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Finals > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

What is the normal vaginal pH.

How is this beneficial?

A

<4.5

inhibits growth of other bacteria

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2
Q

What maintains the normal vaginal pH

A

lactobacilli produce hydrogen peroxide - maintains acidic pH

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3
Q

What is the pathophysiology of bacterial vaginosis

A

disturbance of normal vaginal flora
decrease in lactobacilli
increase in Gardnerella vaginalis, anaerobes and mycoplasma
increase in vaginal pH >4.5

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4
Q

What are the risk factors for BV?

A 
new or multiple sexual partners
scented soaps/douching
STIs
recent abx
IUD
receptive oral sex
smoking
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5
Q

What are the symptoms of BV

A

50% asymptomatic
fishy odour
white/grey homogenous thin vaginal discharge
no soreness/irritation

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6
Q

What is the differential diagnosis for BV

A

vaginal candidiasis
STI
trichomonas vaginalis

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7
Q

What investogations are done for BV

A

high vaginal smear of discharge, gram stained

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8
Q

What are Amsel’s criteria

A

help to diagnose BV - need >=3

homogenous white/grey thin discharge
bacilli on microscopy of smear - clue cells
pH >4.5
positive KOH whiff test

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9
Q

What are clue cells

A

vaginal epithelium studded with gram variable coccobacilli - indicate presence BV

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10
Q

What are the Ison/Hay criteria?

A

Way of classifying BV depending on gram stained smear of vaginal discharge

Grade 1 - mainly lactobacilli = normal
grade 2 - some lactobacilli, others present = intermediate
grade 3 - few lactobacilli, others predominate = BV

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11
Q

What is the management of BV

A

metronidazole 400mg BD 5 days
avoid scented shower gels, douching
?removal IUD

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12
Q

What are the risks of BV in pregnancy

A

premature birth
miscarriage
chorioamnionitis

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13
Q

What microorganism is involved in Vaginal candidiasis

A

Candida albicans - 90%

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14
Q

Describe the pathophysiology of vaginal candidiasis

A

opportunistic - immunocompromised leads to infection

hypersensitivity - changes in oestrogen etc leads to hypersensitivity reaction

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15
Q

What are the risk factors for candida

A 
pregnancy
DM
immunocompromised
recent course of broad spectrum Abx
corticosteroids
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16
Q

What are the symptoms of candida

A

vulval itch
superficial dysruria
vaginal discharge -white, curd like, non-offensive

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17
Q

What can be seen in examination in candida

A

white curd like vaginal discharge
satellite lesions
erythema and swelling of vulva

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18
Q

Differential diagnosis of candidiasis

A 
BV
TV
UTI
contact dermatitis
eczema/psoraisis
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19
Q

What investigations are needed to diagnose candidiasis

A

if uncomplicated - none! do on history + examination

if complicated eg. DM, pregnancy, recurrent
- do vaginal smear and microscopy (see spores adn mycelia)

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20
Q

What is the management of candidiasis

A

topical clotrimazole for vagina

oral fluconazole

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21
Q

What is the management of recurrent candidiasis

A

3 x 150mg oral fluconazole over 10 days

500mg clotrimazole once a week for 6 months

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22
Q

What is the management of candidiasis in pregnancy

A

NOT oral
pessary of clotrimazole - avoid damaging cervix with applicator for vaginal cream

check for otehr STIs which could be dangerous in pregnancy

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23
Q

How quickly should candidiasis clear up with treatment

What should be done if the infection does not clear?

A

within 7-10 days

consider alternative diagnosis
modify predisposing factors eg. diabetic control
consider concordance

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24
Q

When is emergency contraception used?

A

after sexual intercourse if:

unprotected sex
failed method of contraception

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25
Q

What are the options for emergency contraception

A

levonorgestrel
ullipristal acetate
copper IUD

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26
Q

Which method of emergency contraception is most effective?

A

copper IUD

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27
Q

How does levonorgestrel work?

A

synthetic progesterone
prevents ovulation for 5-7days
no effect on implantation

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28
Q

How does ullipristal acetate work?

A

progesterone receptor modulator
delay ovulation for 5-7days
prevents development of follicles/rupture of follicles at time of LH surge but not after

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29
Q

How does the copper IUD work as emergency contraception?

A

toxic to sperm

makes implantation impossible due to inflammation of endometrium

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30
Q

What time frame can each form of emergency contraception be used within?

A

levonorgestrel - 72 hours
ullipristal acetate - 72-120 hours
copper IUD - 5 days/ 5 days ovulation

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31
Q

What are the contraindications to levonorgestrel

A

malabsorption eg crohn’s

enzyme inducing drugs

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32
Q

What are the contraindications to ullipristal acetate

A

malabsorption eg crohn’s
enzyme inducing drugs
breast feeding
hepatic dysfucntion

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33
Q

What are the contraindications to copper IUD

A

uterine fibroids
suspected/documented PID
suspected/documented STI

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34
Q

What needs to be done before inserting a copper IUD

A

test for STI - chlamydia at least

can give dose of prophylactic abx to cover

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35
Q

What are the side effects of hormonal emergency contraception

A 
nausea - should take second dose if vomit within 2/3 hours
diarrhoea
menstrual disturbance
breast tenderness
abdo pain
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36
Q

What are the complications of copper IUD emergency contraception

A 
increased risk of ectopic pregnancy
pelvic infections
expulsion IUD
bleeding
pelvic pain
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37
Q

What causes chlamaydia and what kind of organism is it?

A

Chlamydia trachomatis

obligate intracellular gram -ve bacteria

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38
Q

What do the different serotypes of chlamydia cause?

A 
A-C = conjuntivitis
D-K = urogenital
L1-L3 = lymphogranuloma venereum causing proctitis
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39
Q

How is chlamydia transmitted

A

skin to skin contact

oral, anal, vaginal sex

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40
Q

What is the incubation period for chlamydia

A

7-21 days

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41
Q

What are the risk factors for chlamydia

A 
<25y
sexual partner who is chlamydia +ve
change in sexual partner
unprotected sex
co-infection with another STI
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42
Q

What are the symptoms of chlamydia in a male?

A

none -50%
testicular pain
urethral discharge
dysuria

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43
Q

What are the symptoms of chlamydia in a female?

A 
none- 70%
change in discharge
dysuria
IMB/PCB
deep dyspareunia
lower abdo pain
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44
Q

What are the signs of chlamydia in a male?

A

epididymal tenderness

mucopurulent discharge

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45
Q

What are the signs of chlamydia in a female?

A

mucopurulent endocervical discharge
cervicitis/contact bleeding
cervical motion tenderness
pelvic tenderness

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46
Q

How is chlamydia investigated

A

NAAT

  • male: first catch urine, urethral swab
  • female: vulvo/vaginal swab, endocervical swab, first catch urine

full STI screen

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47
Q

How is chlamydia managed

A

uncomplicated:
- doxycycline 100mg BD 7days
OR
- single dose 1g azityhromycin

avoid sex until treatment finished

contact tracing

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48
Q

When should a test of cure be sought following for chlamydia treatment

A

if pregnant
poor compliance
symptoms persist

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49
Q

What are the complications of chlamydia for women

A

salpingitis or endometritis leading to PID

leading to:
perihepatitis
increased risk ectopic pregnancy
infertility

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50
Q

What are the complications of chlamydia for men

A

epididymitis
epididymo-orchitis

could lead to infertility

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51
Q

What are the risks of chlamydia in pregnancy

A

premature birth
low birth weight

neonatal chlamydial conjunctivitis in first 2 weeks
pneumonia at 1-3months

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52
Q

What is the treatment of chlamydia during pregnancy

A

azithromycin and erythromycin

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53
Q

Which STI can lead to reactive arthritis?

A

Chlamydia

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54
Q

What organism causes gonorrhoea?

A

Neisseria gonorrhoeae

Gram-negative diplococcus

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55
Q

How is gonorrhoea transmitted?

A

unprotected sex - vaginal, oral, anal

vertical

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56
Q

What is the incubation period for gonorrhoea?

A

2-5days

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57
Q

What are the risk factors for gonorrhoea

A

<25y
new sexual partner
MSM
prev infection

58
Q

What are the symptoms of gonorrhoea in a man?

A

mucopurulent urethral discharge

dysuria

59
Q

What are the symptoms of gonorrhoea in a woman?

A 
50% asymptomatic
change in discharge - watery, thin, green/yellow
dyspareunia
dysuria
lower abdo pain
60
Q

What are the signs of gonorrhoea in a man?

A 
mucopurulent urethral discharge
epididymal tenderness (rare!)
61
Q

What are the signs of gonorrhoea in a woman?

A

normal examination
mucopurulent endocervical discharge
cervix bleeds easily
pelvic tenderness

62
Q

What investigations should be done to investigate gonorrhoea

A

males: first pass urine NAAT, urethral swab microscopy and culture
females: endocervical/vaginal swab - NAAT and microscopy and culture

full STI screen - G+C, HIV, syphilis

63
Q

What is the management of gonorrheoa

A

ceftriaxone 500mg IM STAT
azithromycin 1g PO STAT

abstain until finished treatment
contact tracing
advice on safe sex
test of cure after 2 weeks

64
Q

What are the complications of gonorrheoa?

A

females: PID
males: epididymo-orchitis, prostatitis
both: disseminated gonococcal infection

65
Q

What are the some of the problems caused by disseminated gonococcal infection?

A

arthritis
skin lesions
meningitis
endocarditis

66
Q

What problems can gonorrhoea cause in pregnancy>

A

premature labour
spontaneous abortion
early fetal membrane rupture
vertical transmission

67
Q

What problems are associated with vertical transmission of gonorrhoea

A

gonococcal conjunctivitis in neonate - can lead to blindness

68
Q

What organism causes genital warts

A

HPV6 or HPV11 - double-stranded-DNA papovaviruses

causes 90% genital warts

69
Q

How are genital warts transmitted?

A

skint o skin contact

70
Q

Can you still catch genital warts if you use a condom?

A

yes! condom does not completely cover all skin in genital area

71
Q

Which strains of HPV cause cervical cancer

A

HPV16

HPV18

72
Q

What are genital warts

A

benign proliferative epithelial growths

73
Q

What are the risk factors for genital warts

A 
early age at first sexual intercourse
multiple sexual partners
immunosupression
smoking
DM
74
Q

What are the symptoms of HPV

A

no symptoms at all - infection occurs with no warts and then resolves

warts! - painless, fleshy. can be soft/hard, singular/multiple

75
Q

What is the differential diagnosis for HPV

A 
molluscum contagiosum
vestibular papillomatosis
Epidermoid cysts.
Hair follicles.
Sebaceous glands.
Skin tags.
Pearly penile papules
76
Q

What investigations should be done in someone with genital warts?

A

full STI screen
vaginal speculum/rectal proctoscopy
biopsy if atypical ?cancer

77
Q

What is the management of genital warts?

A

reassurance - they are benign and do resolvev spontaneously!

multiple warts:

  1. podophyllotoxin BD 3d/week.
  2. review after 4 weeks, continue if >50% improvement, change to imiguimod OD alternate days 3d/week for 16 weeks
  3. excision

One or few warts

  1. podophyllotoxin BD 3d/week. OR cryo once per week
  2. review after 4 weeks, continue if >50% improvement, change to imiguimod OD alternate days 3d/week for 16 weeks/podo regime
  3. excision
78
Q

What treatments for genital warts are able to be used in pregnancy

A

NOT podophylllotoxin or imiquimod
give cryo once weekly
consider excision or defer untila fter pregnanvy

79
Q

Do genital warts cause any problems during pregnancy

A

no risks to mother or fetus

warts can multiply or enlarge

80
Q

What has been done to reduce the incidence of genital warts?

A

HPV vaccine to 12-13 year old girls
2008 HPV 16 and 18 only
2012 also HPV 6 and 11

81
Q

What causes syphilis?

A

Treponema pallidum

gram negative spirochete

82
Q

How is syphilis transmitted?

A

break in skin or via mucous membrane in sexual contact

vertical transmission to fetus

83
Q

Describe the stages of syphilis

A

primary
= 9-90 days after infection. chancre formation. resolves spontaneously

secondary
= 6-12 weeks after infection. generalised symptoms, lymphadenopathy, rash on soles and palms
resolves in 2/3 months

latent phase - no sx
early = less than 2 years since infection
late = more than two years since infection

teartiaty
type IV hypersensitivity reaction
neurosyphilis, cardiovascular syphilis or gummatous syphilis

84
Q

Describe the chancre seen in primary syphilis

A

raised border, hard base, painless, non-itchy

found on genitals

85
Q

What are the risk factors for syphilis

A

UPSI
multiple sexual partners
HIV
MSM

86
Q

What are the signs and symptoms of secondary syphilis?

A 
fever
headaches
malaise
arthralgia
skin rash on palms and soles
weight loss
painless lymphadenopathy
87
Q

What are the signs and symptoms of gummatous syphilis?

A

Inflammatory fibrous nodules or plaques (granulomas) in bone, skin, mucous membranes, connective tissue, organs

88
Q

What are the signs and symptoms of neurosyphilis?

A

tabes dorsalis = (loss of dorsal column) ataxia, numb legs, absence of deep tendon reflexes, lightning pains, loss of pain and temperature sensation, skin and joint damage.
dementia
meningovascular
Argyle-robertson pupils = loss of light reflex, accomodation remains

89
Q

What are the signs and symptoms of cardiovascular yphilis?

A

aortitis -usually involves the aortic root but may affect other parts of the aorta

aortic regurgitation,
aortic aneurysm
angina.

90
Q

What investigations are done for syphilis?

A

swab and dark field microscopy
blood serology
- EIA for treponemal IgG and IgM = exposure to treponemes
- TPHA/TPPA selective for T pallidum

RPR is used to stage syphilis and show response to treatment

91
Q

What is the management of syphilis

A

early: benzathine penicillin 2.4 megaunits IM STAT
late: benzathine penicillin 2.4 megaunits IM 3 doses at weekly intervals

avoid sexual contact
screen for other STIs
contact tracing
follow up serology
repeat screening to find re-infection
92
Q

What are the risks of having syphilis during pregnancy

A

stillbirth
miscarriage
pre-term labour
congenital syphilis

93
Q

What STIs are pregant women screened for

A

syphilis
HIV
hepatitis B

94
Q

Describe congenital syphilis

A

early = <2y old
rash on palms and soles, hemorrhagic rhinitis, lymphadenopathy, hepatosplenomegaly

late = >2y
arthritis of the knees, Hutchininson’s incisors, saddle nose deformity

95
Q

What reaction can occur after treating syphilis? Descibe this

A

Jarisch Herxheimer reaction

Flu like symptoms 24 hours after treatment due to inflammation secondary to death of treponemes

can be dangerous in pregnancy - can cause contractions, fetal heart rate abnormalities and even stillbirth

96
Q

What causes trichomoniasis

A

Trichonomas vaginalis

anaerobic flagellated protozoan

97
Q

How is trichomoniasis transmitted

A

only through unprotected vaginal sex

not anal or oral!

98
Q

What are the risk factors for TV

A

multiple sexual partners
UPSI
other STIs
older age!

99
Q

What are the symptoms of TV in males?

A

urethral discharge
dysuria
frequency
painful/ithching foreskin

100
Q

What are the symptoms of TV in females?

A

offensive frothy green/yellow discharge
dysuria
dyspareunia
itchy/sore vuvla

101
Q

What are the signs of TV in males?

A

urethral discharge

102
Q

What are the signs of TV in females?

A

offensive frothy green/yellow discharge
strawberry cervix
vulvitis
vaginitis

103
Q

What investigations should be done in suspected TV

A

males: urethral swab/first pass urine for NAAT and MC+S
females: high vaginal swab from posterior fornix/vaginal swab - NAAT and MC+S

104
Q

What is the management of TV

A

metronidazole 2g PO STAT
contact tracing
full STI screen
abstain for 1 week after treatment

105
Q

what are the risks of TV during pregnancy

A

premature labour
low birth weight
maternal post partum sepsis

106
Q

What causes genital herpes

A

HSV1 or HSV2

107
Q

How is herpes transmitted

A

skin to skin contact during sexual intercourse
can be transmitted via oral sex - coldsores

NB: asymptomatic shedding - pt does not need to have symptoms to transmit virus

108
Q

Describe the relationship between primary and recurrent herpes

A

primary = initial infection
virus travels to local sensory ganglion
reactivation = moves back down to skin to cause recurrent infections

109
Q

What are the risk factors for herpes

A 
multiple sexual partners
UPSI
other STIs
oral sex
MSM
HIV
110
Q

What are the symptoms of primary herpes

A 
bilateral red painful blisters around genitals
urethral/vaginal discharge
fever
muscles aches
itchy genitals

resolves after 20 days

111
Q

What are the symptoms of recurrent herpes

A

burning/itching around the genitals
painful red blisters - often unilateral

shorter duration - 10 days
less severe lesions
decrease in severity over time

112
Q

What investigations can be done in suspected herpes?

A

swab from open sore - PCR
can do serology - can identify those with asymptomatic infection but may take up to 12 weeks to become positive after primary infection

113
Q

What is the management of herpes

A

counselling - this is a life long infection
full STI screen
antivirals can decrease the size and number of lesions, but cannot cure it
abstain during outbreaks
contact tracing

primary: aciclovir 400mg TDS for 5 days
recurrent: 800mg TDS 2 days

114
Q

When can suppresive therapy for herpes be considered?

A

> 6 episodes a year

take 400mg BD every day

115
Q

What problems can herpes cause during pregancy

A

risk of transmission to baby at birth causing neonatl herpes

116
Q

Which trimester is a new primary infection of herpes most likely to cause neonatal herpes in?

A

third trimester

117
Q

How is herpes managed during pregnancy

A

primary infection
first/second trimester: aciclovir initially, aciclovir from 36 weeks (400mg TDS), normal vaginal delivery
third trimester:
first/second trimester: aciclovir initially, aciclovir from 36 weeks. C SECTION to reduce risk transmission

recurrent infection
aciclovir at 36 weeks, vaginal delivery

118
Q

Describe neonatal herpes

A

occurs 2 days - 6 weeks after delivery
localised infection - vesciles on skin, eyes or moith
CNS infection can cause lethargy, feeding difficulties and seizures
disseminated infection can cause jaundice, hepatosplenomegaly and DIC

119
Q

What causes HIV

A

human immunodeficiency virus

single stranded RNA retrovirus

120
Q

Describe the pathophysiology og HIV

A

HIV virus infects CD4 T Helper cells

repilicates inside them using reverse transcriptase and integrase enzymes

121
Q

How is HIV transmitted

A

unprotected sex - vaginal, oral, anal
contaminated needles
pregnancy - in utero, at delivery and via breast feeding

122
Q

What are the risk factors for HIV

A

UPSI with someone who has lived in/travelled to Africa
MSM
IVDU
from a high prevalence area

123
Q

Describe the presentation and time course of HIV

A
  1. seroconversion illness
    occurs 2-6 weeks after infection
    flu like - fever, muscle aches, malaise, lymphadenopathy, maculopapular rash, pharyngitis
  2. latent - asymptomatic
  3. symptomatic = AIDS related complex
    weight loss, fever, diarrhoea, night sweats, freq opportunistic infections eg. candida, herpes simplex, HZV
  4. AIDS
    presence of defining illness eg. Hodgkin’s lymphoma, pneumocystis jiroveci
124
Q

How is HIV tested for?

A

serum ELISA - for HIV Ab and p24 antigen

Ab show up 4-6 weeks after infection
p24 antigen shows in active infection even if no Ab yet

125
Q

How is HIV monitored

A

CD4 count

viral load

126
Q

How is HIV treated

A

highly active antiretroviral therapy (HAART) is begun as soon as HIV diagnosis is given
eg. atripla, stribild, triumeq

contact tracing
counselling

127
Q

What other investigations should be done at time of HIV diagnosis

A

Assessment for other infections: eg, tuberculosis, hepatitis B, cytomegalovirus (CMV), toxoplasma, syphilis, varicella.
Screening for co-existing sexually transmitted infections (STIs).
Baseline CXR and cervical smear

128
Q

What are the risks of HIV during pregnancy and how is this reduced?

A

risk of tranmission to fetus in utero, at birth or during breast feeding

HAART during pregnancy and delivery
avoid breastfeeding
neonatal PEP

C section not recommended if viral load is undetectable

129
Q

Explain what PEP is

A

post exposure prophylaxis
given within 72 hours of exposure to HIV
one month course

130
Q

Describe the pathophysiology of PID

A

ascending infective inflammation of upper female genital tract
caused by Chlamydia, gonnorhoea, normal vaginal flora, mycoplasma etc

131
Q

What are the risk factors for PID

A 
15-24
UPSI
sexually active
recent change in sexual partner
history of STI
prev hx of PID
IUD
TOP
gynae surgery
132
Q

What are the symptoms of PID

A 
sometimes none
bilateral pelvic pain
PCB, IMB, heavy bleeding
purulent vaginal or cervical discharge
deep dyspareunia
133
Q

What are the signs of PID

A

bilateral lower abdominal tenderness
speculum: purulent endocervical discharge, cervicitis
bimanual: cervical motion tenderness, adnexal tenderness
fever
N+V

134
Q

What is the differential diagnosis for PID

A 
ectopic pregnancy
appendicitis
tubo-ovarian abscess
ruptured ivarian cyst
endometriosis
UTI
135
Q

What investigations should be done in suspected PID

A

pregnancy test
urine dip and MSU
endocervical and vaginal swab - G+C, TV, BV
full STI screen
TV US scan
laparoscopy - severe cases if diagnostic uncertainty

136
Q

What is the management of mild/moderate PID

A

Abx at home for 14 days
ceftriaxone - 500mg IM STAT
doxycycline 100mg BD PO
metronidazole 400mg BD PO

analgesia
abstain from sexual intercourse until treatment finished
contact tracing

137
Q

What suggests that hospital admission is needed in severe cases of suspected PID

A

If pregnant and especially if there is a risk of ectopic pregnancy.
Severe symptoms: nausea, vomiting, high fever.
Signs of pelvic peritonitis.
Unresponsive to oral antibiotics, need for IV therapy.
Need for emergency surgery or suspicion of alternative diagnosis.

138
Q

What is the treatment for severe PID

A

IV abx in hospital

stop IV when improved for 24 hours and swithv to oral for 14 day course

139
Q

what are the long term consequences of PID

A 
infertility
ectopic pregnancy - due to narrowing and scarring of the fallopian tubes
chronic pelvic pain
Fitz-High-Curtis
tubo ovarian abscess
140
Q

What is androgen insensitivity syndrome

A

X-linked recessive condition
due to end-organ resistance to testosterone
causing genotypically male children (46XY) to have a female phenotype.

141
Q

What are the features of androgen insensitivity syndrome

A

primary amenorrhoea
undescended testes - leading to bilateral groin swellings
no pubic hair
can have small breasts (testosterone converted to oestrogen peripherally)

Finals (32 decks)

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