Sexual Health Flashcards by Luse Mwenechanya

Women with symptoms will be offered which STI investigations?

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

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Women with no symptoms will receive which STI investigations?

VVS - C&G NAAT

Bloods - HIV & Syphilis

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Heterosexual men without symptoms will receive which STI investigations?

First stream urine - C&G NAAT

Bloods - HIV & Syphilis

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Heterosexual men with symptoms will receive which STI investigations?

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

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MSM without symptoms will be offered which investigations?

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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MSM with symptoms will be offered which investigations?

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

Offer Hep B vaccine

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BV is caused by the overgrowth if which bacteria mainly?

Loss of lactobacilli & overgrowth of G vaginalis

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a pH of ≥4.5 can indicate which STI?

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Describe the discharge expected with BV

Thin watery discharge
grey/white
Fishy odour

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

HVS

clue cells

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What is the treatment regime for BV?

Metronidazole 7/7

Clindamycin

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Is chlamydia gram +ve or gram -ve?

Gram -ve

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What does NAAT stand for?

Nucleic acid amplification test

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During pregnancy what treatment options are available for chlamydia?

Azithromycin 1g

Doxycycline 100mg cannot be used in pregnancy

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What type of discharge would be seen with chlamydia?

White/cloudy thick discharge

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Which chlamydial serotypes are most common in the UK?

D-K

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Name some complications of STIs

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

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Frothy discharge would indicate which STI?

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Cervicitis is seen in which STIs?

TV - strawberry cervix
Chlamydia
Gonorrhoea

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A strawberry cervix can be seen in which STI?

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PCB & IMB can be signs of which STIs?

Chlamydia & Gonorrhoea

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What type of bacteria is gonorrhoea?

gram -ve diplococci

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What is the treatment of choice for gonorrhoea?

Ceftriaxone 500mg IM stat

Azithromycin 1g PO stat

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Ophthalmia neonatorum caused by chlamydia is likely to appear when?

2 days post birth

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Ophthalmia neonatorum caused by gonorrhoea is likely to appear when?

1 week post birth

Satellite lesions are present in which vaginal infection?

Candidiasis

Candidiasis is likely to cause superficial or deep dyspareunia?

Superficial

Candida is treated with which antifungals?

Oral fluconazole | Topical clotrimazole

How is candida treated in pregnancy?

clotrimazole pessary

Which STI has mobile flagellated protozoa?

Pseudohyphae would be present under microscopy with which vaginal infection?

Thrush

Chlamydia would cause what symptoms in men?

White/yellow discharge (rare) | Dysuria

Gonorrhoea would cause what symptoms in men?

Green/yellow discharge purulent dysuria

What is balanitis?

Inflammation of the glans penis

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

Urinalysis for glucose | ? diabetes

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

``` candida balanitis circinate balanitis scabies Lichen simplex Lichen sclerosis Lichen planus ```

What would be present on the penis with candida balanitis?

Red papillose Superficial erosions White plaques

What are the differentials for candida balanitis?

Lichen planus | Penile intraepithelial neoplasia (PIN)

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

Circunate balanitis | Associated with reactive arthritis/Reiter's syndrome

What is a differential diagnosis for circulate balanitis?

Psoriasis - indistinguishable

What is the treatment for circunate balanitis?

Topical corticosteroid cream

How does reactive arthritis present?

Urethritis Conjunctivitis Arthritis

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

Scabies | Permethrin 5% - treat whole household & close contacts

How is scabies diagnosed?

Usually clinical | Skin scrapings

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

What treatment is available for lichen simplex?

Emollients | Mild topical steroids

Telangiectasia is present in which penile condition?

Lichen sclerosis | Abnormal dilatation of superficial blood vessels

What is a complication of lichen sclerosis?

Squamous cell carcinoma (<4%)

What are the symptoms of lichen sclerosis? | What is the treatment?

Itchy, sore Palin tropic skin Loss of architecture Potent topical steroids

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

Pubic lice

What is the treatment for pubic lice?

Permethrin 1% or Malathion 0.5% Treat sexual partners

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

Lichen planus

What is proctitis?

inflammation of the lining of the rectum

What are the symptoms of proctitis?

``` Bowel frequency Constipation Tenses Rectal pain Mucous/blood in stools Rectal discharge Fever/lethergy ```

How common is genital herpes?

2nd most common STI after chlamydia

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

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

Shallow painful ulcers under the foreskin

What % of genital herpes is caused by HSV1?

30%

Herpes can cause what if caught during pregnancy?

Herpes encephalitis

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

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

What is the treatment for molluscum contagiousum?

Self limiting, can persist for ~6 months | Can try cryotherapy if persists

Condyloma latum is a manifestation of which disease? | How is it treated?

Secondary syphilis | IM BenPen 2.4MU

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

What is the medical term for genital warts?

Condylomata accuminata

What virus causes genital warts?

HPV 6&11

What is the incubation time of genital warts?

3 months

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

Genital warts

What pharmacological therapies are available for genital warts?

Podophyllin paint - apply weekly

TrepoNeumum Pallidum causes which STI?

Syphilis

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 ```

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

chancre

What does secondary syphilis usually present?

5 weeks to 2 years after primary syphilis

How does secondary syphilis present?

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

When does tertiary syphilis occur?

~5 years after initial infection

What are the features of tertiary syphilis?

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

What is tabes dorsalis

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

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

AIDS is defined as CD4 count of what?

<200x10[6]/L

How effective is PREP at from preventing HIV transmission?

86%

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

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

HIV RNA levels CD4 count Viral load

HAART is commenced when CD4 count reaches what level?

350

what does HAART stand for? | What does it consist of?

Highly active antiretroviral therapy At least 3 antiretrovirals from at least 2 drug classes

What vaccines are offered to those HIV positive?

``` Pneumococcal influenza Hepatitis Tetanus TB prophylaxis ```

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

Yearly

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

1 month

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

18 months | Before this a false positive may occur

What is the most common causative organism for PID?

Chlamydia - 50-60%

What is the management of PID?

Metronidazole Azithromycin 1g stat Ceftriaxone 500mg IM stat

Infection of the lymph nodes by chlamydia causes what complication?

Lymphoma granuloma verum | Infection of L1, L2 & L3

What is the most common presentation of lymphoma granuloma verum?

lymph node enlargement (Baboes) | Haemorrhagic proctitis

What are the RF for LGV?

MSM Anal sex multiple partners prostitutes

What is the treatment of LGV?

Doxycycline 100mg bd for 3 weeks

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

Acute epididymo-orchitis | Testicular torsion

What is the cause of acute epididymo-orchitis?

Gonorrhoea Indwelling catheter Anal intercourse

How does acute epididymo-orchitis present?

Acute onset unilateral tenderness Palpable swelling STI hx - discharge etc

How is acute epididymo-orchitis treated?

STI cause: Ceftriaxone 250mg IM + doxycycline 100mg 10-14 days Non-STI: oflxocacin/ciprofloxacin 14 days