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GOSH > Sexual health > Flashcards

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
Q

Which HPV strains are a/w with cervical intraepithelial neoplasia (CIN)?

A

HPV 16/18

26
Q

What is the presentation of condylomata accuminata?

A

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
Q

What is the treatment for condylomata accuminata?

A

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
Q

What prophylaxis is their against HPV?

A

HPV 6/11/16/18 vaccine given to all 12-13 year olds

29
Q

What is the caustive organism of syphilis?

A

Treponeumum Pallidum - spirochete

30
Q

Tell me the time frame and features of primary syphilis?

A

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
Q

How would you investigate and confirm primary syphilis?

A
  1. Dark field microscopy of ulcer fluid - visualise spirochete treponomes
32
Q

Tell me the time frame and features of secondary syphilis?

A

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
Q

How would you investigate and confirm secondary syphilis?

A

+ve Ab tests:

Cardiolipin Ab tests (VDRL, RPR, WR)

Treponeme specific Ab tests (TPHA, FTA, TPI)

34
Q

Tell me the time frame and features of tertiary syphilis?

A

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
Q

What is the treatment of syphilis?

A
  1. Benzathine Penicilin 1.8g - 2-3 doses at least 1 week apart
  2. Doxcycline as alternative
  3. Erythromycin if pregnant
36
Q

What are the complications in pregnancy of syphilis?

A
  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
Q

What are the common features between HSV and syphilis in early manifestation?

A

Both present with ulceration + lymphadenopathy

HSV is PAINFUL
Syphillis is PAINLESS

38
Q

What is the causative organism of molluscum contagiosum?

A

DNA pox virus

39
Q

What are the features of molluscum contagiosum?

A
  1. Pearly, pink rash over trunk, arms and genitals - painless, umbilicate (painful if disrupted)
40
Q

What is the treatment for molluscum contagiosum?

A
  1. Watch and wait - self-limiting in 6-18 months

2. Cryotherapy, podophyllotxin paint

41
Q

What type of organism causes HIV? what are the common subtypes in the UK?

A

DNA retrovirus which kills CD4+ cells

HIV1 type A & B common in the UK

42
Q

What is the time scale and symptoms of seroconversion for HIV?

A

3 months

  • Flu like symptoms - myalgia, pharyngitis, fever, coryza
  • Maculopapular rash on trunk
  • Exacerbation of chronic conditions like eczema
43
Q

What are the symptoms of clinical latency HIV?

A

Often asymptomatic

may have persistent lymphadenopathy (>1cm for > 3months)

44
Q

What is ARC and what are the symptoms?

A

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
Q

When does AIDS occur and what is it defined as? What is the prognosis?

A

~ 8 years
CD4 level < 200 x10^6

Death in 2 years without HAART

46
Q

What is the investigative ladder for suspected HIV?

A
  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
Q

What is the treatment for HIV?

A

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
Q

What can be given as early intervention treatment for a patient with recent exposure?

A

PEP - given to a patient with exposure < 72 hours

  • aims to prevent seroconversion

GOSH (14 decks)

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