sexual health

Question 1

what is bacterial vaginosis

Answer 1

overgrowth of predominately anaerobic organisms such as gardnerella vaginialis
raised pH

Question 2

features of BV

Answer 2

vaginal discharge: fishy smell
asymptomatic

Question 3

criteria for BV

Answer 3

amsel’s
thin white discharge
clue cells on microscopy: stippled vaginal epithelial cells
vaginal pH > 4.5
positive whiff test

Question 4

management of BV

Answer 4

oral metronidazole 5-7 days
- or single dose metronidazole
if pregnant: oral metronidazole or topical

Question 5

risk factors for vaginal candidiasis

Answer 5

diabetes
drugs: steroids, antibiotics
pregnancy
immunosuppression: HIV

Question 6

presentation of candidiasis

Answer 6

cottage cheese
vulvitis: superficial, dyspareunia, dysuria
itch
vulval erythema, fissuring

Question 7

management for candidiasis

Answer 7

oral fluconazole 150mg single dose
clotrimazole 500mg pessary
can add topical imidazole
pregnant: treat locally

Question 8

what is chlamydia trachomatis

Answer 8

gram neg

Question 9

features of chlamydia

Answer 9

asymptomatic
women: cervicitis (bleeding, discharge) dyuria
men: urethral discharge, dysuria

Question 10

potential complications of chlamydia

Answer 10

epididymitis
PID
endometritis
increased incidence of ectopic pregnancies
infertility
reactive arthritis
perihepatitis (fitz-hugh-curtis)

Question 11

investigations for chlamydia

Answer 11

NAATs
first void urine sample, vulvovaginal swab or cervical swab

Question 12

management of chlamydia

Answer 12

doxycycline 7 days
azithromycin 1g one day, 500mg 2 days
pregnant: azithromycin, erythromycin, amoxicillin

Question 13

what type of bacteria is gonorrhoea

Answer 13

neisseria gonorrhoeae
gram negative diplococcus

Question 14

features of gonorrhoea

Answer 14

males: urethral discharge, dysuria
females: cervicitis- vaginal discharge

Question 15

local complications of gonorrhoea

Answer 15

urethral strictures
epididymitis
salpingitis

Question 16

management of gonorrhoea

Answer 16

IM ceftriaxone 1g
if injections refused: oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose) should be used

Question 17

presentation of disseminated gonococcal infection

Answer 17

tenosynovitis, migratory polyarthritis and dermatitis

Question 18

presentation of mycoplasma genitalium

Answer 18

urethritis
similar to chlamydia
antibiotic resistance

Question 19

management of mycoplasma genitalium

Answer 19

doxycycline 7 days
azithromycin 1g statin

Question 20

organisms that cause PID

Answer 20

Chlamydia trachomatis: the most common cause
Neisseria gonorrhoeae
Mycoplasma genitalium
Mycoplasma hominis

Question 21

presentation of PID

Answer 21

lower abdo pain
fever
deep dyspareunia
dysuria and menstrual irregularities
vaginal or cervical discharge
cervical excitation

Question 22

investigation for PID

Answer 22

pregnancy test
high vaginal swab (often negative)
screen for chlamydia and gonorrhoea

Question 23

management of PID

Answer 23

first line: stat IM ceftriaxone + 14 days of oral doxycycline + oral metronidazole
second line: oral ofloxacin + oral metronidazole

Question 24

complications of PID

Answer 24

perihepatitis (fitz-hugh-curtis)
infertility
chronic pelvic pain
ectopic pregnancy

Question 25

what is trichomonas vaginalis

Answer 25

highly motile, flagellated protozoan parasite

Question 26

features of trichomonas vaginalis

Answer 26

vaginal discharge: offensive, yellow/green, frothy vulvovaginitis strawberry cervix pH > 4.5 asymptomatic in men

Question 27

investigations for trichomonas vaginalis

Answer 27

microscopy of wet mount shows motile trophozites

Question 28

management of TV

Answer 28

oral metronidazole 5-7 days

Question 29

genital herpes presentation

Answer 29

painful genital ulcers - dysuria and pruritus primary infection is the worst tender inguinal lymphadenopathy urinary retention

Question 30

investigations in genital herpes

Answer 30

NAAT HSV serology may be useful

Question 31

management of genital herpes

Answer 31

saline bathing, analgesia, topical anaesthetic oral aciclovir

Question 32

features of genital warts

Answer 32

small 2-5mm fleshy protuberances slightly pigmented may bleed or itch

Question 33

management of genital warts

Answer 33

**topical podophyllum or cryotherapy** imiquimod

Question 34

primary features of syphilis

Answer 34

chancre- painless ulcer at site of sexual contact local non-tender lymphadenopathy often not seen in women

Question 35

secondary features of syphilis

Answer 35

systemic symptoms: fevers, lymphadenopathy rash on trunk, palms and soles buccal snail track ulcers condylomata lata

Question 36

tertiary features of syphilis

Answer 36

gummas ascending aortic aneurysms general paralysis of the insane argyll robertson pupil

Question 37

syphilis Positive non-treponemal test + positive treponemal test

Answer 37

active syphilis infection

Question 38

syphilis: Positive non-treponemal test + negative treponemal test

Answer 38

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

Question 39

syphilis: Negative non-treponemal test + positive treponemal test

Answer 39

successfully treated syphilis

Question 40

management of syphilis

Answer 40

**IM benzathine penicillin** doxycycline