Sexual health Flashcards
Diseases that need contact tracing (+ times)
6mo: chlyamydia, hep B, hep C, seoncdary syphilis
3mo: primary syphilis
2mo: gonorrhoea
12mo: early latent syphilis
ALL SEXUAL CONTACTS: HIV, trichomoniasis (no clear guidelines)
Causes + Sx of cervicitis
Sx of cervicitis: (dysparunia, post coital +intermenstrual bleeding, change in discharge)
Causes
- Chlamydia
- Gonorrhoea
- Mycoplasma genitalium
- Trichomonas vaginalus
- HSV
Causes of epididymorchitis
- STI (chlamydia, gonorrhoea, enteric organisms (MSM)
- UTI
- Viral infection e.g. mumps
- Systemic bacterial infection
Ddx testicular tortion, abscess, cancer
Standard STI testing in aysmptomatic <30
Males: chlamydia FPU NAAT
Females: (1) = endocervical swab NAAT, self collected swab NAAT, (2)= chlamydia FPU NAAT, ano rectal swab (if anal related)
Consider: Hep B, HIV, syphilis, gonorrhoea (MSM, ATSI)
Bacterial vaginosis: Organisms, clinical signs, Ix, Rx, Complications
Organisms: anaerobic bacteria e.g. gardeneilla vaginalus, atropobium vaginae
Sx: offensive, fishy discharge, raised pH
Ix: high vaginal swab- culture
Rx: metronidazole PO or vaginally
Complications : preterm labour, chorio, PID, abortion (risks increased following instrumentation/gynae procedures)
Bacteria causing syphilis
Treponema pallidum
Primary syphilis
- Often asymptomatic
- Painless genital ulcer/chancre (can be multiple) –> well defined with indurated base
- Enlarged rubbery inguinal lymph nodes
Secondary syphilis
- Constitutional symptoms
- Skin rash- scaly, maculopapular can involve trunks, classically palms and soles
- Oral lesions
- Alopecia
- Neurological: cranial nerve palsies, meningitis, opthalmalogical involvement
- Mild hepatitis
Tertiary syphilis
Occurs in 1/3 if not treated for primary or secondary
- Gummas: granulomatous lesions in skin/bone
- CVD: aortitis, aneurysm, valve incompetence
- Neurological: cerebral syphilis- meningoencephalitis
Ix for syphilis
- NAAT swab
Serology: EIA
If + –> Rapid Plasma Reagin (RPR) + TP Particle Agglutination (TPPA)
EIA + TPPA stay + for life, RPR would indicate reinfection
Rx for syphilis
Benzathine penicillin STAT for all infective syphilis (inc. early latent)
3 doses if late latent (non-infective), >24mo since contracted
Sx of chlamydia
cervicitis, epididimo-orchitis, PID, proctitis, urethritis, conjunctivitis
Rx of chlamydia
- doxy 100mg PO 7 days
2. stat dose of azithromycin 1g PO
Sx of mycoplasma genitalium
cervicits, urethritis, pelvic pain (PID)
Rx of mycoplasma genitalium
similar to chlamydia but doxy + azithromycin
N.gonorrhoea Sx
cervicitis, epididimo-orchitis, PID, proctitis, urethritis, conjunctivitis, disseminated disease (macular rash with necrotic pusutles, septic arthritis)
Rx n.gonnorheoa
ceftriaxone IM + azithromycin
Ix for gonorrhoea
NAAT of swab/first pass urine + culture
Trichomonas vaginalis Sx
vulval itch
inflamed vagina+cervix
raised pH of vagina
green, frothy, fishy
Rx trichomonas
Metronidazole 2g stat dose
Sx HSV infection
Painful vesicular ulcers, Erythema, itching, cervicitis, proctitis, systemic features
Rx HSV infection
Valicyclovir (or acyclovir in pregnancy/can be used in anyone) - 10 day course reduced to 5 if rapid reduction in symptoms
Same drugs for recurrence- higher dose, shorter course
HSV complications
Neonatal HSV, enhanced HIV transmission, neuropathic bladder, psychosexual morbidity
HPV strains implicated in genital warts
6,11
Rx of genital warts
Cryotherapy
Topical creams e.g. imiquimod
Causes of pelvic inflammatory disease
Often polymycrobial- chlamydia, n.gonorrhoea, mycoplasma
If postprocedural usually caused be ascending vaginal flora (treat with augmentin or amp/gent/met if this pathology)
Complications of PID
Chronic pain
Ectopic pregnancy
Infertility
Pyschosocial morbidity
Rx of PID
Ceftriaxone + metronidazole +azi/doxy (can all be given IV IF SEVERE)
