Sexual Health Flashcards
(98 cards)
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
2
Q
Women with no symptoms will receive which STI investigations?
A
VVS - C&G NAAT
Bloods - HIV & Syphilis
3
Q
Heterosexual men without symptoms will receive which STI investigations?
A
First stream urine - C&G NAAT
Bloods - HIV & Syphilis
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
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
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
7
Q
BV is caused by the overgrowth if which bacteria mainly?
A
Loss of lactobacilli & overgrowth of G vaginalis
8
Q
a pH of ≥4.5 can indicate which STI?
A
BV
TV
9
Q
Describe the discharge expected with BV
A
Thin watery discharge
grey/white
Fishy odour
10
Q
Which swab is taken if BV is suspected and what may be found on microscopy?
A
HVS
clue cells
11
Q
What is the treatment regime for BV?
A
Metronidazole 7/7
Clindamycin
12
Q
Is chlamydia gram +ve or gram -ve?
A
Gram -ve
13
Q
What does NAAT stand for?
A
Nucleic acid amplification test
14
Q
During pregnancy what treatment options are available for chlamydia?
A
Azithromycin 1g
Doxycycline 100mg cannot be used in pregnancy
15
Q
What type of discharge would be seen with chlamydia?
A
White/cloudy thick discharge
16
Q
Which chlamydial serotypes are most common in the UK?
A
D-K
17
Q
Name some complications of STIs
A
PID
Reactive arthritis - conjunctivitis, urethritis & arthritis
Fitz-Hugh Curtis - liver adhesions
18
Q
Frothy discharge would indicate which STI?
A
TV
19
Q
Cervicitis is seen in which STIs?
A
TV - strawberry cervix
Chlamydia
Gonorrhoea
20
Q
A strawberry cervix can be seen in which STI?
A
TV
21
Q
PCB & IMB can be signs of which STIs?
A
Chlamydia & Gonorrhoea
22
Q
What type of bacteria is gonorrhoea?
A
gram -ve diplococci
23
Q
What is the treatment of choice for gonorrhoea?
A
Ceftriaxone 500mg IM stat
Azithromycin 1g PO stat
24
Q
Ophthalmia neonatorum caused by chlamydia is likely to appear when?
A
2 days post birth
25
Ophthalmia neonatorum caused by gonorrhoea is likely to appear when?
1 week post birth
26
Satellite lesions are present in which vaginal infection?
Candidiasis
27
Candidiasis is likely to cause superficial or deep dyspareunia?
Superficial
28
Candida is treated with which antifungals?
Oral fluconazole
| Topical clotrimazole
29
How is candida treated in pregnancy?
clotrimazole pessary
30
Which STI has mobile flagellated protozoa?
TV
31
Pseudohyphae would be present under microscopy with which vaginal infection?
Thrush
32
Chlamydia would cause what symptoms in men?
White/yellow discharge (rare)
| Dysuria
33
Gonorrhoea would cause what symptoms in men?
Green/yellow discharge
purulent
dysuria
34
What is balanitis?
Inflammation of the glans penis
35
If a man presents with thrush, what other investigation must he also have?
Urinalysis for glucose
| ? diabetes
36
What are the differentials for an itchy rash on the penis?
```
candida balanitis
circinate balanitis
scabies
Lichen simplex
Lichen sclerosis
Lichen planus
```
37
What would be present on the penis with candida balanitis?
Red papillose
Superficial erosions
White plaques
38
What are the differentials for candida balanitis?
Lichen planus
| Penile intraepithelial neoplasia (PIN)
39
A painless mucocutaneous lesion indicates which penile aetiology?
What is this associated with?
Circunate balanitis
| Associated with reactive arthritis/Reiter's syndrome
40
What is a differential diagnosis for circulate balanitis?
Psoriasis - indistinguishable
41
What is the treatment for circunate balanitis?
Topical corticosteroid cream
42
How does reactive arthritis present?
Urethritis
Conjunctivitis
Arthritis
43
Widespread pruritus dermatitis & genital nodules would indicate which penile aetiology?
How is it treated?
Scabies
| Permethrin 5% - treat whole household & close contacts
44
How is scabies diagnosed?
Usually clinical
| Skin scrapings
45
Which condition is caused by chronic rubbing/itching?
| How would you describe the skin?
Lichen simplex
Leathery/thickened skin
Affects the scrotum or labia majora
46
What treatment is available for lichen simplex?
Emollients
| Mild topical steroids
47
Telangiectasia is present in which penile condition?
Lichen sclerosis
| Abnormal dilatation of superficial blood vessels
48
What is a complication of lichen sclerosis?
Squamous cell carcinoma (<4%)
49
What are the symptoms of lichen sclerosis?
| What is the treatment?
Itchy, sore
Palin tropic skin
Loss of architecture
Potent topical steroids
50
Blue spots and perifolluculitis would be present in which skin condition?
Pubic lice
51
What is the treatment for pubic lice?
Permethrin 1%
or Malathion 0.5%
Treat sexual partners
52
A man complaining of flat-topped papules and white lacy papules may have which condition?
Lichen planus
53
What is proctitis?
inflammation of the lining of the rectum
54
What are the symptoms of proctitis?
```
Bowel frequency
Constipation
Tenses
Rectal pain
Mucous/blood in stools
Rectal discharge
Fever/lethergy
```
55
How common is genital herpes?
2nd most common STI after chlamydia
56
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?
Genital herpes
| During attack: aciclovir 200mg 3x a day for 5 days
57
What is the typical presentation of genital herpes on a penis?
Shallow painful ulcers under the foreskin
58
What % of genital herpes is caused by HSV1?
30%
59
Herpes can cause what if caught during pregnancy?
Herpes encephalitis
60
What is the treatment of genital herpes in pregnancy?
If primary herpes contracted in the 3rd trimester - treat with acyclovir throughout pregnancy and deliver via c-section
61
A man comes in complaining of painless pearly coloured spots located in a circle around the corona of his penis
Pearly penile papules
| Normal variant
62
What is the treatment for molluscum contagiousum?
Self limiting, can persist for ~6 months
| Can try cryotherapy if persists
63
Condyloma latum is a manifestation of which disease?
| How is it treated?
Secondary syphilis
| IM BenPen 2.4MU
64
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?
Molluscum contagiousum caused by DNA poxvirus
Self limiting
Can use cryotherapy if persists
65
What is the medical term for genital warts?
Condylomata accuminata
66
What virus causes genital warts?
HPV 6&11
67
What is the incubation time of genital warts?
3 months
68
A woman comes in complaining of painless skin-tag like lesions on her vulva
Genital warts
69
What pharmacological therapies are available for genital warts?
Podophyllin paint - apply weekly
70
TrepoNeumum Pallidum causes which STI?
Syphilis
71
If someone comes in with lymphadenopathy and and ulcer, what are you 2 differentials? And how do you differentiate
Syphilis
HSV
```
Syphilis = painless
HSV = painful
```
72
What is the name given to the painless solitary ulcer found in syphilis?
chancre
73
What does secondary syphilis usually present?
5 weeks to 2 years after primary syphilis
74
How does secondary syphilis present?
Fever, lymphadenopathy
Rash on trunk, palms & soles
Buccal snail track ulcers
Condylomata lata
75
When does tertiary syphilis occur?
~5 years after initial infection
76
What are the features of tertiary syphilis?
Neurosyphilis - dementia, tabes dorsalis
Cardiosyphilis - ascending aortic aneurysms
Gumma - granulomatous lesions of skin & bones
77
What is tabes dorsalis
Demyelination of the dorsal column of the spinal cord caused by territory syphilis
Causes weakness, loss of co-ordination etc
78
What are the complications of syphilis in pregnancy?
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
AIDS is defined as CD4 count of what?
<200x10[6]/L
80
How effective is PREP at from preventing HIV transmission?
86%
81
If someone has had unprotected sex within 4 weeks, what HIV test is conducted?
What is conducted after 4 weeks?
2-4 weeks: HIV p-24 antigen
>4 weeks: HIV antibodies
Confirm -ve result with repeat test in 3 months
82
In a HIV +ve person, what must be measured every 3 months?
HIV RNA levels
CD4 count
Viral load
83
HAART is commenced when CD4 count reaches what level?
350
84
what does HAART stand for?
| What does it consist of?
Highly active antiretroviral therapy
At least 3 antiretrovirals from at least 2 drug classes
85
What vaccines are offered to those HIV positive?
```
Pneumococcal
influenza
Hepatitis
Tetanus
TB prophylaxis
```
86
How often must a HIV positive woman undergo her smear test?
Yearly
87
How long must a baby born to a HIV +ve mother receive PEP for?
1 month
88
When must a baby born to a HIV +ve mother undergo a HIV test?
18 months
| Before this a false positive may occur
89
What is the most common causative organism for PID?
Chlamydia - 50-60%
90
What is the management of PID?
Metronidazole
Azithromycin 1g stat
Ceftriaxone 500mg IM stat
91
Infection of the lymph nodes by chlamydia causes what complication?
Lymphoma granuloma verum
| Infection of L1, L2 & L3
92
What is the most common presentation of lymphoma granuloma verum?
lymph node enlargement (Baboes)
| Haemorrhagic proctitis
93
What are the RF for LGV?
MSM
Anal sex
multiple partners
prostitutes
94
What is the treatment of LGV?
Doxycycline 100mg bd for 3 weeks
95
A man comes to A&E complaining of acute pain, swelling & inflammation of his epididymis
What are the differentials
Acute epididymo-orchitis
| Testicular torsion
96
What is the cause of acute epididymo-orchitis?
Gonorrhoea
Indwelling catheter
Anal intercourse
97
How does acute epididymo-orchitis present?
Acute onset unilateral tenderness
Palpable swelling
STI hx - discharge etc
98
How is acute epididymo-orchitis treated?
STI cause: Ceftriaxone 250mg IM + doxycycline 100mg 10-14 days
Non-STI: oflxocacin/ciprofloxacin 14 days
