Sexual Health Flashcards by Anneliese Brady

What flora colonises the vagina?

Lactobacillus - gives acidic pH

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What is the pH of the vagina in prepubertal and postmenopausal ladies?

pH 6.5-7.5

Lack of oestrogen –> thin, atrophic epithelium

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How does candidiasis present?

Cottage cheese discharge
Vulval irritation itching
Dyspareunia and dysuria
Red and itchy vagina and vulva

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What are risk factors for candidiasis?

Pregnancy
Diabetes
Use of antibiotics

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How is candidiasis treated?

Topical imidazoles

Oral fluconazole

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What is bacterial vaginosis?

Normal lactobacilli are overgrown by mixed flora
Can cause secondary infection in PId
Associated with preterm labour

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How does bacterial vaginosis present?

Grey-white discharge with fishy odour

Vagina isn’t red or itchy

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How is bacterial vaginosis treated?

Metronidazole

Clindamycin

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What infections are caused by foreign bodies?

Toxic shock syndrome - staph aureus –> fever, hypotension and multisystem failure

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What is chlamydia?

Most common bacterial infection

Usually asymptomatic but can cause urethritis and vaginal discharge

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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

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What is Reiter’s syndrome?

Triad of urethritis, conjunctivitis and arthritis

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How is chlamydia investigated?

Nucleic acid amplication tests (NAATs)
Polymerase chain reaction (PCR)
Men - first catch urine
Women - Vulvo-vaginal swab

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Who is included in chlamydia screening?

Men and women

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How is chlamydia treated?

Azithromycin or doxycyline

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What is gonorrhoea?

Caused by gram negative diplococcus
Commonly asymptomatic in women, can have vaginal discharge, urethritis, post-coital bleeding
Men develop urethritis

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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

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How is gonorrhoea tested?

Men - urine

Women - self swab

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How is gonorrhoea treated?

Cefixime

Ceftriaxone

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What are genital warts?

Most common viral STI
Caused by HPV 6+11
Usually multiple and on cervix
16+18 -> cervical intraepithelial neoplasia

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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 ```