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Y4 - GOSH > sexual health > Flashcards

sexual health Flashcards

1
Q

what is the most common cause of vaginal discharge in women of child-bearing age

A

bacterial vaginitis

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2
Q

why is the normal pH of the vagina is 4.5?

A

presence of lactobacilli and so it makes it 4.5 to reduce the presence of other pathogens

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3
Q

what are the causes of vaginal discharge generally

A

non-infective

  • pyhsiological
  • cervical ectopion
  • foregin body

infective

  • Non-STI - Bacterial vaginitis, candida
  • STI - Trichomonas vaginitis
  • STI (endocervical) - chlamydia and gonorrhoea
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4
Q

what is the normal vaginal discharge

A

1-4 ml per 24 hours
usually watery or white
non-offensive odour
varies with the menstrual cycle

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5
Q

what is the pH of the vagina if BV present

A

4.5-6.0

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6
Q

RF for bacterial vaginosis

A 
douching 
Receptive cunnilingus (female receptive oral sex) 
a recent change of partner 
smoking 
present of STI 
black ethnicity
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7
Q

symptoms of bacterial vaginosis

A

inc discharge - white/watery, thin
fishy smelling vaginal discharge
not assoc with soreness, itching

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8
Q

signs of bacterial vaginosis

A

under speculum - white, thin, haemogenous discharge

no signs of inflammation

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9
Q

complications of bacterial vaginosis

A

PID inc BV chacnes

cellutlitis/abscess formation following TV hysterectomy

late miscarriage, preterm birth, PROM, postpartum endometritis

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10
Q

investigation for BV

A

outpatient/GP - low vaginal swab in transport medium to lab

GUM clinic - low vaginal swab (VVS), Gram stain veginal smear- shows purple if gram +ve

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11
Q

what does the gram staining of BV show?

A

purple

eggs with salt and pepper

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12
Q

management of BV

A

general advise - don’t douch, avoid antiseptic agents/bath products

Metronidazole (500mg BD for 7/7) /Clindamycin - oral or topical - can use in pregnancy/breast feeding but alter taste of the milk

only treat if symptomatic

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13
Q

what is the causative agent for candida

A

candida albicans 80-92%

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14
Q

RF for genital candida

A

immune suppression
antibiotic use
elevated oestrogen

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15
Q

symptoms of candida

A

vulval itch, soreness

thick white vaginal discharge

superficial dyspareunia

external dysuria - pain when urine touches skins

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16
Q

signs of candida

A 
erythema 
fissuring 
dicharge 
oedema 
satellite lesions 
excoriations - skin coming off
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17
Q

Ix for candida

A

often treated without investigation on typical symptoms

if not responsive to treatment then investigate

  • MC of gram stained vaginal slide in GUM
  • MC+S of low vaginal swab (VVS)
  • long purple bit - fungal hyphi
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18
Q

Mx of candida

A

general advise - routine use of soap substitute, regular emollient, avoid tight fitting synthetic clothing, local irritants

Clotriamzole perssary 500mg stat

fluconazole 150mg PO stat (not in pregnancy)

no need to treat asymptomatic male partners

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19
Q

What is the causative agent of trichomonas vaginalis

A

flagellated protozoon

almost exlcusively transmitted via sexual intercourse

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20
Q

what are the symptoms of TV

A 
10-50% asymptomatic 
inc vaginal discharge 
vulval itch 
dysuria
lower abdo pain
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21
Q

signs of TV

A

classical frothy yellow discharge in 10-30%

vulvitis

vaginitis

2% strawberry cervix

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22
Q

Ix for TV

A

high vaginal swab and wet mount - so the flagellated TV can swim

VVS NAAT

GP - test for pH which will be elevated

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23
Q

what will the pH of the vagina be if TV present

A

> 4.5

24
Q

Mx of TV

A

general advise - sexual partners should be treated at the same time, avoid sex for 1/52 until partners treated

metronidazole - 200mg TDS for 7/7 or 400mg BD 7/7 or 2g for 1 dose
stat dose not suitable for pregnant ladies

25
Q

what is the most commonly reported curable STI

A

chlamydia trachomatis

26
Q

what age is the highest prevalence of chlamydia

A

< 25

27
Q

RF for chlamydia

A

< 25 yrs
new sexual partner
> 1 partner per year
lack of consistent condom use

28
Q

symptoms of chlamydia

A 
inc vag discharge 
dysuria 
PCB &amp; IMB 
deep dyspareunia
lower abdo pain
29
Q

signs of chlamydia

A

mucopurulent cervicitis +/- contact bleeding

30
Q

what is the window period of investigation for chlamydia

A

2 weeks

31
Q

Ix for chlamydia

A

VVS NAAT in women

first pass urine in man

32
Q

Mx of chlamydia

A

general advise - avoid sex for 1/52 until partners treated, test for cue if pregnancy, non-viable DNA can still be picked up after 3-5 wks following treatment

uncomplicated - doxycycline 100mg BD for 1/7 or azithromycin 1g PO stat

33
Q

complications of chlamydia

A

PID, endometritis, salpingitis

tubal infertility

ectopic pregnancy

sexually acquired reactive arthritis (SARA)

peri-hepatitis (Fitz-HughCurtis syndrome) - deranged LFT and dysuria

34
Q

what is the causative agent for gonorrhoea

A

Nisseria gonorrheae

35
Q

where does gonorrhoea usually infect?

A

mucous membrane ie urethra, endocervix, rectum, pharynx, conjunctiva

36
Q

what are the symptoms of gonorrohea

A

altered vaginal discharge
PCB or IMB or menorrhagia
lower abdo pain in 25%
urethral infection –> dysuria

37
Q

what is a must have ddx if you have PCB

A

gonorrhoea –> poking the cervix so it bleeds

38
Q

ix for gonorrhoea

A

gram stained slide for microscopy from infected site - dipococci

VVS NAAT for gonorrhoea

bacterial swab for gonorrhoea culture from infected site

39
Q

mx for gonorrhoea

A

always culture for sensitivity

avoid sex for 1/52 until treatment completed

ceftriaxone 500mg IM

1g azithromycin PO as single dose

40
Q

complication of gonorrhoea

A

PID

41
Q

what is the general causes of urethral discharge in male

A

gonococcal –> gonococcal urethritis

non-gonococcal –> chlamydia/ non-chlamydial eg mycoplasma genitalium/non-specific urethritis

42
Q

what is the triad of urethritis

A

discharge
discomfort
dysuria

43
Q

what must you do if there is urethral discharge in a man

A

always investigate

44
Q

where are the primary sites of infection for gonorrhoea urethritis

A

urethra
rectum
pharynx

so need 3 sites investigation in MSM

45
Q

symptoms of gonorrhoea urethritis

A

80% will have urethritis +/- yellow discharge

46
Q

ix for gonorrhoea urethritis

A

GUM setting –> gram stain microscopy or rectal smear –> dipolococci

other setting –> NAAT from site of infection

47
Q

mx for gonorrhoea urethritis

A

ceftriaxone 500mg IM & 1g azithromycin PO as single doses

48
Q

complications of gonorrhoea urethritis as single doses in men

A

o Epididymo-orchitis, proctitis (inflammation of the lining of the gut), disseminated gonorrhoea

49
Q

what can cause lymphogranuloma venereum

A

chlamydia in male

50
Q

symptoms of chlamydia in man

A

o lymphogranuloma venereum (long term lymphatic system infection –lymphadenopathy)
o Clear/white discharge
o rectal symptoms investigate for lymphogranuloma venereum

51
Q

ix for chlamydia urethritis

A

o GUM  gram stained urethral or rectal smear meeting

o Other siting  NAAT from sites of infection

52
Q

mx of chlamydia in man

A

o Doxycycline 100mg BD for 7/7 (C/I in pregnancy) or azithromycin 1g PO stat
o If Epididymo-orchitis  extended treatment

53
Q

what are some of the causative organisms of chlamydia

A 
C.trachomatis
Mycoplasma genitalium 
ureaplasma 
Trachomons vaginalis 
adenovirus 
HSV
54
Q

Ix for non-specific urethritis

A

Gum –> gram stain urethral smear

other setting –> NAAT swab if -ve and symptom persist then refer to GUM

leucocyte esterase test –> +ve leucocuyre on FPU indicative of urethritis

55
Q

Mx of NSU

A

doxycycline 100mg BD 7/7
or
azithromycin 1g stat

Y4 - GOSH (12 decks)

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