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Obs & Gynae > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

What flora colonises the vagina?

A

Lactobacillus - gives acidic pH

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2
Q

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

A

pH 6.5-7.5

Lack of oestrogen –> thin, atrophic epithelium

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3
Q

How does candidiasis present?

A

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

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4
Q

What are risk factors for candidiasis?

A

Pregnancy
Diabetes
Use of antibiotics

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5
Q

How is candidiasis treated?

A

Topical imidazoles

Oral fluconazole

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6
Q

What is bacterial vaginosis?

A

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

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7
Q

How does bacterial vaginosis present?

A

Grey-white discharge with fishy odour

Vagina isn’t red or itchy

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8
Q

How is bacterial vaginosis treated?

A

Metronidazole

Clindamycin

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9
Q

What infections are caused by foreign bodies?

A

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

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10
Q

What is chlamydia?

A

Most common bacterial infection

Usually asymptomatic but can cause urethritis and vaginal discharge

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11
Q

What is the main complication of chlamydia?

A

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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12
Q

What is Reiter’s syndrome?

A

Triad of urethritis, conjunctivitis and arthritis

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13
Q

How is chlamydia investigated?

A

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

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14
Q

Who is included in chlamydia screening?

A

Men and women

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15
Q

How is chlamydia treated?

A

Azithromycin or doxycyline

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16
Q

What is gonorrhoea?

A

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

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17
Q

What are complications of gonorrhoea?

A

Bacteraemia
Acute septic arthritis
PID

Increases risk of HIV
Infection in pregnancy - miscarriage, preterm birth, neonatal infection

Associated with chlamydia

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18
Q

How is gonorrhoea tested?

A

Men - urine

Women - self swab

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19
Q

How is gonorrhoea treated?

A

Cefixime

Ceftriaxone

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20
Q

What are genital warts?

A

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

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21
Q

How are genital warts treated?

A

Topical podophyllin or imiquimod

Cryotherapy

22
Q

What causes genital herpes?

A

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

23
Q

How is genital herpes investigated?

A

Examination and viral swabs

24
Q

How is genital herpes treated?

A

Aciclovir in severe infection

Avoid in neonates

25
Q

How does primary syphilis present?

A

Painless ulcer, usually single but could be multiple
Commonest site is cervix
Arises 3-6 weeks after infection
Associated with inguinal lymphadenopathy

26
Q

How does secondary syphilis present?

A

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

27
Q

What are the complications of syphilis?

A

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

28
Q

How is syphilis diagnosed and treated?

A

Swab of primary ulcer
Serological blood test

IM penicillin

29
Q

What is trichomoniasis?

A

Prevalent worldwide but uncommon in UK
Offensive grey-green discharge
Vulval irritation
Cervicitis - strawberry appearance

30
Q

How is trichomoniasis diagnosed and treated?

A

Wet film microscopy, staining or culture of vaginal swabs

Metronidazole

31
Q

What other STIs cause genital ulcers?

A 
Herpes
Syphilis
Chancroid
Lymphogranuloma venereum
Donovanosis
32
Q

What kind of virus is HIV?

A

Retrovirus

33
Q

What are risk factors for HIV?

A 
Multiple sexual partners
Migration from high prevalence areas
Presence of other STI 
IVDU
Sexual contact with men
34
Q

What is the diagnostic criteria for AIDs?

A

Opportunistic infections
Malignancy
CD4 less than 200

35
Q

What does HIV increase the risk of?

A

CIN (30%) - and progression to malignancy is more rapid
Candidiasis
Menstrual disturbances

36
Q

What is endometritis?

A

Infection confined to cavity of uterus alone
Commonly spreads to pelvis
Result of instrumentation of uterus or complication of pregnancy

37
Q

What organisms can cause endometritis?

A 
Chlamydia
Gonorrhoea
Bacterial vaginosis
E. coli
Staph
38
Q

How does endometritis present?

A

Persistent and heavy bleeding
Pain - tender uterus
Open cervical os
Fever may be absent

39
Q

What investigations should be done for endometritis?

A

Vaginal and cervical swabs

FBC

40
Q

What is the management of endometritis?

A

Broad spectrum Abx

Evacuation of retained products of conception

41
Q

What is pelvic inflammatory disease?

A

Salpingitis
Usually co-exists with endometritis
Almost never occurs in presence of viable pregnancy

42
Q

What are the risk factors for PID?

A

Young, poor, sexually active nulliparous women
Sexual factors
Uterine instrumentation - insertion of IUD
Complications of childbirth and miscarriage
Descending infection from local organs

43
Q

What are protective factors for PID?

A

COCP

Mirena

44
Q

What causes PID?

A

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

45
Q

How does PID present?

A

BILATERAL lower abdo pain with deep dyspareunia
Abnormal vaginal bleeding or discharge
Fever
Tachycardia

46
Q

How is PID investigated?

A

Endocervical swabs for gonorrhoea and chlamydia
FBC
Blood culture
Pelvic USS - exclude abscess or ovarian cyst

47
Q

How is PID treated?

A

Analgesics

Parenteral cephalosporin

48
Q

What are complications of PID?

A

Abscess
Tubal obstruction and subfertility
Chronic PID
Ectopic pregnancy

49
Q

What causes chronic PID?

A

Non/inadequate treatment of PID
Dense pelvic adhesions
Obstruction of fallopian tubes

50
Q

How does chronic PID present?

A 
Chronic pelvic pain
Dysmenorrhoea
Deep dyspareunia
Heavy and irregular menstruation
Fixed retroverted uterus
51
Q

How is chronic PID investigated and treated?

A

Laparascopy
Analgesics
Abx
Salpingectomy

52
Q

What are causes of vaginal discharge?

A 
COCP
Pregnancy
Bacterial vaginosis
Candidiasis
Chlamydia
Gonorrhoea
TV
Atrophic vaginitis
Foreign bosy
Malignancy

Obs & Gynae (20 decks)

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