Sexual Health Flashcards
What flora colonises the vagina?
Lactobacillus - gives acidic pH
What is the pH of the vagina in prepubertal and postmenopausal ladies?
pH 6.5-7.5
Lack of oestrogen –> thin, atrophic epithelium
How does candidiasis present?
Cottage cheese discharge
Vulval irritation itching
Dyspareunia and dysuria
Red and itchy vagina and vulva
What are risk factors for candidiasis?
Pregnancy
Diabetes
Use of antibiotics
How is candidiasis treated?
Topical imidazoles
Oral fluconazole
What is bacterial vaginosis?
Normal lactobacilli are overgrown by mixed flora
Can cause secondary infection in PId
Associated with preterm labour
How does bacterial vaginosis present?
Grey-white discharge with fishy odour
Vagina isn’t red or itchy
How is bacterial vaginosis treated?
Metronidazole
Clindamycin
What infections are caused by foreign bodies?
Toxic shock syndrome - staph aureus –> fever, hypotension and multisystem failure
What is chlamydia?
Most common bacterial infection
Usually asymptomatic but can cause urethritis and vaginal discharge
What is the main complication of chlamydia?
Pelvic infection –> tubal damage –> subfertility or chronic pelvic pain
Increases risk of HIV
Infection during pregnancy - miscarriage, preterm birth, neonatal infection
What is Reiter’s syndrome?
Triad of urethritis, conjunctivitis and arthritis
How is chlamydia investigated?
Nucleic acid amplication tests (NAATs)
Polymerase chain reaction (PCR)
Men - first catch urine
Women - Vulvo-vaginal swab
Who is included in chlamydia screening?
Men and women
How is chlamydia treated?
Azithromycin or doxycyline
What is gonorrhoea?
Caused by gram negative diplococcus
Commonly asymptomatic in women, can have vaginal discharge, urethritis, post-coital bleeding
Men develop urethritis
What are complications of gonorrhoea?
Bacteraemia
Acute septic arthritis
PID
Increases risk of HIV
Infection in pregnancy - miscarriage, preterm birth, neonatal infection
Associated with chlamydia
How is gonorrhoea tested?
Men - urine
Women - self swab
How is gonorrhoea treated?
Cefixime
Ceftriaxone
What are genital warts?
Most common viral STI
Caused by HPV 6+11
Usually multiple and on cervix
16+18 -> cervical intraepithelial neoplasia
How are genital warts treated?
Topical podophyllin or imiquimod
Cryotherapy
What causes genital herpes?
Caused by HSV types 1 (mouth) or 2 (genitals)
Primary infection is worst
- multiple small painful vesicles around introitus
- local lymphadenopathy, dysuria
Virus lies dormant in dorsal root ganglion -> reactivation of more minor infection
How is genital herpes investigated?
Examination and viral swabs
How is genital herpes treated?
Aciclovir in severe infection
Avoid in neonates
How does primary syphilis present?
Painless ulcer, usually single but could be multiple
Commonest site is cervix
Arises 3-6 weeks after infection
Associated with inguinal lymphadenopathy
How does secondary syphilis present?
As ulcer disappears until up to 6 months later
Systemic eruption of non-itchy symmetrical rash on palms and soles
Warts around groin
Generalised illness, arthritis, meningitis
If untreated will be become latent
What are the complications of syphilis?
Congenital syphilis if pregnant mother has primary or secondary infection –> deafness, teeth problems, death
Tertiary syphilis - aortic regurgitation, dementia, tabes dorsalis (paresis of the insane) and gummata
How is syphilis diagnosed and treated?
Swab of primary ulcer
Serological blood test
IM penicillin
What is trichomoniasis?
Prevalent worldwide but uncommon in UK
Offensive grey-green discharge
Vulval irritation
Cervicitis - strawberry appearance
How is trichomoniasis diagnosed and treated?
Wet film microscopy, staining or culture of vaginal swabs
Metronidazole
What other STIs cause genital ulcers?
Herpes Syphilis Chancroid Lymphogranuloma venereum Donovanosis
What kind of virus is HIV?
Retrovirus
What are risk factors for HIV?
Multiple sexual partners Migration from high prevalence areas Presence of other STI IVDU Sexual contact with men
What is the diagnostic criteria for AIDs?
Opportunistic infections
Malignancy
CD4 less than 200
What does HIV increase the risk of?
CIN (30%) - and progression to malignancy is more rapid
Candidiasis
Menstrual disturbances
What is endometritis?
Infection confined to cavity of uterus alone
Commonly spreads to pelvis
Result of instrumentation of uterus or complication of pregnancy
What organisms can cause endometritis?
Chlamydia Gonorrhoea Bacterial vaginosis E. coli Staph
How does endometritis present?
Persistent and heavy bleeding
Pain - tender uterus
Open cervical os
Fever may be absent
What investigations should be done for endometritis?
Vaginal and cervical swabs
FBC
What is the management of endometritis?
Broad spectrum Abx
Evacuation of retained products of conception
What is pelvic inflammatory disease?
Salpingitis
Usually co-exists with endometritis
Almost never occurs in presence of viable pregnancy
What are the risk factors for PID?
Young, poor, sexually active nulliparous women
Sexual factors
Uterine instrumentation - insertion of IUD
Complications of childbirth and miscarriage
Descending infection from local organs
What are protective factors for PID?
COCP
Mirena
What causes PID?
Chlamydia - asymptomatic, symptoms due to secondary infection
Gonorrhoea - acute presentation
Endometritis, bialteral salpingitis and parametritis
Perihepatitis occurs in 10% and causes right upper quadrant pain due to adhesions
How does PID present?
BILATERAL lower abdo pain with deep dyspareunia
Abnormal vaginal bleeding or discharge
Fever
Tachycardia
How is PID investigated?
Endocervical swabs for gonorrhoea and chlamydia
FBC
Blood culture
Pelvic USS - exclude abscess or ovarian cyst
How is PID treated?
Analgesics
Parenteral cephalosporin
What are complications of PID?
Abscess
Tubal obstruction and subfertility
Chronic PID
Ectopic pregnancy
What causes chronic PID?
Non/inadequate treatment of PID
Dense pelvic adhesions
Obstruction of fallopian tubes
How does chronic PID present?
Chronic pelvic pain Dysmenorrhoea Deep dyspareunia Heavy and irregular menstruation Fixed retroverted uterus
How is chronic PID investigated and treated?
Laparascopy
Analgesics
Abx
Salpingectomy
What are causes of vaginal discharge?
COCP Pregnancy Bacterial vaginosis Candidiasis Chlamydia Gonorrhoea TV Atrophic vaginitis Foreign bosy Malignancy
