PO Metronidazole
Severe? All are IV
Avoid Unprotected sex

85
Q

What is Lymphogranuloma Venereum

A

Lymphogranuloma venereum is an STI caused by the L1, L2, or L3 serovars of Chlamydia trachomatis

86
Q

Main Risk Factor of Lymphogranuloma venereum

A

MSM

87
Q

Presentations of Lymphogranuloma venereum

A

Painless Genital Ulcer
- 3-12 Days after infection

Inguinal Lumphadenopathy
Proctitis (MSM)
Systemic Symptoms

88
Q

Investigating Lymphogranuloma venereum

A

PCR from Swab
- Especially for Chlamydia

89
Q

Managing Lymphogranuloma venereum

A

Oral Doxycycline (100mg BD 21 Days)
Oral Tetracycline (2g OD 21 days)
Oral Erithromycin (500mg QD 21 Days)

90
Q

What is Balanitis?

A

Inflammation of the Glans Penis by Candida or Lichen Schlerosus

91
Q

Presentation of Balanitis

A

Candida
- White Itchy lesions

Lichen Schlerosus
- White shiny plaques
- Koebener Phenomenon
- BXO

Balanitis Xerotic Obliterans
- White Plaque @ urethral meatus +/- Phimosis

92
Q

Managing Balanitis

A

Candida?
Topical Clotrimazole

BXO/Lichen?
High Potency Steroid
- Clobetasol Propionate

93
Q

What is Chancroid?

A

Sexually transmitted infection of the genital skin caused by the gram-negative bacillus Haemophilus ducreyi

94
Q

Aetiology of Chancroid

A

Haemophilius Ducreyi
Tropical Travel
Poor Hygiene/ living Situation

95
Q

Presentation of Chancroid

A

Painful Genital Lesion +/- bleeding
Painful Lymphadenopathy (Bubo)
Symptom onset <10 days post contact

96
Q

Investigating Chancroid

A

1st) Clincial Exam
Culture/PCR) Haemophillius Ducreyi

97
Q

Managing Chancroid

A

Antibiotics and Analgesia
- Ceftriaxone
- Azithromycin
- Ciprofloxacin

Buboes?
Incision and drainage

98
Q

What is hypoactive sexual desire disorder?

A

6+ months of…
- Low libido
- Low sex cue response
- Low Initiation of sex

99
Q

What are some risk factors of HSDD

A

Mood (Depression/ Anxiety)
Endocrine (Diabetes)
Meds (Opioids/SSRI)
Relationship Problems
Abuse and Trauma

100
Q

What are two sex stimulants

A

Dopamine Agonists
Melanocortin

101
Q

What are two sex inhibitants

A

5-HT
Opiods

102
Q

Investigating HSDD

A

Bloods and History

103
Q

Managing HSDD

A

Flibanserin (Rebalance Neurotransmitters)
Bremelanotide (Sexual Desire)

Others
- Sex Therapy
- Stress Management
- Kegel Exercises

104
Q

What is Anorgasmia?

A

Falure to orgasm depsite adequate stimulation for 6+ months

105
Q

Causes of Anorgasmia

A

Mood
Diabetes
Postmenopause
Post Hysterectomy
Stress
Dyspaerunia
SSRI
Abuse

106
Q

Investigating Anorgasmia

A

Bloods

107
Q

Managing Anorgasmia

A

Clitoral Vacuum
COCP/ HRT
Sex Education
- Clitoral Stimulation

Couple’s Therapy
Direct Orgasm Treatment
- ThermiVa Radio Freqency

108
Q

What is Vaginismus

A

Involuntary contractions of vaginal muscle during penetration causing pain

109
Q

Risk factors for Vaginismus

A

Anxiety
Trauma/ FGM
Surgeries

110
Q

Presentations of Vaginismus

A

Problematic sex
Pap Smears avoided
Can’t Insert IUS/IUS

111
Q

Managing Vaginismus

A

Sex Education
Kegel Exercises
Vaginal Dilation Therapy
Sex Psychology

112
Q

What is Vulvodynia?

A

3+ months of chronic vuoval pain with and without provoking

113
Q

Managing Vulvodynia

A

Prevent Friction
Kegel Exercises
Analgesia
Vestibulodynia? Vestibulectomy

114
Q

What is Erectile dysfuntion?

A

Consistent or recurrent inability to attain or maintain penile erection for a sufficient sexual performance

115
Q

Causes of Erectile Dysfunction

A

Cardiovascular Risk Factors

Vascular disease
- Poor blood flow to penis

Medications
- Antihypertensives
- SSRI’s
- Beta Blockers

Autonomic Neuropathy
- Diabetes and Alcohol
- Spinal Cord Compression

Psychological
- Anxiety and Depression

Endocrinological
- Hyperprolactinaemia
- Prolactinoma and Hypogonadism

Pelvic Surgery
- Bladder or Prostatectomy

Anatomical
- Peyrione’s (Scar tissue in penis causing bend in erection)

116
Q

Presentation of Erectile Dysfunction

A
  • Reduced sexual desire
  • Difficult Ejaculating
  • Performance Anxiety
  • Sudden onset = Psychogenic
  • Gradual onset = Organic Cause
117
Q

What are the features of an organic cause for erectile dysfunction?

A

Gradual Onset
Lack of Tumescence
Normal Libido

118
Q

Investigating Erectile Dysfunction

A

1) Sexual and Psychologial History
2) Blood Tests (FBC, TFT, Prolactin and Testosterone)
3) Cardiovascular QRISK3

119
Q

Managing Erectile Dysfunction

A

Psychosexual Therapy
Oral Phosphodiesterase Inhibitor
- Sildenafil (Increase NO = Blood flow)

Vacuum Erection device
Intra Cavernosal Injection
Penile Prostheses/ Ring

120
Q

Sildenafil Action/side effects and interactions
“Little Blue Pill”

A

Action
Oral Phosphodiesterase Inhibitor to increase nitric oxide

Side Effects
Headache/ Flushing/ Hypotension/ Blue Vision

Contraindications
Nitrate use
Hypertension/Hypotension
Arrythmia AND Angina
Stroke/MI

121
Q

What is Pyrionie

A

T2 Collagen deposition in Tunica Albuginda causing a deformed penis shape w/ abnormal fixed erection

122
Q

What are the genetic associations of Peyrionie’s

A

HLA DR5
Dupuytren

123
Q

Investigating Peyrionie’s

A

Penile USS
- Hyperechogenic Fibrotic Plaques

124
Q

Managing Peyrionie’s

A

Plication( Sraightening surgery)
Intrapenile Injection (Collagenase)

125
Q

What is premature ejaculation?

A

6+ months of Ejaculation <1min of sex with or without penetration before the patient wants it

126
Q

What are the causes of premature ejaculation?

A

Performance Anxiety
Pornography
Hyperthyroid
Sex Abuse

127
Q

Investigating Premature Ejaculation

A

Sex Bloods

128
Q

Managing premature ejaculation

A

Stop Start Squeeze technique
54321 Breathing technique
Keigel Exercises
Lidocaine Cream
Dapoxetine SSRI

3a mehdi (5 decks)

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