Sexual Health Flashcards
Chlamydia incubation + S+S
Incubation: 4 weeks in men, unknown for women
S+S: thin + watery discharge, dysuria, PCB, IMB, dyspareunia
Complications of STIs + STI risks in pregnancy
Complications: PID, perihepatitis (Fitz-Hugh-Curtis), Reiters syndrome (arthritis, uveitis, conjunctivitis), tubal infertility, increased risk of ectopic
For men: epididymo-orchitis
STI risks in pregnancy: PROM, prematurity, low birth weight, postpartum endometriosis
Chlamydia investigations + treatment
Vulvovaginal swab, urine for PCR Azithromycin 1g single dose (safe in pregnancy) Doxycycline 100mg for 7 days
Obligate intracellular parasite
Gonorrhoea S+S + incubation
Incubation = 2-5 days S+S: green discharge (from cervical os, urethra, Skene’s or Bartholin’s glands) Dysuria, urethritis, IMB/ PMB
Gonorrhoea investigations + treatment
VVS for NAAT testing ECS for culture + sensitivity Ceftriaxone IM single dose + azithromycin 1g oral single dose (safe in pregnancy)
Herpes incubation + pathology
5-14 days Enters distal processes of sensory neuron + stays dormant in root ganglion. Periodically reactivates + travels down axon into basal skin layers
Herpes S+S
Primary infection: flu like symptoms, inguinal lymphadenopathy, vulvitis, ulcers = lasts 3 weeks
Herpes complications
Meningitis Sacral radiculopathy Transverse myelitis Myalgia Erythema multiforme
Herpes implications in pregnancy
Primary infection = miscarriage or labour Neonatal risks = transmission high with NVD if during primary maternal infection
Herpes management
Treatment with acyclovir helpful in first 5 days Delivery by CS if labour within 6 weeks of primary infection
Genital warts (causes, S+S, management)
HPV 6 + 11 S+S: tiny flat patches on vulval skin, may affect cervix Manage with podophyllin solution applied daily, cryotherapy
Syphilis primary infection (incubation, S+S)
10-90 days post infection Solitary, painless ulcer (chancre) + inguinal lymphadenopathy
Secondary syphilis presentation
Occurs within first 2 years of infection (usually 4-8 weeks after) Generalised polymorphic rash on palms + soles, non-itchy Macular lesions on trunk + arms Generalised lymphadenopathy Condyloma lata (wart lesions on genitals + mouth) Anterior uveitis
Latent syphilis
Disease present but asymptomatic
Tertiary syphilis presentation
Over 2 years Neurosyphilis, cardiovascular + gummata (nodular plaques in skin or bone, firm + coppery red)
Neurosyphilis presentation
Headache, 3/6/8 CN involvement, papilloedema, hemiplegia Paranchymatous (ataxia, lightening pain, absent reflexes)
Cardiovascular syphilis presentation
Aortic regurgitation, aortitis
Investigations for syphilis (+ microscopy findings)
NAAT or bloods Smear from primary lesion = spirochaetes
Management of syphilis
Ben-penicillin + procaine penicillin
Balanitis (who, causes, S+S, management)
Commonly affects boys under 4 y/o + uncircumcised males Causes: candida, bacterial infection, STI, poor hygiene, psoriasis S+S: redness, irritation, soreness, dysuria Management: treat underlying cause, avoid soaks
Acute HIV S+S
Influenza like illness, rash Fever, myalgia, lymphadenopathy, pharyngitis
Investigations for HIV
Ab to the core = deeloped in 2-6 weeks Repeat test after 3 months due to delayed seroconversion
Management of HIV
HAART = combination antiretroviral regime
Advanced HIV S+S
Persistent lymphadenopathy Fever, night sweats, diarrhoea, weight loss Oral candidiasis, herpes, seb dermatitis, impetigo
Bacterial vaginosis cause + S+S
Overgrowth of anaerobes (Gardnerella) White grey discharge, fishy smell
pH >4.5 - 6
BV implications in pregnancy
Late miscarriage Preterm birth PPROM
BV investigations + RF
Increasing vaginal pH (>4.5) Clue cells on microscopy
Hay/Ison criteria gram stained vaginal smear
RF: douching, black ethnicity, smoking, STI
BV management
Metronidazole oral (beware of Disulfram reaction) + clindamycin cream (can weaken condoms so don’t use during treatment)
Trichomonas S+S
Frothy green offensive smelling discharge Itching + soreness
Dysuria
Strawberry cervix
Superficial dyspareunia
Trichomonas implications in pregnancy
Preterm delivery Low birth weight
Trichomonas investigations + management, what does it look like
Wet mount microscopy or VVS NAAT Metronidazole 2g stat dose + 400mg BD for 5-7 days (avoid in first trimester)
Sexual partners should be treated simultaneously
Candidiasis RF
Antibiotics, pregnancy, COCP, DM, anaemia, high oestrogen
Candidiasis S+S
Itching + soreness, satellite lesions Thick curd like white discharge Dysuria Superficial dyspareunia
Candidiasis management
Clotrimazole pessary + cream (safe in pregnancy) Fluconazole oral = not safe in pregnancy
STD swabs + what they test for
HVS = MC+S, candida, TV, BV Endocervical = M,C+S, gonorrhoea + chlamydia
Complications of chlamydia
Reactive arthritis, urethritis, conjunctivitis
Characteristic vesicle skin lesions: keratoderma blenorrhagica
Also called Reiter’s syndrome
Lymphogranuloma venereum = lymphadenopathy
Neonatal conjunctivitis + pneumonia
Genital warts management in pregnancy
Cryotherapy - podyphillin is contraindicated
Management of cryptococcal meningitis
IV amphoterecin B
What can syphilis cause in pregnancy?
Hutchinson teeth
What does chlamydia look like on a swab?
Gram negative intracellular rods
What is lichen planus?
Found around genitals, commonly on vulva
Skin hypopigmentation + atrophy, giving shiny look
White polygonal papules - can form plaques
Treat with steroids
Increases risk of vulval carcinoma
What bug causes syphilis + what are the long term complications?
Treponema pallidum
Aortic regurg, dementia, tabes dorsalis, gummata
What do the following discharges signifiy: white cottage cheese, white/ thin, green, grey/ odorous, yellow/ green + frothy
Cottage cheese = candida
White/ thin = chlamydia
Green = gonorrhoea
Grey + odorous = BV (Gardnerella)
Yellow/ green + frothy = TV
Summary of vaginal infections
What is disseminated gonorrhoea?
Fever, pustular rash, polyarthralgia
Describe standard screening for men + women
Men: NAAT (urine or VVS) + serology
MSM: 3 site testing NAAT
Hep B + C for those at risk
What extra swabs can be done + for what?
Microscopy HVS (gram stain + wet mount) for BV + TV
Micrscopy (gram stain of endo-urethral swab) for urethritis
Mid stream urine dip + culture for testicular pain
VVS NAAT - can do TV as well
PCR for herpes + treponemes ulcers
NAAT for mycoplasma gen
Who is at the greatest risk of HIV?
MSM
