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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?

A

Chlamydia

25
Q

What are the microbiological characteristics of chlamydia trachomatis?

A

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
Q

Which serological types of chlamydia are associated with genital infection?

A

Serovars D-K

27
Q

What is the treatment for uncomplicated chlamydia? Why is this dosing used and why is it important?

A

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
Q

Where does gonorrhoea infect?

A

urethra, rectum, throat and eyes, endocervix

29
Q

Which STI is a Gram negative diplococcus, which often appears intracellularly?

A

Neisseria gonorrhoea

30
Q

How are chlamydia and gonorrhoea diagnosed?

A 
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
Q

What tests can be done specifically for gonorrhoea?

A

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
Q

How is gonorrhoea treated? Why?

A

IM ceftriaxone + oral azithromycin

many strains of gonorrhoea are resistant to penicillins, tetracyclines, quinolones, and most oral cephalosporins

33
Q

What organism causes syphilis?

A

treponema pallidum

34
Q

How is syphilis tested for?

A

PCR or serology (for antibodies)
Does NOT stain with Gram stain
Cannot be grown in culture medium

35
Q

What are the 4 stages of syphilis?

A
  • 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
Q

What tests can be used to diagnose syphilis?

A
  • 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
Q

What is the screening test for syphilis?

A

Combined IgG and IgM ELISA

38
Q

Patient has positive combined IgG and IgM screening test for syphilis. What is the next step in management?

A

Further tests:

  • IgM ELSIA
  • VDRL test
  • TPPA test
39
Q

What is the treatment for syphilis?

A

Penicillin

40
Q

Which types of HPV are associated with genital warts?

A

6 and 11

41
Q

Which types of HPV are associated with cervical cancer?

A

16 and 18

42
Q

How are genital warts treated?

A

Cryotherapy

podophyllotoxin cream/lotion

43
Q

What is the treatment for trichomonas vaginalis?

A

oral metronidazole

44
Q

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?

A

Encourage her to tell him to get tested

Sexual health clinic can contact them anonymously.

45
Q

How long should people wait to have sex after treatment for chlamydia infection?

A

No sex until one week after both partners have been treated. Even abstain from protected sex, as condoms are not reliable enough

46
Q

Is a test of cure required for chlamydia infection?

A

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
Q

Are HIV, Hepatitis, and syphilis routinely tested for?

A

Yes the tests for these are offered in the sexual health clinic - high risk group.

48
Q

How is genital Herpes tested for?

A

Swab de-roofed vesicles - only works when patient is symptomatic.

49
Q

If patient presents to GP and tests positive for gonorrhoea, what is the most appropriate management?

A

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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