sexual health Flashcards
what is the most common cause of vaginal discharge in women of child-bearing age
bacterial vaginitis
why is the normal pH of the vagina is 4.5?
presence of lactobacilli and so it makes it 4.5 to reduce the presence of other pathogens
what are the causes of vaginal discharge generally
non-infective
- pyhsiological
- cervical ectopion
- foregin body
infective
- Non-STI - Bacterial vaginitis, candida
- STI - Trichomonas vaginitis
- STI (endocervical) - chlamydia and gonorrhoea
what is the normal vaginal discharge
1-4 ml per 24 hours
usually watery or white
non-offensive odour
varies with the menstrual cycle
what is the pH of the vagina if BV present
4.5-6.0
RF for bacterial vaginosis
douching Receptive cunnilingus (female receptive oral sex) a recent change of partner smoking present of STI black ethnicity
symptoms of bacterial vaginosis
inc discharge - white/watery, thin
fishy smelling vaginal discharge
not assoc with soreness, itching
signs of bacterial vaginosis
under speculum - white, thin, haemogenous discharge
no signs of inflammation
complications of bacterial vaginosis
PID inc BV chacnes
cellutlitis/abscess formation following TV hysterectomy
late miscarriage, preterm birth, PROM, postpartum endometritis
investigation for BV
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
what does the gram staining of BV show?
purple
eggs with salt and pepper
management of BV
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
what is the causative agent for candida
candida albicans 80-92%
RF for genital candida
immune suppression
antibiotic use
elevated oestrogen
symptoms of candida
vulval itch, soreness
thick white vaginal discharge
superficial dyspareunia
external dysuria - pain when urine touches skins
signs of candida
erythema fissuring dicharge oedema satellite lesions excoriations - skin coming off
Ix for candida
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
Mx of candida
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
What is the causative agent of trichomonas vaginalis
flagellated protozoon
almost exlcusively transmitted via sexual intercourse
what are the symptoms of TV
10-50% asymptomatic inc vaginal discharge vulval itch dysuria lower abdo pain
signs of TV
classical frothy yellow discharge in 10-30%
vulvitis
vaginitis
2% strawberry cervix
Ix for TV
high vaginal swab and wet mount - so the flagellated TV can swim
VVS NAAT
GP - test for pH which will be elevated
what will the pH of the vagina be if TV present
> 4.5
Mx of TV
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
what is the most commonly reported curable STI
chlamydia trachomatis
what age is the highest prevalence of chlamydia
< 25
RF for chlamydia
< 25 yrs
new sexual partner
> 1 partner per year
lack of consistent condom use
symptoms of chlamydia
inc vag discharge dysuria PCB & IMB deep dyspareunia lower abdo pain
signs of chlamydia
mucopurulent cervicitis +/- contact bleeding
what is the window period of investigation for chlamydia
2 weeks
Ix for chlamydia
VVS NAAT in women
first pass urine in man
Mx of chlamydia
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
complications of chlamydia
PID, endometritis, salpingitis
tubal infertility
ectopic pregnancy
sexually acquired reactive arthritis (SARA)
peri-hepatitis (Fitz-HughCurtis syndrome) - deranged LFT and dysuria
what is the causative agent for gonorrhoea
Nisseria gonorrheae
where does gonorrhoea usually infect?
mucous membrane ie urethra, endocervix, rectum, pharynx, conjunctiva
what are the symptoms of gonorrohea
altered vaginal discharge
PCB or IMB or menorrhagia
lower abdo pain in 25%
urethral infection –> dysuria
what is a must have ddx if you have PCB
gonorrhoea –> poking the cervix so it bleeds
ix for gonorrhoea
gram stained slide for microscopy from infected site - dipococci
VVS NAAT for gonorrhoea
bacterial swab for gonorrhoea culture from infected site
mx for gonorrhoea
always culture for sensitivity
avoid sex for 1/52 until treatment completed
ceftriaxone 500mg IM
1g azithromycin PO as single dose
complication of gonorrhoea
PID
what is the general causes of urethral discharge in male
gonococcal –> gonococcal urethritis
non-gonococcal –> chlamydia/ non-chlamydial eg mycoplasma genitalium/non-specific urethritis
what is the triad of urethritis
discharge
discomfort
dysuria
what must you do if there is urethral discharge in a man
always investigate
where are the primary sites of infection for gonorrhoea urethritis
urethra
rectum
pharynx
so need 3 sites investigation in MSM
symptoms of gonorrhoea urethritis
80% will have urethritis +/- yellow discharge
ix for gonorrhoea urethritis
GUM setting –> gram stain microscopy or rectal smear –> dipolococci
other setting –> NAAT from site of infection
mx for gonorrhoea urethritis
ceftriaxone 500mg IM & 1g azithromycin PO as single doses
complications of gonorrhoea urethritis as single doses in men
o Epididymo-orchitis, proctitis (inflammation of the lining of the gut), disseminated gonorrhoea
what can cause lymphogranuloma venereum
chlamydia in male
symptoms of chlamydia in man
o lymphogranuloma venereum (long term lymphatic system infection –lymphadenopathy)
o Clear/white discharge
o rectal symptoms investigate for lymphogranuloma venereum
ix for chlamydia urethritis
o GUM gram stained urethral or rectal smear meeting
o Other siting NAAT from sites of infection
mx of chlamydia in man
o Doxycycline 100mg BD for 7/7 (C/I in pregnancy) or azithromycin 1g PO stat
o If Epididymo-orchitis extended treatment
what are some of the causative organisms of chlamydia
C.trachomatis Mycoplasma genitalium ureaplasma Trachomons vaginalis adenovirus HSV
Ix for non-specific urethritis
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
Mx of NSU
doxycycline 100mg BD 7/7
or
azithromycin 1g stat
