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Sexual health Flashcards

1
Q

What is the most common cause of vaginal discharge and what are the causative organisms?

A

Bacterial vaginosis caused by anaerobes: gardnerella. vaginalis or mycoplasma. hominis

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2
Q

What are the typical symptoms/signs of bacterial vaginosis?

A

Vaginal discharge

  • white/grey creamy, foul “fish” smelling
  • worse after sex or menstruation (due to release of amines from proteolysis)
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3
Q

What is the diagnostic criteria for BV?

A

Amsel criteria (3 out of 4)

  • White/grey creamy disco
  • Foul smelling fishy vag
  • Clue cells grown in culture
  • pH > 4.5
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4
Q

Treatment for bacterial vaginosis?

A

Cause is anaerobic therefore

  1. Metronidazole 400mg BD 5d or 2g single dose
  2. Clindamycin 2% topical cream 7d
  3. Discourage overfishing of vag - can destroy normal flora
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5
Q

What are the symptoms of candidiasis?

A
  1. Thick, curd like discharge
  2. Superficial dyspareunia
  3. Dysuria
  4. Vulval - itchy, sore, erythema
  5. Vaginal - erythema, typical white plaques
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6
Q

What are the investigative findings for BV?

A
  1. Microscopy - Clue cells
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7
Q

What are the treatments for Candidiasis (thrush)

A
  1. Fluconazole 150mg single dose
    or
  2. Clotrimazole pessary
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8
Q

In whom is fluconazole contraindicated?

A

Pregnancy

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9
Q

What are the investigations to diagnose chlamydia or gonorrhoea?

A
  1. Vulvovaginal or Endocervical swab with NAAT to detect n.gonorrhoea or c.trachomatis
  2. Must CS all gonorrhoea swabs before commencing Tx
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10
Q

What are the symptoms of trichomoniasis vaginalis?

A
  1. Vaginal discharge - yellow/green frothy, foul smelling
  2. Dysuria
  3. Strawberry cervix - punctate lesions
  4. Vulva itchy + sore
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11
Q

What are the similarities and differences in symptoms and signs of chlamydia and gonorrhoea?

A

Chlamydia

  • Discharge - white, cloudy
  • Deep dyspareunia
  • Dysuria on voiding
  • Vague lower abdo pain
  • ± IMB and PCB

Gonorrhoea

  • Discharge - green, watery, purulent
  • Pus
  • Dysuria on voiding
  • Abdominal pain
  • ± IMB and PCB
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12
Q

What is the treatment of gonorrhoea?

A
  1. IM Ceftriaxone 500mg STAT + Azithryomycin 1g PO

or

  1. Spectinomycin + Azithryomycin (if pen allergic)
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13
Q

What is the treatment of chlaymdia?

A
  1. Azithromycin 1g or

2. Doxycycline 100mg BD 7d

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14
Q

What is the treatment of cervical HSV infection?

A
  1. Saline wash
  2. Analgesia
  3. Topical anaesthetic
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15
Q

What are the symptoms of cervical HSV infection?

A
  1. Prodrome - tingly, itchy skin around affected area
  2. Flu-like symptoms
  3. Vulva sore + itchy (vulvitis)
  4. Rash: purulent vesicular ulcers
  5. Watery purulent discharge
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16
Q

What are the features of gonococcal conjunctivitis? What is the onset period?

A
  1. Purulent RED EYE (conjunctivitis) B/L or U/L
  2. Purulent watery discharge
  3. Keratitis –> photophobia and decreased acuity
  4. Lymphadenopathy
  5. Tender eye lid
  • hyper-acute sudden onset within 12-24hrs
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17
Q

What are the features of chlamydial conjunctivitis? when does it occur?

A
  1. Mild prolonged conjunctivitis (3-12 months)

2. Green-stringy discharge (mornings)

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18
Q

What is the general treatment for bacterial conjunctivitis

A

Most cases are self-limiting and therefore do not require treatment

Abx must be given to those with chlamydial or gonococcal cause

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19
Q

What are the key features of ophthalmia neonatorum and what is the cause? when does it occur?

A
  1. Purulent exudative discharge
  2. Chemosis - oedema of conjunctiva
  3. Conjunctivitis

mainly caused by chlamydia but can also be gonorrhoea, s.aureus, s.penumoniae

First 28 days of life

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20
Q

What are the features of disseminated gonorrhoea?

A
  1. Polyarthritis
  2. Polyarthralgia
  3. Tenosynovitis
  4. Fever
  5. Pustular rash
21
Q

What is the definition of ophthalmia neonatorum?

A

Any conjunctivitis within first 28 days of life

22
Q

What subtypes of chlamydia cause chlamydial conjunctivitis?

A

Sero-types D-K of C.Trachomatis

23
Q

What are the most common cervical and vaginal infections and how would you investigate them?

A
  1. Cervical
    - Bacterial vaginosis
    - Candidiasis
    - Trichomonas. vaginalis
    - ->investigate using high vaginal swab and MSC
  2. Vaginal
    - Chlamydia
    - Gonorrhoea
    - HSV1
    - -> Investigate using endocervical and vulvovaginal swab with NAAT
24
Q

What is Condylomata accuminata?

A

Ano-genital warts caused by HPV 6/11

25
Which HPV strains are a/w with cervical intraepithelial neoplasia (CIN)?
HPV 16/18
26
What is the presentation of condylomata accuminata?
Typically asymptomatic but: 1. Vulval warts - flat pappilomatous lesions - benign - painless - may become confluent - can become caught on clothing 2. Superficial dyspareunia 3. local skin irritation - burning or pruiritis
27
What is the treatment for condylomata accuminata?
Home 1. Podophyllin pain - weekly 2. Podophyllotoxin pain - BD, 3d cycles for 4wks 3. Barrier contraception for new partners Clinic: 1. Cryotherapy 2. Lazer, Scissor excision, electro-cautery 3. Tri-chloro-acetic acid
28
What prophylaxis is their against HPV?
HPV 6/11/16/18 vaccine given to all 12-13 year olds
29
What is the caustive organism of syphilis?
Treponeumum Pallidum - spirochete
30
Tell me the time frame and features of primary syphilis?
occurs 2-3 wks post-infection (treponeum.p enters during sex) 1. "Chancre" - single, painless, HARD ulcer (typically on genitals or mouth) 2. Inguinal lymphadenopathy
31
How would you investigate and confirm primary syphilis?
1. Dark field microscopy of ulcer fluid - visualise spirochete treponomes
32
Tell me the time frame and features of secondary syphilis?
6wks to 6 months post-infection (generalised infection) 1. Rash: head, trunk, hands, soles (may be scaly) 2. Alopecia 3. Anterior uveitis 4. Oral snail track ulcers 5. Condylomata lata - flat grey/pink disc shape papule 6. Hepatitis - RUQ pain + tender
33
How would you investigate and confirm secondary syphilis?
+ve Ab tests: Cardiolipin Ab tests (VDRL, RPR, WR) Treponeme specific Ab tests (TPHA, FTA, TPI)
34
Tell me the time frame and features of tertiary syphilis?
Occurs at ≥ 2 years 1. Gumata - granulomas develop in skin, bones, viscera (testis + lungs) 2. Neurosyphilis - Dementia - Tabes dorsalis (ataxia, lightning pain, decreased reflexes, Argyll-Robertson pupils, Charcot's joints) 3. Cardiosyphilis - syphillis aortis --> aortic aneurysm, regurgitation + angina
35
What is the treatment of syphilis?
1. Benzathine Penicilin 1.8g - 2-3 doses at least 1 week apart 2. Doxcycline as alternative 3. Erythromycin if pregnant
36
What are the complications in pregnancy of syphilis?
1. TORCH transmission 2. Prematurity 3. Early - Rash, sabre shin (anteriorly bent sting) 4. Late - Hutchinson's triad (blind, deaf (CNVIII injury), notched central incisors))
37
What are the common features between HSV and syphilis in early manifestation?
Both present with ulceration + lymphadenopathy HSV is PAINFUL Syphillis is PAINLESS
38
What is the causative organism of molluscum contagiosum?
DNA pox virus
39
What are the features of molluscum contagiosum?
1. Pearly, pink rash over trunk, arms and genitals - painless, umbilicate (painful if disrupted)
40
What is the treatment for molluscum contagiosum?
1. Watch and wait - self-limiting in 6-18 months | 2. Cryotherapy, podophyllotxin paint
41
What type of organism causes HIV? what are the common subtypes in the UK?
DNA retrovirus which kills CD4+ cells | HIV1 type A & B common in the UK
42
What is the time scale and symptoms of seroconversion for HIV?
3 months - Flu like symptoms - myalgia, pharyngitis, fever, coryza - Maculopapular rash on trunk - Exacerbation of chronic conditions like eczema
43
What are the symptoms of clinical latency HIV?
Often asymptomatic | may have persistent lymphadenopathy (>1cm for > 3months)
44
What is ARC and what are the symptoms?
AIDS related complex (ARC) is considered a prodrome to AIDS - high HIV viral load and low CD4+ T-cells Fever, Night seats, Weight loss, Diarrhoea Opportunistic infections - Oral - candida, hairy leukoplakia, EBV - Skin - molloscum contagiosum, shingles, warts - Serious - TB, pneumocystis, atypical pneumonia, cryptococcal meningitis, CMV, retinitis
45
When does AIDS occur and what is it defined as? What is the prognosis?
~ 8 years CD4 level < 200 x10^6 Death in 2 years without HAART
46
What is the investigative ladder for suspected HIV?
1. Point of care (POC) test - rapid finger prick test - results in 30 mins - can be bought over the counter - +ve results must be confirmed by ELISA 2a. Fourth generation test - contains HIV serum Ab and HIV P24 Ag test combined - must confirm -ve result with 2nd test 3 months later (to account for sero-conversion) 2b. Serum Ab - test 2-4 weeks post-exposure 2c. HIV p24 Antigen screen - test > 4 weeks post exposure Must consider Pregnancy test and full STI screen (other infections are likely present)
47
What is the treatment for HIV?
HAART (highly active anti-retroviral therapy) - OD tablet - must have CD4 > 350 (or NHS will not fund tx) - x2 NRTI = Tenofovir and Emtricitabine or Lamivudine and one of a. Ritonovir (protease inhibitor) b. Efavirenz (NNRTI) c. Integrase inhibitor
48
What can be given as early intervention treatment for a patient with recent exposure?
PEP - given to a patient with exposure < 72 hours - aims to prevent seroconversion

GOSH (14 decks)

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