Sexual Health

Question 1

Antibiotic of choice for chlamydia infection?

Answer 1

Doxycycline, 100mg BD, 7 day course

If pregnant/breastfeeding - Azithromycin/amoxicillin/erythromycin

Question 2

Antibiotic of choice for Gonorrhoea?

Answer 2

Ceftriaxone 500mg IM
+
Azithromycin 1g PO

Failure of Abx notify PHE

Question 3

Antibiotic of choice for Syphilis?

Answer 3

IM Benzathine Penicillin

NB - Jarisch Herxheimer reaction - endotoxin release from dying microbes - 24hrs of malaise/fever

Question 4

Management of genital warts?

Answer 4

Conservative - 1/3 go in 6 months

Ablative - cryotherapy
Topical - podophyllotoxin, imiquimod cream

Offer vaccine

Question 5

Management of Balanitis

Answer 5

Hygiene measures
Topical creams - hydrocortisone
Metronidazole 2g STAT dose, or 500mg/7 days

Question 6

Management of Trichomonas Vaginalis

Answer 6

Metronidazole 2g PO, STAT

Or 500mg, BD, 7days

Question 7

Presentation of Trichomonas Vaginalis?

Answer 7

50% asymptomatic
Frothy, green-yellow discharge
Strawberry cervix
Itch/soreness, odour, pain and dysuria

Question 8

Investigations offered at GUM clinic

Answer 8

Chlamydia & Gonorrhoea - Males- first catch urine
- Women - High vaginal/endocervical swab
HIV/syphilis blood test

Question 9

Clinical features of Candidiasis

Answer 9

itch, cottage cheese discharge, non-offensive odour, dyspareunia, soreness

pH will be <4.5
in BV / trichomonas - will be >4.5

Question 10

Management of candidiasis/thrush?

Answer 10

PV clotrimazole/econazole/miconazole

Consider PO fluconazole if severe infection

Question 11

Management of Bacterial vaginosis?

Answer 11

Metronidazole 2g STAT dose
Or 400mg, BD, 5-7 days

Hygiene measures

Question 12

Presentation of Bacterial Vaginosis?

Answer 12

Overgrowth with anaerobic organisms (lactobacilli - acidic)
Thin, white, fishy smelling discharge. No itch or soreness

Most common cause of abnormal discharge

Question 13

Management of active Herpes Infection?

Answer 13

Oral Aciclovir, 400mg, TDS, 5 days - to induce remission

Cleaning measures - salt water, local anaesthetic cream, rest, analgesia

Question 14

Advice for active herpes infection in pregnancy?

Answer 14

Give aciclovir in pregnancy

If active in 3rd trimester, both mother and baby at risk of severe infection
Offer C-section

Question 15

What testing is available for HIV?

Answer 15

Rapid point of care test - 3rd/4th gen test - result in clinic - HIV detectable via p24 antigen, 4 weeks post infection - if 3rd gen, 12 weeks

Blood test - 4th gen test, but result not instant - must go to lab