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4th Year - Management > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

HIV - CD4 levels

A

Normal = >600

HIV Treatment = <350

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2
Q

HIV Seroconversion Syndrome

A

Flu like symptoms/ SPUR infection

Sudden drop in CD4 before body mounts response

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3
Q

HIV -Testing

A

Verbal consent to test

Test: 4 weeks after exposure
Re test: 3 months to confirm

P24 antigen detected by 2-4 weeks

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4
Q

HIV - Risk

A 
MSM or sex with MSM
IVDU or sex with IVDU
HIV +ve Partner
Partner not from the UK
Paid or pay for sex
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5
Q

HIV - Prevention (Non-Medical)

A

Screening
Condom access and promotion
Clean needles and exchanges

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6
Q

HIV - Medical Prevention

A

PEP

  • Following occupational exposure (within 1 hour)
  • Then HAART for 28 days

HAART
- Reduce to undetectable viral load

PrEP

  • Pre exposure prophylaxis
  • Currently only on private Rx

PEPSE
- Condom failure/UPSI in last 72hours

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7
Q

HIV - Clinical Presentation

A

Opportunistic infections

  • Severe
  • Persistant
  • Unusual
  • Recurrent

e.g. herpes, shingles, oral thrush, hairy leukoplakia

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8
Q

HIV and Malignancy

A

AIDS defining (marks point where HIV becomes AIDs)

  • Kaposis sarcoma (herpes)
  • Non-hodgkins lymphoma
  • Invasive cervical carcinoma

Other:
NSC lung cancer, anal, tongue Ca

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9
Q

HIV - Treatment

A
  1. Treat opportunistic infection
  2. Prevention of infection
    - aciclovir for herpes
    - CD4 <200 = co-trimoxazole to prevent toxoplasmosis
    - <50 = Azithromycin
  3. HAART
    - 3 drugs from 2 different classes
    - Anyone diagnosed with HIV should have HAART
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10
Q

HIV - HAART Side Effects

A
  • Reduced bone density
  • N&V
  • Systemic hypersensitivity reaction
  • Insomnia
  • Cushing’s
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11
Q

HIV - HAART Interactions

A

Contraception
- Use Depo

Resistance

  • Baseline resistance
  • If patient compliant, consider?

P450 inhibitors

Steroids
- Increased cushings’

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12
Q

Female Investigations

A

Swabs

  • HVS
  • VVS
  • Endo cervical

Bloods

  • HIV
  • Syphilis

Urine dip

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13
Q

Male Investigations

A

First void urine

Bloods

  • HIV
  • Syphilis

Swabs

  • If discharge, urethral
  • MSM: oropharyngeal/rectal swab
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14
Q

Chlamydia Rx

A

Azithromycin 1g stat

or

Doxycyline 200mg then 100mg OD for 7 days

PARTNER NOTIFICATION
- No intercourse until both have been treated

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15
Q

Vaginal Infection - Rx

A

BV/TV
- Metronidazole 400mg BD 7 days

Candida
- Clotrimazole +/- topical canesten

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16
Q

Gonorrhoea Rx

A

Ceftriaxone 500mg IM Stat

AND

Azithromycin 1g stat

17
Q

Rash/Skin Changes - Investigations

A

Swab

  • Viral PCR for herpes
  • Subpreputial

Urine dip
- Glucose if candida

18
Q

Rash/Skin Changes Rx

A

Candida
- Clotrimazole +/-canesten

Eczema
- Betnovate

Lichen sclerosis
- Potent steroid

Scabies

  • Permethrin
  • Treat household contacts
19
Q

STI Complications - Local Female

A

PID

  • Tubal infertility
  • Ectopic

Perihepatitis
- Fitz-Hugh-Curtis

Bartholin’s Abcess

20
Q

STI - Complications - Local Male

A

Epididymorchitis

  • Ceftrioxone 500mg IM
  • Doxycucline 100mg BD for 14 days

Proctitis

  • Treat cause (STI)
  • DDx = shigella if diarrhoea (stool samples)
21
Q

Skin/Membrane STI Complications

A

Bacterial conjunctivitis

  • Chlamydia = low grade irritation
  • Gonorrhoea = purulent discharge and Rx

Sexually Acquired reactive arthritis
- <1% of chlamydia = inflammation of tendoms/fascia

Reiter’s Syndrome (HLA-B27)

  • Urethritis
  • Arthritis
  • Conjunctivitis

Disseminated gonococcal infection

  • Rare
  • Skin lesions, arthralgia etc.
22
Q

Lymphomagranuloma Venerum - Mx

A

Doxycycline 100mg BD for 3 weeks
- Partner notification

RF - big cities, sex parties

Invasive chlamydia strand
- Fibrosis, strictures, fistulae

23
Q

STIs in Pregnancy - Rx

A

Chlamydia - IUGR, PROM, Prematurity
- Azithromycin 1g stat

Gonorrhoea - LBW, Prematurity

  • Ceftrioxone 500mg IM stat
  • Azithromycin 1g stat
24
Q

STIs in Pregnancy - Neonatal Complications

A

Opthalmia Neonatorum

  • Chlamy = 1-2 weeks
  • Gonn = <5 days

Neonatal Pneumonitis

  • Clamydia, 1-3 months
  • Cough, increased RR
  • Give Erythromycin IV

4th Year - Management (11 decks)

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