Sexual Health Flashcards
HIV - CD4 levels
Normal = >600
HIV Treatment = <350
HIV Seroconversion Syndrome
Flu like symptoms/ SPUR infection
Sudden drop in CD4 before body mounts response
HIV -Testing
Verbal consent to test
Test: 4 weeks after exposure
Re test: 3 months to confirm
P24 antigen detected by 2-4 weeks
HIV - Risk
MSM or sex with MSM IVDU or sex with IVDU HIV +ve Partner Partner not from the UK Paid or pay for sex
HIV - Prevention (Non-Medical)
Screening
Condom access and promotion
Clean needles and exchanges
HIV - Medical Prevention
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
HIV - Clinical Presentation
Opportunistic infections
- Severe
- Persistant
- Unusual
- Recurrent
e.g. herpes, shingles, oral thrush, hairy leukoplakia
HIV and Malignancy
AIDS defining (marks point where HIV becomes AIDs)
- Kaposis sarcoma (herpes)
- Non-hodgkins lymphoma
- Invasive cervical carcinoma
Other:
NSC lung cancer, anal, tongue Ca
HIV - Treatment
- Treat opportunistic infection
- Prevention of infection
- aciclovir for herpes
- CD4 <200 = co-trimoxazole to prevent toxoplasmosis
- <50 = Azithromycin - HAART
- 3 drugs from 2 different classes
- Anyone diagnosed with HIV should have HAART
HIV - HAART Side Effects
- Reduced bone density
- N&V
- Systemic hypersensitivity reaction
- Insomnia
- Cushing’s
HIV - HAART Interactions
Contraception
- Use Depo
Resistance
- Baseline resistance
- If patient compliant, consider?
P450 inhibitors
Steroids
- Increased cushings’
Female Investigations
Swabs
- HVS
- VVS
- Endo cervical
Bloods
- HIV
- Syphilis
Urine dip
Male Investigations
First void urine
Bloods
- HIV
- Syphilis
Swabs
- If discharge, urethral
- MSM: oropharyngeal/rectal swab
Chlamydia Rx
Azithromycin 1g stat
or
Doxycyline 200mg then 100mg OD for 7 days
PARTNER NOTIFICATION
- No intercourse until both have been treated
Vaginal Infection - Rx
BV/TV
- Metronidazole 400mg BD 7 days
Candida
- Clotrimazole +/- topical canesten
Gonorrhoea Rx
Ceftriaxone 500mg IM Stat
AND
Azithromycin 1g stat
Rash/Skin Changes - Investigations
Swab
- Viral PCR for herpes
- Subpreputial
Urine dip
- Glucose if candida
Rash/Skin Changes Rx
Candida
- Clotrimazole +/-canesten
Eczema
- Betnovate
Lichen sclerosis
- Potent steroid
Scabies
- Permethrin
- Treat household contacts
STI Complications - Local Female
PID
- Tubal infertility
- Ectopic
Perihepatitis
- Fitz-Hugh-Curtis
Bartholin’s Abcess
STI - Complications - Local Male
Epididymorchitis
- Ceftrioxone 500mg IM
- Doxycucline 100mg BD for 14 days
Proctitis
- Treat cause (STI)
- DDx = shigella if diarrhoea (stool samples)
Skin/Membrane STI Complications
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.
Lymphomagranuloma Venerum - Mx
Doxycycline 100mg BD for 3 weeks
- Partner notification
RF - big cities, sex parties
Invasive chlamydia strand
- Fibrosis, strictures, fistulae
STIs in Pregnancy - Rx
Chlamydia - IUGR, PROM, Prematurity
- Azithromycin 1g stat
Gonorrhoea - LBW, Prematurity
- Ceftrioxone 500mg IM stat
- Azithromycin 1g stat
STIs in Pregnancy - Neonatal Complications
Opthalmia Neonatorum
- Chlamy = 1-2 weeks
- Gonn = <5 days
Neonatal Pneumonitis
- Clamydia, 1-3 months
- Cough, increased RR
- Give Erythromycin IV
