Sexual Health Flashcards
What do the Fraser Guidelines relate to?
Giving contraception and sexual health advice to those under 16 without parental consent
Pneumonic to remember Fraser competence
UPSIS = unprotected sex is silly
young person Understands the advice given
Parental involvement encouraged by clinician
young person likely to continue having Sexual intercourse
it is in the young persons best Interest to supply them with contraception
Young persons physical and mental health is likely to Suffer without contraception
What is the Sexual Offences Act 2003?
Sexual intercourse and all forms of sexual touching of minors (under 16yrs) are illegal in England and Wales
Children under 13 years are deemed incapable of consent. It is therefore classified as rape or sexual assault and must be reported.
There is no legal obligation to report sex between 13-16 yr olds unless exploitation is suspected
What is the commonest STI and which age group is it most common in?
Chlamydia Trachomatis
Commonest in 15-25 age group (approx 5% infected)
Why is chlamydia trachomatis difficult to culture?
It is an obligate intracellular bacteria (cannot replicate outside of host cell)
What is the incubation period of chlamydia trachomatis?
1-3 weeks
What % of people with chlamydia are asymptomatic?
50% men and 75% women
Thus often found on screening, contact tracing or when complications present
What are the signs/symptoms of chlamydia infection in females?
- Increased vaginal discharge secondary to cervicitis
- Urethritis (dysuria, frequency, urgency)
- PCB and IMB
- Deep dyspareunia
- Lower abdo pain
- +/- contact bleeding
What complications can arise from chlamydia infection in women?
PID (10-30% infections) Tubal infertility Increased risk of ectopic pregnancy Perihepatitis - Fitz-Hugh-Curtis syndrome Reactive arthritis (more common in men)
What is Reiters disease (Reactive Arthritis)?
Triad of:
- Arthritis
- Urethritis
- Conjunctivitis
(occurs after infection, esp of GI or urogenital tract)
Can’t pee, see or climb up a tree
What are implications of chlamydia infection in pregnancy?
PROM and premature delivery
Low birth weight
Postpartum endometriosis
Infection can spread from the cervix into the uterine cavity causing chorioamnionitis
What are the signs/symptoms of chlamydia infection in males?
- Dysuria
- Urethral discharge = white, cloudy or watery
- Testicular pain due to epididymo-orchitis
- Scrotal pain / swelling
What complications can arise from chlamydia infection in men?
- Acute epididymo-orchitis (usually unilateral pain)
- Proctitis
- Infertility
- Reactive arthritis
How does chlamydia present in neonates?
- Neonatal conjunctivitis (30% within first 2 weeks)
- Neonatal pneumonia (15% within first 4 months)
- Otitis media
- Can develop vaginal infection
What investigations are done for chlamydia? What is the window period?
Women:
- Vulvovaginal swab + NAAT
- First catch urine sample
Men:
- Urethral swab + NAAT
- First catch urine sample
Window period = 2 weeks
What is the treatment for chlamydia?
Doxycycline 100mg PO BD for 7 days
If doxycycline contraindicated :
Azithromycin 1g PO STAT
If doxycycline and azithromycin contraindicated:
Erythromycin 500mg BD for 10-14 days
Oflaxacin 200mg BD or 400mg OD for 7 days
Abstinence until partner is treated and Abx completed
What is the treatment for chlamydia in pregnancy?
Azithromycin 1g PO STAT
Test of cure
If azithromycin contraindicated:
Erythromycin 500mg BD for 10-14 days
Test of cure
What is the causative organism of Gonorrhoea infection? Describe it
Neisseria gonorrhoea - intracellular gram negative diplococcus
What are the initial sites of infection of chlamydia and gonorrhoea?
Columnar epithelium of urethra, endocervix, rectum, pharynx or conjunctiva (depending on mode of exposure)
What is the incubation period of gonorrhoea?
2-5 days (in 80% men who develop urethral symptoms)
Asymptomatic gonorrhoea is particularly common in which sites?
Pharynx, cervix and rectum (common in both sexes)
What are the signs/symptoms of gonorrhoea infection in females?
Symptoms • Altered/increased vaginal discharge - thin, watery, green/yellow • Dysuria • Dyspareunia • Lower abdominal pain • IMB or PCB - rarely
Signs
• Mucopurulent endocervical discharge from cervical os, urethra, Skene’s glands or Bartholin’s glands
• Easily induced cervical bleeding
• Pelvic tenderness
What are complications of gonorrhoea infection in females?
- PID (approx 15% infections)
- Bartholin’s or Skene’s abscess
- Tubal infertility
- Increase risk of ectopic pregnancy
- Disseminated gonorrhoea = fever, pustular rash, migratory polyarthralgia, septic arthritis
- Rarely gonococcal endocarditis (M&F)
What are the complications of gonorrhoea infection in pregnancy?
Chorioamnioitis
Postpartum endometritis
PROM, premature delivery and low birth weight
What are the signs/symptoms of gonorrhoea infection in males?
- Urethral discharge = yellow, green, white
- Dysuria
- Urethritis
- Foreskin swelling
- Scrotal pain / swelling
- Tender inguinal LN
What are complications of gonorrhoea infection in males?
- Epididymo-orchitis
- Abcesses of paraurethral glands
- Urethral stricture
- Disseminated gonorrhoea
- Secondary infertility due to damage to epididymis
What are the signs/symptoms of gonorrhoea infection in neonates?
Opthalmia neonatorum (gonococcal conjunctivitis) Can develop vaginal infection
What investigations are done for gonorrhoea in males and females?
Females
• Endocervical/vaginal swab - NAAT
• Endocervical/urethral swab - microscopy + culture (Amies charcoal transport medium)
Males
• First pass urine - NAAT
• Urethral/meatal swab - microscopy + culture
Pharyngeal and rectal swabs if indicated
What is the treatment for gonorrhoea?
Abx (same in pregnancy)
Single dose IM ceftriaxone 1g
AND
PO azithromycin 1g/ciprofloxacin 500mg
Do test of cure for all at 2 weeks after therapy
Avoid sex for 7 days or/and until they + their partners have completed treatment
What is the causative organism of syphilis? What is its shape and gram stain?
Treponema pallidum Sprirochaete (spiral shaped)
Gram-negative
How is syphilis transmitted?
Sexual transmission - break in skin or intact mucous membranes
Via placenta from mother to foetus - congenital syphilis
Infected blood products
What is the initial site of infection of syphilis?
Site of contact - usually genitals, perianal area or mouth
How many stages are there in syphilis infection?
4
1) Primary
2) Secondary
3) Latent
4) Late/Tertiary
When does the primary stage of syphilis occur?
9-90 weeks after exposure
What are the features of the primary stage of syphilis?
After inoculation, a papule (slightly raised lesion with no fluid) appears before ulcerating into a chancre (singular painless, hard, non-itchy ulcer)
It resolves after 3-8 weeks
Describe the appearance of a chancre
Round and clean with an indurated base and defined edges, non-purulent
When does the second stage of syphilis occur?
4-8 weeks after appearance of primary chancre
if primary untreated, 25% develop into secondary
What are the features second stage of syphilis?
MULTI-SYSTEM
- Maculopapular symmetrical skin rash - hands and soles of feet - not painful or itchy
- Fever, malaise, arthralgia, weight loss, headaches
- Condylomata lata - elevated plaques like warts on moist areas of skin - inner thighs, anogenital region, axillae - highly infectious
- Painless lymphadenopathy
- Silvery-grey mucous membrane lesions/ulcers - oral, pharyngeal, genital
When does the latent stage of syphilis occur?
Early = <2yr after infection Late = >2yr after infection
What are the features of latent stage syphilis?
People with untreated syphilis but no symptoms = latent syphilis
When does the tertiary stage of syphilis occur?
1-10 years after exposure
it is now rare due to advent of penicillin
What are the features of the tertiary stage of syhpillis?
Gummatous syphilis…
• Granulomas form in bone, skin, URT, mouth
Neurosyphilis…
• Tabes dorsalis - ataxia, numb legs, absence of deep tendon reflexes, lightning pains, loss of pain + temperature sensation, skin + joint damage
• Dementia - cognitive impairment, mood alterations, psychosis
• Meningovascular complications - CN palsies, stroke
• Argyll Robertson pupil - constricted and unreactive to light but reacts to accommodation
Cardiovascular…
• Aortic regurgitation (diastolic murmur) - aortic valvulitis
• Angina
• Dilation and calcification of ascending aorta - syphilitic aortitis (atherosclerotic-type change in the ascending aorta)
Why is syphilis particularly worrying in pregnancy and what can it cause?
Syphilis can cross the placenta
- Preterm delivery
- stillbirth
- congenital syphilis
What investigations are done for syphilis?
Serology:
- Rapid plasma regain (RPR) and venereal disease reference laboratory (VDRL) most commonly used
Dark ground microscopy of chancre fluid to detect spirochaete
PCR testing of swabs from lesions
What is the treatment for syphilis?
Benzylpenicillin 2.4MU IM single dose in primary + secondary syphilis
Benzylpenicillin 2.4MU IM weekly for 3 weeks in tertiary syphilis
Dose = 2.4 million units
Penicillin allergy - doxycycline (CI in pregnancy so can use erythromycin)
What is the causative organism of trichomonas? Describe it
How does it replicate?
Trichomoniasis Vaginalis
Anaerobic flagellated protozoan
Replication: binary fission whilst destroying epithelial cells through direct contact + release of cytotoxins
What are the symptoms and the signs of trichomonas?
Asymptomatic in 10-50%
Symptoms
• Profuse, foul-smelling, greenish/yellow, frothy discharge
• Vaginal and vulval irritation/soreness/itchiness
• Dysuria
• Superficial dyspareunia
Signs
• Abnormal vaginal discharge - frothy yellow/green
• Vulvitis + vaginitis
• Strawberry cervix - erythematous, punctuate appearance
What does trichomonas vaginalis infect and how is it spread?
Infects the vagina, urethra and paraurethral glands in women.
Almost exclusively transmitted via sexual intercourse
What are the implications of trichomonas in pregnancy and post-partum period?
Associated with PROM, pre-term delivery and low birth weight
TV infection at delivery can predispose to maternal postpartum sepsis
Metronidazole can affect taste of breast milk
What investigations can be done for trichomonas?
High vaginal swab from posterior fornix for saline wet-mount microscopy - can see flagellated protozoa swimming around
Culture in a Trichomonas medium = gold standard
NB There is no test for males so they must be treated if their partner is infected
What is the treatment for trichomonas?
Metronidazole 2g PO single dose
OR
Metronidazole 400mg BD for 5-7 days
Treat sexual partners of preceding four weeks simultaneously - metronidazole 400mg BD for 7 days
What does high vaginal swab look for?
What does endocervical swab look for?
HVS = TV / candida / BV
ECS = NG / CT
What is the commonest cause of abnormal discharge in women of childbearing age?
Bacterial vaginosis
What is the pH range of the vagina in BV?
pH >4.5-6.0
Normal pH < 4.5
What type bacteria dominate the vaginal flora in BV?
How do they end up colonising the vagina?
Anaerobes
- Gardenerella vaginalis
- Mycoplasma hominis
Normal vaginal flora is disturbed, leading to reduction in lactobacilli (large rod-shaped organisms that produce hydrogen peroxide to help maintain acidic pH < 4.5 in vagina and inhibit growth of other microorganisms) in the vagina
Is BV sexually transmitted?
No
What are some risk factors for BV?
- Vaginal douching or use of scented soaps
- Receptive cunnilingus
- Recent antibiotic use
- Intrauterine devices
- Black ethnicity
- Recent change of sexual partner
- Smoking
What are the signs/symptoms of BV?
- Asymptomatic (50%)
- Profuse, whitish grey, offensive smelling vaginal discharge
- Characteristic ‘fishy’ smell = due to presence of amines released by bacterial proteolysis
What are the implications of BV in pregnancy?
- Late miscarriage (2nd trimester)
- Preterm birth
- PROM
- Post-partum endometriosis
What investigations can be done for BV?
Microscopy - high vaginal swab is gram-stained; sample of vaginal discharge transferred to slide and mixed with normal saline (wet mount preparation)
- ‘clue cells’ - vaginal epithelial cells studded with gram variable coccobacilli
- Reduced numbers of lactobacilli
- Absence of leucocytes
Isolation of Gardnerella vaginalis does not diagnose BV - found in vagina of 50+% uninfected women
Vaginal pH > 4.5
KOH whiff test - KOH added to discharge causes release of strong fishy odour
What is the treatment of BV?
First line - metronidazole 400mg BD PO for 5-7 days
Second line - clindamycin 2% cream vaginally at night for 7 days or tinidazole
Oral probiotics
What is thrush?
Infection with a yeast-like fungus, most commonly Candida albicans = Candiasis
How common is candidiasis?
70% women experience at some point, 20-40% women are chronic carriers
What are risk factors for developing candidiasis?
Things which alter the vaginal microflora eg:
- Antibiotic use
- Pregnancy
- High dose COCP (oestrogen)
- Diabetes mellitus
- Immunosuppression - HIV, iatrogenic
NOT sexually transmitted
What are the signs/symptoms of candidiasis?
- Vulvitis - itching and soreness
- Thick, curd-like, white non-offensive vaginal discharge
- Dysuria
- Superficial dyspareunia
- Vulval erythema, fissuring, satellite lesions
- Excoriations
= unlikely to cause significant complications unless woman severely immunocompromised
What are the implications of candidiasis in pregnancy?
Very common in pregnancy with no major adverse effects
What investigations are done for candidiasis?
Clinical diagnosis - often treated without investigations on typical symptoms
- Culture from HVS or LVS
- Microscopic detection of spores and pseudohyphae on wet slides
What is the treatment of candidiasis?
As so many women are chronic carriers = only treat if symptomatic
Clotrimazole pessary 500mg PV STAT +/- topical clotrimazole cream
OR
Fluconazole 150mg PO STAT (CI in pregnancy)
Topical antifungals not systemically absorbed = safe at all gestations
General advice eg wear cotton underwear / avoid irritants
What is normal Vaginal Discharge?
1-4mls per 24 hours
White or clear
Non - offensive odour
Varies with menstrual cycle
Name some causes of Vaginal Discharge with post-coital coital bleeding
Infection
- Chlamydia
- Gonorrhoea
Cervical abnormality
- Polyp
- Ectopy
- Premalignant (CIN)
- Malignancy
What is lymphogranuloma venerum (LGV)?
A type of chlamydia which can cause rectal symptoms. Very invasive and required prolonged treatment (sometimes anal reconstructions required)
What is balantitis?
What is posthitis?
Balanitis = inflammation of the glans penis (head of penis) Posthitis = inflammation of the prepuce (foreskin)
= Balanoposthitis
Who does balantitis most commonly affect?
Boys <4yr and men who have not been circumcised
What is the possible aetiologies of balantitis?
- Candida (most common)
- Bacterial infection
- STI eg chlamydia, gonorrhoea, genital herpes
- Irritant / allergic
- Poor hygiene
- Psoriasis
- Lichen sclerosis
- Zoon’s (plasma cell) balantitis
- Circinate balanitis
- Fixed drug eruptions
- Premalignant conditions
What are the signs/symptoms of balantitis?
Variable
- redness, irritation, unpleasant odour
- redness at the end of penis
- smegma = thick lumpy discharge from under the foreskin
- may have difficulty retracting foreskin
- dysuria
What investigations can be done for balantitis?
Urethral swab
What is the management of balanoposthitis?
Treat underlying cause:
- Floconazole 150mg PO single dose for candidal balantitis
- Fluxlocacillin 500mg QDS for 7 days for bacterial balantitis
- Metronidazole 400mg BD for 7 days if anaerobic (gardnerella) balantitis
Mild steroid cream for allergies / irritants (but do not use alone in infection as it can make it worse)
- Topical hydrocortisone 1% once daily for up to 14 days
If phimosis present (unretractable foreskin) may need circumcision
General advice eg clean penis everyday with water and avoid irritants
Name some normal anatomical variants which may be mistaken for warts (4)
Pearly penile papules
Fordyce spots
Parafrenular glands
Vestibular papillae
What are anogenital warts and what causes them?
Benign lesions caused by HPV
(90% types 6 or 11)
Warts may also contain oncogenic types (8 and 16) but these usually cause dysplastic lesions
What is condylomata acuminate?
(ano)genital warts
What are the signs/symptom of genital warts?
Varied appearance eg tiny flat patches on vulval skin, small papilliform (cauliflower-like) swellings, can affect cervix
May be asymptomatic = HPV infection very common and most do not result in visible genital tract lesions
What investigations are done for genital warts?
Clinical diagnosis
May need biopsy to exclude neoplasia
What is the management of genital warts?
Skin lesion can be removed but virus is still in system (eg can come back when immunosuppressed)
No treatment option - some resolves spontaneously
Physical ablation = cryotherapy, excision, electrocautery
Topical application = podophyllotoxin (tetarogenic), imiquimod
What is the prevention of HPV?
Vaccination - quadrivalent vaccine since 2012 for girls (6, 8, 11, 16)
MSM not protected - but just started vaccine for boys
How is molluscum contagiosum spread in young adults and where on body does it affect?
Sexual transmission typically affecting young adults. Affects genitals, pubic region, lower abdo, upper thighs, buttocks
Describe a characteristic molluscum contagiosum lesion
Smooth surfaced, firm, dome-shaped papule with central umbilication
How is molluscum contagious diagnosed and treated?
Clinically
No treatment - takes approx 6 months to go away
Genital molluscum - offer routine STI screen
What virus causes herpes?
HSV-1 = oral HSV-2 = genital
(HSV-1 can cause genital herpes but 70% are caused by HSV-2)
How common is herpes?
2nd most common STI in the UK (after chlamydia, before genital warts and gonorrhoea)
- approx 70% population infected
What is the incubation period of HSV?
5-14 days
What are the signs/symptoms of primary HSV infection?
How long do they typically last?
Primary infection = usually more severe
Local symptoms (anogenital herpes):
- Painful ulceration
- Dysuria
- Vaginal / urethral discharge
- Vulvitis and pain (could be severe enough to cause urinary retention)
- Ulcers can coalesce to form larger superficial lesions with characteristic serpiginous edges
Systemic:
- Flu-like illness (muscle aches, malaise, headache)
3 weeks
Describe what happens when herpes is reactivated
HSV remains latent in dorsal root ganglion
When reactivated, it travels down the axon and into basal skin layers
Some episodes will be symptomatic whilst others are asymptomatic.
What can trigger a reactivation of herpes?
Stress, sex, menstruation
What are some complications of herpes?
- Meningitis
- Sacral radiculopathy (can cause urinary retention / constipation)
- Transverse myelitis
Disseminated infection - Myalgia
- Auto-inoculation to distant sites
- Erythema multiforme
What are the implications of herpes in pregnancy?
Primary infection can lead to miscarriage or preterm labour
What are the implications of herpes in neonates?
- Transmission rate from vaginal delivery during primary infection can be as high as 50% but rare during recurrent attack
- Neonatal herpes appear during first 2 weeks of life = 25% confided to eyes and mouth, 75% widely disseminated (high morbidity and mortality)
How is herpes investigated?
Usually clinical diagnosis
Viral culture of vesicle fluid = gold standard
Acute and convalescent antibodies may be helpful
What is the treatment of herpes?
No cure
Treatment with aciclovir can help to shorten duration and severity if given within 5 days of onset of symptoms
What is the management of herpes during pregnancy?
If labour is within 6wks of primary infection then delivery by CS recommended (provided membranes have not been ruptured for >4hrs)
With active vesicles from recurrent attack, risk vs benefit of surgery against small chance of neonatal infection
How does HPV cause cervical caner
HPV only oncogenic if it can enter cells and reach the nucleus for cell replication. Usually cannot enter cells.
Nicotine holds cell membranes open, allowing viral entry. Smoking increases risk of cervical cancer in a HPV +ve woman by twenty !!!
What are the 4 HIV stages of presentation?
1) Primary HIV
2) Asymptomatic - screening
3) Symptomatic
4) Advanced HIV
What are the signs/symptoms of primary HIV (acute infection with HIV)?
Non-specific, flu-like illness
- Fever
- Malaise
- Myalgia
- Lymphadenopathy
- Pharyngitis
- Rash
- Some present with an AIDs defining illness, neurological involvement or persistently low CD4 count (<200 cells/mm cubed)
Diagnosis within 6 months, recent -ve HIV test supports diagnosis
How long do symptoms of primary HIV infection / seroconversion last?
Begins 2-6 weeks after infection lasting 5-10 days (rarely > 14 days)
What are the window periods for antigen and HIV antibody detection?
p24 antigen detected 2-4wks after infection
HIV antibody detected 4-8wks after infection
- Thus a 4th generation (Ag/Ab) HIV test will detect the majority of infected patients by 4 weeks after an infection
What investigations are done for HIV?
Antibodies to core (p24) and surface (GP 41, 120, 160) proteins develop in 2-6wks
= repeat after 3 months in case delayed seroconversion
How long does the asymptomatic stage of HIV last?
Average 5-10yrs
List some example symptoms of symptomatic HIV:
- Non-specific
- Skin lesions
- Oral lesions
- Recurrent bacterial infections
- Abnormal blood results
- Non-specific: persistent lymphadenopopathy, fever, myalgia, diarrhoea
- Skin lesions: folliculitis, multi-site Herpes zoster, seborrhoea keratitis
- Oral lesions: candidiasis, oral hairy leukoplakia
- Recurrent bacterial infections: pneumonia, impetigo
- Abnormal blood results: lymphopenia, thrombocytopenia
What is a healthy CD4 count?
Greater than 500 cells/mm3 = marker of healthy immune function
If falls lower than this, individuals at greater risk of opportunistic infections (used as a guide of when to start HAART)
List types of intercourse increasing risk of HIV transmission from most to least risk
Receptive anal intercourse > receptive vaginal intercourse > insertive anal intercourse > insertive vaginal intercourse
What investigations and monitoring are done for HIV?
Routine - U&Es, FBC, lipid / bone profile, glucose
Serology - Hep A, B (surfaceAg and coreAb), Hep C, Syphilis
HIV viral load, CD4 count
What is the HIV test I?
Rapid point of care test
- Bedside test / in clinic
- Results in front of patient
What are the pros and cons of the HIV test I?
Pros:
- Quick to perform and get results in 30 mins
- Good for needle phobic pt
Cons:
- Some are 3rd generation = only pick up antibodies not antigen (12wk window period)
- Reactive tests require a laboratory venous sample for results confirmation
What is the HIV test II?
Venous blood sample in clotted tube, sent to the lab - ELISA (enzyme-linked immunosorbent assay) - detects HIV antibodies and p24 antigen
What are the pros and cons of the HIV test II?
Pros:
- Accurate
- 4th generation test will pick up in 4 wk window period
Cons:
- Results not instant
What is PrEP? When can it be taken?
Pre-Exposure Prophylaxis
- Given to HIV -ve people
- Taken before, during and after sex
- Can be taken daily or around sexual activity
- V effective
- Now free on NHS woooo
What is PEPSE? When can it be taken?
Post Exposure Prophylaxis
- HIV medication taken after high risk sex / exposure
- Within 72hrs of risk (ideally within 24hrs)
- Take for 28 days
- Obtained from sexual health clinics of A&E
- Need for baseline HIV test and monitoring
How is HIV prevented MTCT (mother to child transmission)?
- Routine antenatal screening (opt-out)
- Delivery by CS
- PEP for baby for 4wks after brith
- Formula feeding (low income get milk vouchers)
- Avoid delivery before 34wks, PROM, invasive procedures during labour such as fetal blood sampling
What is HAART?
Highly active antiretroviral therapy = sustained inhibition of viral replication. Results in reinstitution of immune system in most pt, even those with advanced disease and low CD4 counts
What are NRTIs and NNRTIs?
Nucleoside/nucleotide analogues (NRTIs) and non-nucleoside agents (NNRTIs) inhibit viral reverse transcriptase enzyme
NRTIs
- Zidovudine
- Abacavir
NNRTIs:
- Nevirapine
- Etravirine
Name other examples of antiretroviral therapy
- Protease inhibitors (PIs) eg Indinavir
- Entry inhibitors eg Enfuviritide
- Fusion inhibitors
- CCR5 antagonists
- Integrase inhibitors eg Raltegravir
= often in pt who have failed previous ARV treatments or developed ARV resistance
What two features are diagnostic of AIDS?
Development of opportunistic infections or malignancy (including cervical carcinoma) or a CD4 count <200cells/mm cubed
List some common AIDS defining diseases in:
1) Resource rich countries
2) Resource poor countries
1) Resource rich countries:
- Pneumocystitis pneumonia
- Oesophageal candida
- Non-Hodgkin’s lymphoma
- TB (pulmonary and extra pulmonary)
2) Resource poor countries
- TB (pulmonary and extra pulmonary)
- HIV wasting syndrome
- Cerebal toxoplasmosis
- Cryptococcus meningitis
List 3 infections specific to MSM
- Rectal LGV
- New variant syphilis
- Anal canal warts and anal intraepithelial neoplasia
HIV risk assessment questions in sexual health clinic
- IVDU
- MSM
- CSW
List 4 dermatological conditions causing vulval pruritis
Lichen sclerosus
Lichen planus
Eczema / lichen simplex
Psoriasis
List 4 infections and infestations causing vulval pruritis
Candidiasis Trichomonoiasis Prodrome of recurrent herpes simplex infection Genital warts Scabies Prediculosis pubis Threadworms
What is bartholinthitis?
Inflammation of one or both of the two Bartholin’s glands, which are located one on either side of the opening of the vagina, behind the labia
What complication can occur during treatment of syphilis?
Jarisch Herxheimer reaction - inflammatory response secondary to death of treponemes
Flu-like illness within 24 hours of treatment
Supportive measures to manage
What is the vaginal pH in trichomonas?
pH > 5.0
What is Amsel’s criteria for diagnosis of BV?
Amsel’s criteria for diagnosis of bacterial vaginosis (3 of following 4 points should be present)
• Thin, white homogenous discharge
• Clue cells on microscopy - stippled vaginal epithelial cells
• Vaginal pH > 4.5
• Positive whiff test - add KOH, results in fishy odour
