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Theo's Obs And Gynae > Sexual Health > Flashcards

Sexual Health Flashcards

0
Q

How long is the incubation period with syphilis?

A

Three weeks

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1
Q

What bacteria causes syphilis?

A

Treponema pallidum

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2
Q

What are the categories of acquired syphilis?

A

Primary:

  • incubation period 2-3 weeks
  • local infection

Secondary:

  • incubation period 6-12 wk
  • generalised infection

Latent syphilis:
- asymptomatic syphilis of around 2 years duration

Late symptomatic syphilis:
- ‘tertiary syphilis’ - cardiovascular, neurosyphilis

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3
Q

How does primary syphilis present?

A

Primary lesion develops at the site of infection

Small painless papule, which forms an ulcer (chancre) with a red margin, discharging clear serum

Usually around coronal sulcus, glans and prepuce, vulva, labia, occasionally mouth and genitalia

May have enlarged regional lymph nodes

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4
Q

How does secondary syphilis present?

A

Secondary syphilis appears 6 weeks after primary lesion

Systemic presentation - nighttime headaches, malaise, fever, aches, generalised polymorphic rash on palms, soles, or face

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5
Q

What is neurological syphilis?

A

Presentation of tertiary syphilis

May be asymptomatic but with abnormal CSF

May be symptomatic:
Tabes dorsalis - dorsal column loss
Dementia
Meningovascular involvement

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6
Q

What is cardiovascular syphilis?

A

Presentation of tertiary syphilis

Characterised by aortitis, spreading dismally from aortic root

Clinical manifestations include aortic regurgitation, aortic aneurysm, angina

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7
Q

How should suspected syphilis be investigated?

A

Screen for all STIs

Request treponemal enzyme immunoassay for IgM for early infection (primary syphilis)

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8
Q

How should primary syphilis be treated?

A

Benzathine penicillin IM single dose

Oral azithromycin single dose - second line

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9
Q

How common is gonorrhoea?

A

Accounts for 7% of newly diagnosed STIs

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10
Q

How long is the incubation period for gonorrhoea?

A

Between 2-5 days, but may be up to 10 days

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11
Q

How often is gonorrhoea asymptomatic in men and women?

A

Men - 90-95%

Women - 50%

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12
Q

How does gonorrhoea present in men?

A

Usually asymptomatic

Urethral infections:
Mucopurulent discharge, dysuria
Epidydymal tenderness/swelling

Rectal infection - anal discharge, perianal pain, pruritis, bleeding
Pharyngeal infection

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13
Q

How does gonorrhoea present in women?

A 
Urethral infection:
Dysuria without frequency
Mucopurulent endocervical discharge
Contact bleeding of cervix
Pelvic/abdominal tenderness

Rectal infection
Pharyngeal infection

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14
Q

What bacteria causes gonorrhoea?

A

Neisseria gonorrhoea

Gram negative diplococci

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15
Q

How is gonorrhoea managed?

A

Ceftriaxone 500mg IM stat plus azithromycin 1g orally stat

Partner notification
No sexual intercourse until both partners have completed their abx

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16
Q

What are the complications of gonococcal urethritis in men?

A 
Urethral scarring and structure
Acute epididymitis
Prostatitis
Seminal vesiculitis
Penile lymphangitis
Peri-urethral abscess
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17
Q

What are he complications if gonorrhoea in women?

A

Barthholins abscess

Pelvic inflammatory disease, resulting in infertility, chronic pelvic pain and perihepatitis

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18
Q

What bacteria causes chlamydia?

A

Chlamydia trachomatis

Small obligate intracellular gram negative bacteria

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19
Q

How does chlamydia present in women?

A 
Often asymptomatic
Vaginal discharge
Dysuria
Lower abdominal pain
Fever
Intermenstrual or postcoital bleeding
Dyspareunia
Cervical excitation
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20
Q

How does chlamydia present in men?

A 
Often asymptomatic
Dysuria
Urethral discharge
Epididymo-orchitis
Unilateral testicular pain and swelling 
Fever
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21
Q

What are other presentations of chlamydia infections?

A

Reactive arthritis
Perihepatitis (fitz-Hugh Curtis syndrome)
Proctitis with mucopurulent discharge
Pharyngeal infection

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22
Q

What is the triad of Reiters syndrome?

A

Urethritis
Arthritis
Conjunctivitis

Can be triggered with chlamydial infection

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23
Q

What is the treatment of chlamydia?

A

1g azithromycin
Or
7 days doxycycline

Alternatives include erythromycin and
Ofloxacin

Partner notification
No sexual inter course until both partners have completed their abx

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24
Q

What is a differential for vaginal discharge in a young woman?

A

Bacterial vaginosis
Candida albicans
Trichomonas vaginalis

Chlamydia trachomatis
Neisseria gonorrhoea

Cervical ectopy
Pregnancy
Retained tampons
Foreign body

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25
Q

How should female genital infections been investigated?

A

Look at appearance of vaginal discharge and perform vaginal pH (BV)

High vaginal swab - BV, candida and TV

Vulvovaginal swab - chlamydia and gonorrhoea NAAT

Endocervical swab for GC culture

Syphilis serology and HIV

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26
Q

What are causes of post coital bleeding?

A

Infection:
Chlamydia
Gonorrhoea

Cervical abnormality:
Polyp
CIN
Cervical malignancy
Ectopy
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27
Q

What investigations should be done to investigate post coital bleeding?

A

Speculum

Vulvovaginal swab - chlamydia and gonorrhoea NAAT

Endocervical swab - gonorrhoea culture

Cervical assessment - smear and colposcopy

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28
Q

What is a differential for dysuria in young women?

A 
UTI
Chlamydia trachomatis
Gonorrhoea
Genital herpes
Genital candidiasis
Trichomonas vaginalis
Vulval dermatoses
29
Q

How might dysuria be investigated?

A

Examine vulva - signs if excoriation, fissuring, erythema, oedema
Take herpes/syphilis swab from vulval
ulcer
MSU
Perform vulvovaginal swab for chlamydia and gonorrhoea NAAT
Perform high vulvovaginal swabs for candida, TV and BV
Endocervical swab for gonorrhoea culture

30
Q

How should a suspected STI/UTI be investigated in a male?

A

Urethral swab - grab stained smear and culture for gonorrhoea
FSU - chlamydia and gonorrhoea NAAT
MSU to exclude UTI
Syphilis and HIV serology

If MSM- rectal and pharyngeal swabs for chlamydia and gonorrhoea - NAAT is culture

31
Q

What is a differential for genital rash?

A 
Candida
Strep/staph
Anaerobes
Trichomonas
Gardnerella
Syphilis
Heroes simplex
Circinate balanitis
Lichen sclerosis
Lichen planus
Psoriasis
Eczema
32
Q

What is a differential for genital itch?

A

Thrush
Trichomoniasis in females
Scabies
Pthyris pubis

Dermatitis
Lichen sclerosis
Lichen planus
Lichen simplex

33
Q

How should genital rash be investigated?

A

Supreputial swab for candida and bacterial culture

Urinalysis for glucose if candida suspected

Viral swab for HSV

Syphilis serology if genital ulcer

STI screen if appropriate

Biopsy if necessary

34
Q

What is general advice to give to patients with genital rash?

A

Salt water bathing
Avoid soaps while inflammation persists
Use aqueous cream/E45 wash as soap substitute

35
Q

What is the treatment for candida infection?

A

Topical antifungals -

e.g canesten cream BD until symptoms resolve (clotrimaxole)

36
Q

What is the treatment for lichen planus?

A

Usually self limiting

37
Q

What is the treatment for lichen sclerosis?

A

Potent topical steroid

Requires long term follow up due to small risk if malignant transformation

38
Q

How does candida balanitis present?

A

Common condition

Red papules, superficial erosion, or white plaques

39
Q

How is candida balanitis managed?

A

Exclude diabetes, lichen planus and candidal balanitis

Topical therapy- clotrimaxole cream or fluconazole

40
Q

How does circinate balanitis present?

A

Painless, mucocutaneous lesions

Associated with sexually acquired reactive arthritis

Skin lesions are similar to psoriasis

41
Q

How does scabies present?

A

Widespread pruritic dermatitis, genital nodules, burrows in fingerspaces

42
Q

How is scabies diagnosed?

A

Clinical

Skin scrapings may help

43
Q

What is the management of scabies

A

Permethrin 5% cream

Treat household and close contacts

44
Q

What is pthyris pubis and how does it present?

A

Pubic lice

Genital itch
Blue spots
Perifolliculitis

45
Q

What is the treatment of pthyris pubis?

A

Permethrin 1% or malathion 0.5%

Treat sexual partners

46
Q

How does lichen simplex present?

A

Due to chronic rubbing or scratching?

Poorly demarcated plaques of thickened skin

Usually affects scrotum in men and labia majors in women

47
Q

How is lichen simplex treated?

A

Avoid irritants
Emollients/moisturiser
Mild topical steroid

48
Q

How does lichen sclerosis present?

A

Itching or soreness

Pale, Atrophic skin, erosions, telangiectasia, loss of architecture

May develop into SCC (4%)

49
Q

How is lichen sclerosis treated?

A

General skin advice

Potent topical steroids

50
Q

How does lichen planus present?

A

Lichen planus is an inflammatory condition of unknown aetiology

Different morphological appearances:
Violaceous, flat-topped papules
White lacy papules
Plaques or erosions

Itching is main symptom

Self limiting

51
Q

How many people under 25 are colonised with HSV-1?

A

60%

Majority acquired subclinically - 80% unaware they are infected

52
Q

How many men and women are affects by genital herpes!

A

Female - 1 in 8

Male - 1 in 25

53
Q

How often do recurrences occur in herpes?

A

Males have more recurrences

These are usually self limiting, and last 7-12 days

HSV1 - 1-2 recurrences a year
HSV2 - 4-6 recurrences a year

Recurrences usually decrease over time

20% have no recurrences

54
Q

How should a herpes outbreak be treated?

A

Saltwater bathing
Topical anaesthetic/oral analgesia
Acyclovir 400mg 3x a day for 5 days

55
Q

How can herpes be passed on, and how can this be prevented?

A

Direct contact with mucous membranes or skin

Most infectious during recurrence, although viral shedding occurs when asymptomatic

Avoid sex during recurrences, use condoms otherwise

56
Q

What causes molluscum contagiosum?

A

Molluscum virus - DNA pox virus

57
Q

How is molluscum contagiosum treated?

A

Cryotherapy
Currette
Enucleation
Podophyllotoxin

58
Q

How do genital warts tend to appear?

A

Smooth polypoidal lesions

59
Q

What virus causes genital warts?

A

Human papilloma virus (HPV)

60
Q

What types if HPV are responsible for genital warts?

A

HPV subtypes 6 and 11 responsible for 90% of genital warts

HPV subtypes 16-18 tend not to cause genital warts, instead cause cervical cancer

61
Q

How are genital warts transmitted?

A

HPV gains access to basal epithelial layer through micro abrasions in genital skin during sexual contact

May be transmitted by oral-genital contact- rarely transmitted by digital genital contact

62
Q

What is the incubation period for genital warts?

A

Usually 3 months

Can be as short as 3 weeks, can be as long as 2 years

63
Q

How are genital warts treated?

A

Ablative therapies:
Cryotherapy - if few warts
Podophyllotoxin cream - if many warts
Electrocautery - for intrameatal warts

Immune modulation:
Imiquimod 5% cream - persistent warts - low recurrence rates

Surgical:
Curettage
Excision
Debulking

64
Q

How long do genital warts take to resolve?

A

Most resolve by 3 months with treatment

Detectable in genital skin for 1 year

May recur, and a small minority may have persistent warts

May be re-infected with a different HPV strain

65
Q

How long is a patient with genital warts infectious for?

A

3 months after the warts have resolved

66
Q

Can genital warts be transmitted when asymptomatic?

A

Yes

Condoms do not eliminate transmission, they just reduce it

67
Q

Can anal genital warts occur without anal sex?

A

Yes

HPV is a multicentric infection, and not limited to initial site of infection

68
Q

What is lymphogranuloma venereum?

A

STI caused by chlamydia trachomatis

Presents with painless papule which ulcerates and heals

Then develop lymphadenopathy and inguinal abscesses

69
Q

What causes strawberry cervix?

A

Trichomonas

Punctate erythematous appearance of cervix in trichomoniasis

70
Q

What is chancroid?

A 
Ulcerative condition if the genitalia which develops to cause:
Single /multiple ulcers
Phimosis
Enlargement of inguinal lymph nodes
Abscess
Discharging sinus

Caused by haemophilus ducreyi

Theo's Obs And Gynae (22 decks)

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