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GOSH - LM > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

Women with symptoms will be offered which STI investigations?

A

VVS - for C&G NAAT
HVS - TV, BV, thrush
Endocervical - G culture
Bloods - HIV & syphilis

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2
Q

Women with no symptoms will receive which STI investigations?

A

VVS - C&G NAAT

Bloods - HIV & Syphilis

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3
Q

Heterosexual men without symptoms will receive which STI investigations?

A

First stream urine - C&G NAAT

Bloods - HIV & Syphilis

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4
Q

Heterosexual men with symptoms will receive which STI investigations?

A

first stream urine - C&G NAAT
Urethral Swab - G culture
Bloods - HIV & syphilis

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5
Q

MSM without symptoms will be offered which investigations?

A

First stream urine - C&G NAAT
Pharyngeal swab - C&G NAAT
Rectal swab - C&G NAAT
Bloods - HIV, Syphilis, Hep B

Offer Hep-B Vaccine

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6
Q

MSM with symptoms will be offered which investigations?

A 
First stream urine - C&G NAAT
Urethral swab - G culture 
Pharyngeal swab - C&G NAAT
Pharyngeal swab - G culture 
Rectal swab - C&G culture 
Rectal swab - G culture
Blood test - HIV, syphilis, hep b

Offer Hep B vaccine

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7
Q

BV is caused by the overgrowth if which bacteria mainly?

A

Loss of lactobacilli & overgrowth of G vaginalis

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8
Q

a pH of ≥4.5 can indicate which STI?

A

BV

TV

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9
Q

Describe the discharge expected with BV

A

Thin watery discharge
grey/white
Fishy odour

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10
Q

Which swab is taken if BV is suspected and what may be found on microscopy?

A

HVS

clue cells

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11
Q

What is the treatment regime for BV?

A

Metronidazole 7/7

Clindamycin

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12
Q

Is chlamydia gram +ve or gram -ve?

A

Gram -ve

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13
Q

What does NAAT stand for?

A

Nucleic acid amplification test

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14
Q

During pregnancy what treatment options are available for chlamydia?

A

Azithromycin 1g

Doxycycline 100mg cannot be used in pregnancy

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15
Q

What type of discharge would be seen with chlamydia?

A

White/cloudy thick discharge

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16
Q

Which chlamydial serotypes are most common in the UK?

A

D-K

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17
Q

Name some complications of STIs

A

PID
Reactive arthritis - conjunctivitis, urethritis & arthritis
Fitz-Hugh Curtis - liver adhesions

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18
Q

Frothy discharge would indicate which STI?

A

TV

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19
Q

Cervicitis is seen in which STIs?

A

TV - strawberry cervix
Chlamydia
Gonorrhoea

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20
Q

A strawberry cervix can be seen in which STI?

A

TV

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21
Q

PCB & IMB can be signs of which STIs?

A

Chlamydia & Gonorrhoea

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22
Q

What type of bacteria is gonorrhoea?

A

gram -ve diplococci

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23
Q

What is the treatment of choice for gonorrhoea?

A

Ceftriaxone 500mg IM stat

Azithromycin 1g PO stat

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24
Q

Ophthalmia neonatorum caused by chlamydia is likely to appear when?

A

2 days post birth

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25
Q

Ophthalmia neonatorum caused by gonorrhoea is likely to appear when?

A

1 week post birth

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26
Q

Satellite lesions are present in which vaginal infection?

A

Candidiasis

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27
Q

Candidiasis is likely to cause superficial or deep dyspareunia?

A

Superficial

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28
Q

Candida is treated with which antifungals?

A

Oral fluconazole

Topical clotrimazole

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29
Q

How is candida treated in pregnancy?

A

clotrimazole pessary

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30
Q

Which STI has mobile flagellated protozoa?

A

TV

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31
Q

Pseudohyphae would be present under microscopy with which vaginal infection?

A

Thrush

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32
Q

Chlamydia would cause what symptoms in men?

A

White/yellow discharge (rare)

Dysuria

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33
Q

Gonorrhoea would cause what symptoms in men?

A

Green/yellow discharge
purulent
dysuria

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34
Q

What is balanitis?

A

Inflammation of the glans penis

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35
Q

If a man presents with thrush, what other investigation must he also have?

A

Urinalysis for glucose

? diabetes

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36
Q

What are the differentials for an itchy rash on the penis?

A 
candida balanitis 
circinate balanitis 
scabies 
Lichen simplex
Lichen sclerosis 
Lichen planus
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37
Q

What would be present on the penis with candida balanitis?

A

Red papillose
Superficial erosions
White plaques

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38
Q

What are the differentials for candida balanitis?

A

Lichen planus

Penile intraepithelial neoplasia (PIN)

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39
Q

A painless mucocutaneous lesion indicates which penile aetiology?
What is this associated with?

A

Circunate balanitis

Associated with reactive arthritis/Reiter’s syndrome

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40
Q

What is a differential diagnosis for circulate balanitis?

A

Psoriasis - indistinguishable

41
Q

What is the treatment for circunate balanitis?

A

Topical corticosteroid cream

42
Q

How does reactive arthritis present?

A

Urethritis
Conjunctivitis
Arthritis

43
Q

Widespread pruritus dermatitis & genital nodules would indicate which penile aetiology?
How is it treated?

A

Scabies

Permethrin 5% - treat whole household & close contacts

44
Q

How is scabies diagnosed?

A

Usually clinical

Skin scrapings

45
Q

Which condition is caused by chronic rubbing/itching?

How would you describe the skin?

A

Lichen simplex
Leathery/thickened skin
Affects the scrotum or labia majora

46
Q

What treatment is available for lichen simplex?

A

Emollients

Mild topical steroids

47
Q

Telangiectasia is present in which penile condition?

A

Lichen sclerosis

Abnormal dilatation of superficial blood vessels

48
Q

What is a complication of lichen sclerosis?

A

Squamous cell carcinoma (<4%)

49
Q

What are the symptoms of lichen sclerosis?

What is the treatment?

A

Itchy, sore
Palin tropic skin
Loss of architecture

Potent topical steroids

50
Q

Blue spots and perifolluculitis would be present in which skin condition?

A

Pubic lice

51
Q

What is the treatment for pubic lice?

A

Permethrin 1%
or Malathion 0.5%

Treat sexual partners

52
Q

A man complaining of flat-topped papules and white lacy papules may have which condition?

A

Lichen planus

53
Q

What is proctitis?

A

inflammation of the lining of the rectum

54
Q

What are the symptoms of proctitis?

A 
Bowel frequency 
Constipation 
Tenses 
Rectal pain
Mucous/blood in stools 
Rectal discharge 
Fever/lethergy
55
Q

How common is genital herpes?

A

2nd most common STI after chlamydia

56
Q

A woman comes in complaining of painful spots on her vulva these were initually red and are now open ulcers
You also note inguinal lymphadenopathy

What is your diagnosis? What is your treatment?

A

Genital herpes

During attack: aciclovir 200mg 3x a day for 5 days

57
Q

What is the typical presentation of genital herpes on a penis?

A

Shallow painful ulcers under the foreskin

58
Q

What % of genital herpes is caused by HSV1?

A

30%

59
Q

Herpes can cause what if caught during pregnancy?

A

Herpes encephalitis

60
Q

What is the treatment of genital herpes in pregnancy?

A

If primary herpes contracted in the 3rd trimester - treat with acyclovir throughout pregnancy and deliver via c-section

61
Q

A man comes in complaining of painless pearly coloured spots located in a circle around the corona of his penis

A

Pearly penile papules

Normal variant

62
Q

What is the treatment for molluscum contagiousum?

A

Self limiting, can persist for ~6 months

Can try cryotherapy if persists

63
Q

Condyloma latum is a manifestation of which disease?

How is it treated?

A

Secondary syphilis

IM BenPen 2.4MU

64
Q

A man comes in complaining of spots on his penis
On inspection there is a small cluster of spots which are umbilicate.
What causes this?

A

Molluscum contagiousum caused by DNA poxvirus
Self limiting
Can use cryotherapy if persists

65
Q

What is the medical term for genital warts?

A

Condylomata accuminata

66
Q

What virus causes genital warts?

A

HPV 6&11

67
Q

What is the incubation time of genital warts?

A

3 months

68
Q

A woman comes in complaining of painless skin-tag like lesions on her vulva

A

Genital warts

69
Q

What pharmacological therapies are available for genital warts?

A

Podophyllin paint - apply weekly

70
Q

TrepoNeumum Pallidum causes which STI?

A

Syphilis

71
Q

If someone comes in with lymphadenopathy and and ulcer, what are you 2 differentials? And how do you differentiate

A

Syphilis
HSV

Syphilis = painless
HSV = painful
72
Q

What is the name given to the painless solitary ulcer found in syphilis?

A

chancre

73
Q

What does secondary syphilis usually present?

A

5 weeks to 2 years after primary syphilis

74
Q

How does secondary syphilis present?

A

Fever, lymphadenopathy
Rash on trunk, palms & soles
Buccal snail track ulcers
Condylomata lata

75
Q

When does tertiary syphilis occur?

A

~5 years after initial infection

76
Q

What are the features of tertiary syphilis?

A

Neurosyphilis - dementia, tabes dorsalis
Cardiosyphilis - ascending aortic aneurysms
Gumma - granulomatous lesions of skin & bones

77
Q

What is tabes dorsalis

A

Demyelination of the dorsal column of the spinal cord caused by territory syphilis
Causes weakness, loss of co-ordination etc

78
Q

What are the complications of syphilis in pregnancy?

A

blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars
rhagades (linear scars at the angle of the mouth)
keratitis
saber shins
saddle nose
deafness

79
Q

AIDS is defined as CD4 count of what?

A

<200x10[6]/L

80
Q

How effective is PREP at from preventing HIV transmission?

A

86%

81
Q

If someone has had unprotected sex within 4 weeks, what HIV test is conducted?

What is conducted after 4 weeks?

A

2-4 weeks: HIV p-24 antigen

> 4 weeks: HIV antibodies

Confirm -ve result with repeat test in 3 months

82
Q

In a HIV +ve person, what must be measured every 3 months?

A

HIV RNA levels
CD4 count
Viral load

83
Q

HAART is commenced when CD4 count reaches what level?

A

350

84
Q

what does HAART stand for?

What does it consist of?

A

Highly active antiretroviral therapy

At least 3 antiretrovirals from at least 2 drug classes

85
Q

What vaccines are offered to those HIV positive?

A 
Pneumococcal
influenza 
Hepatitis 
Tetanus 
TB prophylaxis
86
Q

How often must a HIV positive woman undergo her smear test?

A

Yearly

87
Q

How long must a baby born to a HIV +ve mother receive PEP for?

A

1 month

88
Q

When must a baby born to a HIV +ve mother undergo a HIV test?

A

18 months

Before this a false positive may occur

89
Q

What is the most common causative organism for PID?

A

Chlamydia - 50-60%

90
Q

What is the management of PID?

A

Metronidazole
Azithromycin 1g stat
Ceftriaxone 500mg IM stat

91
Q

Infection of the lymph nodes by chlamydia causes what complication?

A

Lymphoma granuloma verum

Infection of L1, L2 & L3

92
Q

What is the most common presentation of lymphoma granuloma verum?

A

lymph node enlargement (Baboes)

Haemorrhagic proctitis

93
Q

What are the RF for LGV?

A

MSM
Anal sex
multiple partners
prostitutes

94
Q

What is the treatment of LGV?

A

Doxycycline 100mg bd for 3 weeks

95
Q

A man comes to A&E complaining of acute pain, swelling & inflammation of his epididymis
What are the differentials

A

Acute epididymo-orchitis

Testicular torsion

96
Q

What is the cause of acute epididymo-orchitis?

A

Gonorrhoea
Indwelling catheter
Anal intercourse

97
Q

How does acute epididymo-orchitis present?

A

Acute onset unilateral tenderness
Palpable swelling
STI hx - discharge etc

98
Q

How is acute epididymo-orchitis treated?

A

STI cause: Ceftriaxone 250mg IM + doxycycline 100mg 10-14 days

Non-STI: oflxocacin/ciprofloxacin 14 days

GOSH - LM (2 decks)

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