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Sexual Health Flashcards

1
Q

What are the common causes of vaginal discharge?

A 
Phsyiological
Candida
Trichomonas vaginalis
bacterial vaginosis
gonorrhoea
chlamydia (although this is rarely the presenting symptom)
cervical ectropion
foreign body
cancer
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2
Q

Patient presents with vaginal discharge which she describes as resembling cottage cheese, and also has painful, itchy vulva. What is the most likely diagnosis?

A

Candida infection

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3
Q

Patient presents with offensive yellow/green frothy vaginal discharge, vulvovaginitis and a strawberry cervix. What is the most likely diagnosis?

A

Trichomonas vaginalis

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4
Q

Patient presents with offensive, fishy, grey/white, thin, watery vaginal discharge. Vaginal pH is >4.5 (raised). What is the most likely diagnosis?

A

Bacterial vaginosis

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5
Q

What are the typical presenting features of pelvic inflammatory disease?

A 
pelvic pain
fever
deep dyspareunia
vaginal discharge
(dysuria)
(menstrual irregularities)
cervical excitation may be seen on examination
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6
Q

What comprises the normal vaginal flora?

A

Lactobacillus - predominates “healthy” vangina

Others may include strep viridans, group B beta-haemolytic strep, candida (small numbers)

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7
Q

What is the role of Lactobacillus in the vagina?

A

Produces lactic acid and hydrogen peroxide to suppress the growth of other bacteria

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8
Q

What are the non-sexually transmitted genital tract infections?

A

Candida infection (vaginal thrush - most cases caused by C.albicans)
Bacterial vaginosis
Prostatitis

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9
Q

What are the predisposing factors for candida infection?

A
  • Recent antibiotic therapy
  • High oestrogen levels (pregnancy, certain contraceptives)
  • Poorly controlled diabetes
  • immunocompromised patients
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10
Q

How is candida infection diagnosed?

A

Most cases are clinical diagnosis

High vaginal swab for culture

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11
Q

How is Candida infection treated?

A

Topical clotrimazole - pessary or cream

Oral fluconazole

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12
Q

How does C.albicans look on Gram film?

A

Yeasts with budding and hyphae

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13
Q

What organisms are involved in bacterial vaginosis?

A

Gardnerella vaginalis
Mobiluncus
anaerobes

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14
Q

How is Bacterial vaginosis diagnosed?

A

Most cases are clinical diagnosis
Can measure vaginal pH (will be raised - >4.5)
High vaginal swab can be examined for presence of CLUE CELLS - Hay-Ison scoring system us used to estimate proportion of clue cells (highly subjective and inaccurate)

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15
Q

How is bacterial vaginosis treated?

A

Metronidazole

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16
Q

When looking at microscopy of a high vaginal swab sample taken from a patient, you see clue cells. What is the most likely diagnosis?

A

Bacterial vaginosis

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17
Q

Male patient presents with urinary frequency, urgency and dysuria. He also pain in his lower back and abdomen, and penis. You perform a PR exam and his prostate is tender. What is the likely diagnosis?

A

Acute bacterial prostatitis

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18
Q

What organisms can cause acute bacterial prostatitis?

A

same as UTI - cloakrooms (e.g. E.coli), enterococcus

In patients

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19
Q

How is acute bacterial prostatitis diagnosed?

A

clinical signs + MSSU for culture and sensitivities

+ first pass urine if testing for chlamydia/gonorrhoea

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20
Q

How is acute bacterial prostatitis treated?

A

Ciprofloxacin for 28 days (which can be altered depending on culture results)
Timethoprim for 28 days if C.diff risk is high

21
Q

List 3 common bacterial STIs

A

chlamydia trachomatis
Neisseria gonorrhoea
Treponema pallidum (syphilis)

22
Q

List 4 common viral STIs

A

Human Papilloma Virus (genital warts)
Herpes simplex (genital herpes)
HIV
Hepatitis

23
Q

List 3 common parasite STIs.

A

Trichomonas vaginalis
Phthirus pubis (pubic lice)
Scabies

24
Q

What is the commonest bacterial STI in the UK?

25
What are the microbiological characteristics of chlamydia trachomatis?
Infects the urethra, rectum, throat and eyes, and the endocervix Obligate intracellular bacteria (do not reproduce outside a host cell) Does NOT stain with Gram stain (no peptidoglycan in cell wall)
26
Which serological types of chlamydia are associated with genital infection?
Serovars D-K
27
What is the treatment for uncomplicated chlamydia? Why is this dosing used and why is it important?
Azithromycin - 1g oral - single dose Single dose of oral azithromycin is sufficient for treating chlamydia because it has a very long half life and this is useful because there is no need to monitor compliance/have follow up appointments
28
Where does gonorrhoea infect?
urethra, rectum, throat and eyes, endocervix
29
Which STI is a Gram negative diplococcus, which often appears intracellularly?
Neisseria gonorrhoea
30
How are chlamydia and gonorrhoea diagnosed?
``` Combined Nucleic Acid Amplification Tests (NAATs) or PCR - tests for both organisms in 1 test (highly sensitive and specific tests) Samples taken: - male: FIRST PASS urine - female: HVS or vulvo-vaginal swab - rectal and throat swabs - eye swabs ```
31
What tests can be done specifically for gonorrhoea?
Microscopy - of urethral/endocervical swabs in sexual health clinic Culture on agar plates - endocervical, rectal and throat, NOT high vaginal swab; only in sexual health clinic can do NAAT and PCR (but these also test for chlamydia)
32
How is gonorrhoea treated? Why?
IM ceftriaxone + oral azithromycin | many strains of gonorrhoea are resistant to penicillins, tetracyclines, quinolones, and most oral cephalosporins
33
What organism causes syphilis?
treponema pallidum
34
How is syphilis tested for?
PCR or serology (for antibodies) Does NOT stain with Gram stain Cannot be grown in culture medium
35
What are the 4 stages of syphilis?
- Primary lesion (chancre): organism multiplies at inoculation site and gets into blood. Chancre will heal - Secondary stage - large numbers of circulating bacteria with multiple manifestations (ulcers, rash, flu-like symptoms) - Latent stage: no symptoms, low-level multiplication of spirochaete in intimate of blood vessels - Late stage: CV or neurovascular complications many years later
36
What tests can be used to diagnose syphilis?
- Swab of primary or secondary lesions for PCR - serology for non-specific and specific antibodies to T.pallidum in blood Dark ground microscopy for spirochetes (not in Tayside)
37
What is the screening test for syphilis?
Combined IgG and IgM ELISA
38
Patient has positive combined IgG and IgM screening test for syphilis. What is the next step in management?
Further tests: - IgM ELSIA - VDRL test - TPPA test
39
What is the treatment for syphilis?
Penicillin
40
Which types of HPV are associated with genital warts?
6 and 11
41
Which types of HPV are associated with cervical cancer?
16 and 18
42
How are genital warts treated?
Cryotherapy | podophyllotoxin cream/lotion
43
What is the treatment for trichomonas vaginalis?
oral metronidazole
44
Patient tests positive for chlamydia after unprotected sex with a casual partner. She does not want to tell her longterm boyfriend, but he should be tested. He is not registered with the same GP. What are the options?
Encourage her to tell him to get tested | Sexual health clinic can contact them anonymously.
45
How long should people wait to have sex after treatment for chlamydia infection?
No sex until one week after both partners have been treated. Even abstain from protected sex, as condoms are not reliable enough
46
Is a test of cure required for chlamydia infection?
Not routinely done In pregnant women, test of cure often done. Can also be done in patients who have been re-exposed If test of cure is done, done 5-6 weeks after treatment (because PCR is very sensitive and will also pick up dead organisms)
47
Are HIV, Hepatitis, and syphilis routinely tested for?
Yes the tests for these are offered in the sexual health clinic - high risk group.
48
How is genital Herpes tested for?
Swab de-roofed vesicles - only works when patient is symptomatic.
49
If patient presents to GP and tests positive for gonorrhoea, what is the most appropriate management?
Refer to sexual health clinic because GPs often don't have IM ceftriaxone and pt probably needs contact tracing done by sexual health doctors

Reproduction (10 decks)

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