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4th Year > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

What are the 4 parts of a sexual history?

A
  1. With whom - male/female, regular/casual
  2. Type of sex - oral, vaginal, anal
  3. Condoms and contraception
  4. Risk assessment
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2
Q

What are the 5 parts of a risk assessment?

A
  • Known HIV +ve partner
  • MSM
  • IVDU
  • Sex with someone born outside UK
  • Paid or been paid for sex
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3
Q

What makes up an STI screen for an asymptomatic female?

A

Own VVS for chlamydia and gonorrhoea

Bloods for HIV, syphilis and hep B

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4
Q

What makes up an STI screen for a SYMPTOMATIC female?

A 
VVS for C+G - NAAT
2nd VVS for microscopy
Speculum - cervical smear if needed
HVS for BV, candida and Trichomonas - slide and plate
Endocervical swab for G culture
Bloods for HIV, S, Hep B
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5
Q

What colours are the NAAT and HVS/ECS tubes?

A 
NAAT = red
HVS/ECS = black
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6
Q

What makes up an STI screen for asymptomatic males?

A

1st void urine test for C+G

Bloods for HIV, S, Hep B

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7
Q

What makes up an STI screen for SYMPTOMATIC males?

A

Urine
Bloods
Urethral opening swab - slide and plate
Examine pelvis and penis

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8
Q

What makes up an STI screen for an asymptomatic MSM?

A

Throat, rectum, penis swab
Urine
Bloods

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9
Q

What makes up an STI screen for a SYMPTOMATIC MSM?

A

2x triple swab
Urine
Bloods
Examination

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10
Q

What type of test is a VVS?

A

NAAT test for C+G

2 week window

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11
Q

What type of test is first void urine?

A

NAAT test for C+G

2 week window

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12
Q

What type of test is a HVS?

A

Microscopy for BV, Candida and trichomonas

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13
Q

What type of test is an endocervical swab?

A

Culture for gonorrhoea sensitivities

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14
Q

What are the blood tests done in an STI screen?

A

HIV antibody and p-24 antigen - 3 month window
Syphilis treponemal antibody - 5 week window
Hep A IgM
Hep B surface antigen (HBsAh)
Anti-HCV

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15
Q

What type of test is a viral swab?

A

Viral PCR for herpes

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16
Q

What is chlamydia?

A

Intracellular bacteria

Affects columnar epithelium of GU tract

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17
Q

What are the symptoms of Chlamydia?

A

Vaginal discharge - mucopurulent
Lower abdominal pain
PCB, IMB

Dysuria and urethral discharge in men

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18
Q

How is Chlamydia diagnosed?

A

NAAT
VVS in women (red tube)
First void urine or urethral swab in men

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19
Q

What is the treatment of chlamydia?

A

1g Azithromycin STAT then 500mg next day, 250mg day after

OR 100mg Doxycycline BD 7 days

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20
Q

What advice should you give people with Chlamydia?

A

Abstain during treatment of both partners completed
Future condom use
Test for cure not necessary unless pregnant

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21
Q

What are some complications of chlamydia?

A 
PID
Reactive arthritis
Reiter's syndrome
Fitz-Hugh-Curtis syndrome
Conjunctivitis
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22
Q

What are the features of PID?

A

Abdo pain

Tubal infertility possibly

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23
Q

What is Reiter’s syndrome?

A

Triad of:

  • Urethritis
  • Arthritis
  • Conjunctivits

Associated with HLA-B27

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24
Q

What is Fitz-Hugh-Curtis syndrome?

A

Perihepatitis - characterised by pyrexia, RUQ pain, guarding, abnormal LFTs

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25
Q

What are the complication of chlamydia in pregnancy?

A

IUGR
Chorioamnionitis
Preterm delivery/PROM
Miscarriage

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26
Q

What is the treatment of chlamydia in pregnancy?

A

Erythromycin

Doxycycline = contraindicated in pregnancy

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27
Q

What are two neonatal complications of chlamydia?

A

Ophthalmia neonatorum

Neonatal pneumonitis

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28
Q

What is ophthalmia neonatorum?

A

Presents 1-2 weeks
Conjuctivitis, conjunctival oedema, purulent exudate
Tx = erythromycin

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29
Q

What is neonatal pneumonitis?

A

Presents 1-3 months
Staccato cough, tachypnoea
Tx = erythromycin

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30
Q

What type of bacteria is gonorrhoea?

A

Gram-negative diplococcus

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31
Q

What are the symptoms of gonorrhoea?

A 
Vaginal discharge - endocervical
Lower abdominal pain
Dysuria
Proctitis with rectal bleeding
Urethral discharge in men
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32
Q

How is gonorrhoea diagnosed?

A

Endocervical swab - culture
VVS - NAAT
Urethral, rectal, throat swabs

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33
Q

What is the treatment of gonorrhoea?

A

Ceftriaxome 500mg IM
Azithromycin 1g PO etc

TEST FOR CURE

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34
Q

What are some complications of gonorrhoea?

A

PID
Subfertility
Bartholin’s abscess
Similar to chlamydia

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35
Q

What is the treatment of gonococcal PID?

A

Ceftriaxone STAT plus doxycycline AND metronidazole for 14 days

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36
Q

What is Thrichomonas vaginalis?

A

Flagellate protozoan

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37
Q

How does TV present?

A 
Vulval soreness and itching
Foul smelling frothy green discharge
Dysuria
Dyspareunia
Strawberry cervix
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38
Q

How is TV diagnosed?

A

Vaginal pH >5.0

Seen on saline wet-mount (pathognomonic)

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39
Q

What is the treatment of TV?

A

Metronidazole 2g STAT or 400mg BD 7 days
Both partners and contact tracing
Test for cure

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40
Q

What is bacterial vaginosis?

A

Increased anaerobes and decreased lactobacilli -> alkaline pH
Eg. Gardenella vaginalis, Mycoplasma hominis etc

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41
Q

What are the features of BV?

A

Fishy discharge
Grey/white discharge adherent to vaginal walls
More prominent during and following menstruation

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42
Q

What is the Amsel criteria for diagnosing BV?

A
  1. Presence of clue cells on microscopy
  2. Creamy grey/white discharge seen
  3. Vaginal pH >4.5
  4. Release of fishy odour upon alkali addition

Need 3+ for diagnosis

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43
Q

What is the Hay criteria for BV?

A

Grade 1 = normal, lactobacillus predominates
Grade 2 = intermediate, Gardenerella +/- Mobiluncus seen with lactobacillus
Grade 3 = BV, lactobacillus absent, mostly Gardenerella

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44
Q

What is the treatment for BV?

A

Metronidazole 400mg BD 5 days or 2g STAT

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45
Q

Why is BV an issue in pregnancy?

A

If in 1st trimester, can cause late 2nd trimester miscarriages

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46
Q

What should women with a history of 2nd trimester miscarriages have?

A

Early pregnancy vaginal swab and treatment

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47
Q

What is vulvovaginal candidiasis?

A

90% = candida albicans

48
Q

What are some risk factors for candidiasis? (5)

A 
Pregnancy
Immunocompromised
High dose COCP
Broad spectrum Abx
HRT
49
Q

What are the features of candidiasis?

A 
Vulval itching and soreness
Thick cottage cheese discharge
Dyspareunia
Dysuria
Erythema
50
Q

What is the vaginal pH of candidiasis?

A

Normal

51
Q

How is candidiasis diagnosed?

A

HVS microscopy - see budding yeasts and pseudohyphae

Cultured on Sabutaud’s medium

52
Q

What is the treatment of candidiasis?

A

Only if symptomatic
500mg Clotrimazole pessary
OR topical 10% clotrimazole cream
OR oral fluconazole 150mg

53
Q

What is the treatment of a complicated candida infection?

A

Same but for 2 weeks

Eg. severe, pregnancy, DM

54
Q

What is recurrent candida infection?

A

4+ episodes per year with positive microscopy

Tx = Fluconazole 150mg PO 3 doses every 72hrs then 150mg weekly for 6 months

55
Q

What is lichen simplex?

A

Chronic rubbing causes eczema and itching causes lichenification

56
Q

What are the features of lichen simplex?

A

Poorly demarcated plaques with scaling, excoriations and lichenification

57
Q

What is the management of lichen simplex?

A

Emollients mainly

Possibly mild topical steroids

58
Q

What causes lichen planus?

A

Unknown

59
Q

What are the features of lichen planus?

A

Itchy, papular eruption with a fine scale

Can also be oral - white stripes on tongue = Wickham’s stricture

60
Q

What is the treatment of lichen planus?

A

Conservative - usually self-limiting

Same as lichen simplex

61
Q

What is lichen sclerosis?

A

Destructive inflammatory skin condition
Affects anogenital area
Often have another AUTOIMMUNE condition

62
Q

What causes lichen sclerosis?

A

Autoimmune

Hyalinization of skin -> fragility and loss of anatomy

63
Q

What are the features of lichen sclerosis?

A

Fragile skin
Loss of anatomy
Stricturing and narrowing of vaginal opening
Vulval itching

64
Q

What investigation may be useful for lichen simplex?

A

Biopsy - can confirm diagnosis

65
Q

What is the treatment of leeching sclerosis?

A

Potent topical steroids

66
Q

What is a complication of lichen sclerosis?

A

Squamous cell carcinoma

67
Q

What is vulvodynia?

A

Vulval discomfort, often BURNING

In absence of skin disease

68
Q

What are the features balanitis?

A

Sore, inflamed glans penis
Can’t retract foreskin
Dysuria
Possibly discharge

69
Q

What can cause candida balanitis?

A

Diabetes - do BM and urine dip
Oral Abx
Poor hygiene
Immunosuppression

70
Q

What are some skin changes that may be present with candida balanitis?

A

Red papules with superficial erosions

White plaques

71
Q

What is the treatment of balanitis?

A

Candida = Clotrimazole 1% cream
Bacterial = Flucloxacillin
Anaerobe = Metronidazole
Hygiene measures

72
Q

What are Pthyris pubis?

A

Pubic lice/crabs

73
Q

What are the features of Pthyris pubis?

A

Genital itch
Blue spots
Perifolliculitis

74
Q

What would indicate a diagnosis of Pthyris pubis?

A

Egg is pubic hair

75
Q

What is the treatment of Pthyris pubis?

A

Permethrin 1%

Treat all sexual contacts

76
Q

What are Hirsuties coronae glandis or coronal papules?

A

Pearly penile papules on ridge of glans penis

Normal

77
Q

What are epidermoid cysts?

A

Small hard lumps which grow under the skin

78
Q

What are Fordyce spots?

A

White/yellow bumps due to enlarged oils glands

Generally on face, can be on genitalia

79
Q

What are the types of Herpes?

A 
HSV1 = oral infection
HSV2 = anogenital infection
80
Q

What happens once infected with herpes?

A

Can remain latent in sensory ganglia

Lytic lesions at times of stress

81
Q

What are the features of primary HSV infection?

A

Irritation or parasthesia at lesion site -> painful papule -> ulcer
Whole episode completed within a week
Some systemic flu-like symptoms also

82
Q

What are the features of HSV reactivation?

A

Times of stress/menstruation
Shorter and less severe than primary infection
50% patients

83
Q

How is HSV diagnosed?

A

Clinical

Can do viral PCR swab (black tube)

84
Q

What is the treatment of HSV infection?

A

Aciclovir 400mg TDS oral 5 days

85
Q

What is the treatment of recurrent HSV?

A

None needing, self-limiting
Saline baths and analgesia

Frequent attacks = acyclovir in first 24hrs of attack

86
Q

What are the complications of HSV infection?

A

Autonomic neuropathy -> urinary retention
Aseptic meningitis
Secondary bacterial infection

87
Q

What do you do if a women gets primary herpes in the 1st or 2nd trimester?

A

Give Aciclovir 400mg TDS from 36 weeks

Reduces reactivation risk and need for LSCS

88
Q

What do you do if a women gets primary herpes in the 3rd trimester?

A

Takes 6 weeks for antibody response to develop against HSV to protect neonate
Greatest risk
LSCS recommended
Same as 1st/2nd trimester Mx otherwise

89
Q

What is the management if a women has active HSV in labour?

A

LSCS

If vaginal delivery occurs = IV acyclovir for mother and neonate and avoid invasion procedures

90
Q

What causes genital warts?

A

HPV 6 and 11

91
Q

How are genital warts transmitted?

A

Gains entry via basal epithelial layer through microabrasions during sexual contact

92
Q

How are genital warts prevented?

A

Gardasil vaccination at 12yrs includes 6 and 11 subtypes

93
Q

What is the incubation period for genital warts?

A

3 months

Anywhere from 3wks to 2yrs

94
Q

Can you contract genital warts from an asymptomatic partner?

A

Yes

95
Q

What therapies are available for genital warts?

A

Ablation
Immune modulation
Surgery

96
Q

What are the ablative therapies for genital warts?

A

Cryotherapy - if <6 warts

Podophyllotoxin cream - it >6 warts

97
Q

What are the immune modulation therapies for genital warts?

A

Imiquimod 5% cream = keratinised, persistent or recurrent warts
Lower recurrence rate (30%)

98
Q

What organism causes syphilis?

A

Treponema pallidum

99
Q

How is syphilis transmitted?

A

Abrasion in skin or intact mucous membrane

3 week incubation

100
Q

How does primary syphilis present?

A

9-90 days post-expose
Painless ulcer = chancre
Resolves in 2-6 weeks

101
Q

How does secondary syphilis present?

A

6 weeks to 6 months post-exposure
Generalised infection and lymphadenopathy
Maculopapular rash on palms and soles
Systemic symptoms

102
Q

How does tertiary syphilis present?

A

10-40 years post-exposure

With severe organ effects

103
Q

What is neurosyphilis?

A

Dorsal column loss, dementia, meningeal involvement

104
Q

What is cardiovascular syphilis?

A

Aortic regurg, AAA, angioma

105
Q

What are gumma?

A

Locally destructive fibrous nodules

Affect bones and skin generally

106
Q

What is early latent syphilis?

A

Positive serology but no clinical evidence in first 2yrs of infection

107
Q

What is late latent syphilis?

A

Positive serology after >2yrs of infection

108
Q

What investigations should be performed for suspected syphilis?

A

Serology
Dark group microscopy from ulcer
PCR from ulcer

109
Q

How accurate is serology?

A

Primary = 70-80%
Secondary = 100%
Repeat in 3 months if negative with genital ulcer

110
Q

What is the advantage of microscopy and PCR?

A

Can give immediate treatment

111
Q

What is the treatment for syphilis?

A

Benzathine Penicillin 2.4MU IM STAT

112
Q

What is the 2nd line treatment for syphilis?

A

Oral azithromycin

113
Q

What is the treatment of neurosyphilis?

A

Procaine benzylpenicillin 750mg IM for 10 days
OR
Doxycycline 100mg BD 14 days

114
Q

What is Jarisch-Herxheimer reaction?

A

Reaction to syphilis treatment
Acute febrile illness with headache, myalgia, chills
Usually resolves within 24 hours

115
Q

What is the major complication of syphilis infection in pregnancy?

A

1/4 have 2nd trimester miscarriage or stillbirth

10% chance of neonatal death

116
Q

What measures are taken to avoid syphilis in pregnancy?

A

All women screened at booking

4th Year (15 decks)

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