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GOSH > Sexual health > Flashcards

Sexual health Flashcards

1
Q

What are some INFECTIVE causes for changes in discharge?

A

NON STI

  • BV
  • Candida (thrush)

STI
Vaginal
-Trichomonas vaginalis

Endocervical/urethral

  • Clamydia trachoma’s
  • Neisseria gonorrhoea
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2
Q

What are some non-infective causes of changes in discharge?

A

Cervical ectropion
Foreign body
Physiological (some discharge for women is normal)

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3
Q

What is the commonest cause of vaginal discharge in women of CBA?

A

Bacterial vaginosis

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4
Q

What is the pathophysiology of BV?

A
  • There is overgrowth of anaerobic bacteria (gardnerella vaginalis bacteria)
  • Causing lack of lactobacilli meaning the pH of the vagina increases (normal=4.5m BV=4.5-6)
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5
Q

BV
What does the discharge look like and what symptoms are commonly experienced?

How many are symptomatic?

A

Discharge

  • increased volume
  • thin and watery
  • fishy odor

symptoms
-may have dyspareunia/ dysuria
NO SORENESS, NO ITCHINESS

50% patients with BV are asymptomatic

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6
Q

What is a complication of BV?

What are some obstetric complications of PID?

A

Complications of BV

  • PID
  • Cellulitis/abcess formation following TV hysterectomy
PID in pregnancy 
Obstetric complications
- Late miscarriage 
- Pre-term birth
- PROM
- Post-Delivery endometritis
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7
Q

If you suspect BV what tests should you do?

A

-low vaginal swab (for MC+S)>CLUE CELLS
-pH of vagina (will be >4.5)
-+ve WHIFF TEST (K+)
(at lab: Hay-Ison gram stained vaginal smear)

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8
Q

What management should be recommended for BV?

A

LIFESTYLE (no douching or tight clothing, wash with water)

MEDICATION (treat if symptomatic/having surgery)

  • metronidazole (5-7 days) (oral or topical-advise if breast feeding)
  • if allergic: clindamycin

(same treatment in pregnancy)

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9
Q

What organism causes thrush?

A

Candida (vast majority is albicans)

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10
Q

Who is most likely to get candida?

A
  • Immunosuppressed (e.g. HIV/pregnancy/diabetes)
  • Abx use
  • Elevated oestrogen (COCP)
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11
Q

Presentation of candida? (symptoms and signs)

A

Symptoms of candida

  • thick creamy lumpy discharge (cottage cheese)
  • vulval itchiness and soreness
  • dyspareunia (superficial)
  • dysuria (external)
Signs 
-excoriations and fissures
-redness/rash on vulva
(satellite lesions) 
-odema
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12
Q

How should we investigate a patient with suspected candida?

A
  • Candida is so common that it often doesn’t require investigation before treatment
  • Can do microscopy of vaginal swab if in doubt/unresponsive to treatment
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13
Q

How should we manage a case of candida?

A

LIFESTYLE:

  • Soap substitute
  • Emollient for external skin
  • Lose clothes

MEDICAL:

  • Topical or oral anti fungal
  • Based on choice (if pregnant>topical)

E.g. oral fluconazole or clotrimazole pessary/cream (if preg)

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14
Q

Is trichomonas vaginalis an STI?

A

YES - it is commonly mistaken for BV or candida

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15
Q

What are some symptoms/signs of trichomonas vaginalis?

How many are asymptomatic

A

Symptoms of trichomonas vaginalis

  • INCREASED offensive discharge
  • Vulval itch and soreness
  • Dysuria
  • Lower abdo pain

Signs

  • Classical frothy yellow discharge (30% of patients)
  • Inflamtaion (vulvitis and vaginitis)
  • pH>4.5
  • STRAWBERRY CERVIX (highly suggestive but only present in 10%)

Up to 50% can be asymptomatic

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16
Q

If you suspect a woman might have TV how should you investigate?

A

Trichomonas vaginalis investigations

  • speculum and posterior fornix swab
  • send for wet mount microscopy
  • vulvovaginal NAAT swab
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17
Q

How should we treat a woman with TV?

Do you treat sexual partners for TV?

How long should you avoid sex?

A

2g Metronidazole stat dose
OR
400mg metronidazole BD for 5-7 days (this is the more effective regime and this should ALWAYS BE GIVEN TO MALES and if in 1st trimester)

-Treat partners and avoid sex for 1 week and until partners have completed treatment

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18
Q

What is the most common STI in the UK?

A

Chlamydia Trachomatis (obligate intracellular organism) (gram negative)

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19
Q

What are the chances you will pass on chlamydia if you have it?

A
  • 75% (very high transmission rate)

- Majority of people are asymptomatic

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20
Q

What are some symptoms of chlamydia?

A

Symptoms

  • increased vaginal discharge
  • PCB and IMB (endocervical)
  • Pain: lower abdo pain, dysuria and deep dyspareunia
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21
Q

What might you find on speculum examination in a women with chlamydia or gonorrhoea?

A

Clamydia

  • Mucopurulent cervicitis
  • Contact bleeding of the cervix
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22
Q

What are some complications of chlamydia? (gynae and systemic and neonatal)

A 
Complications of chlamydia
Gynae problems:
-PID
-endometriosis
-salpingitis 
-Tubal infertility 
-Ectopic pregnancy

Systemic problems:

  • Sexually acquired reactive arthritis
  • Fitz-Hugh Curtis Syndrome (perihepatitis)
  • Problems if pregnant-baby gets conjunctivitis/pneumonia
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23
Q

What investigations should you do in someone you suspect to have chlamydia?

A

Chlamydia testing

  • NAAT VVS or urine (both after 2 weeks)
  • Consider swabbing in different sites for microscopy (throat and rectum in MSM)
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24
Q

How long do you have to wait for chlamydia to show as positive on test?

A

2 weeks

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25
Q

How should we manage chlamydia?

What about if they are pregnant?

What should they do about sex?

A
  • DOXYCYCLINE 7 days (not in pregnancy)
  • If PREGNANT give AZITHROMYCIN (and re-test in 3-5 weeks later weeks her to make sure the infection has been cleared)
  • Abstain for 1 week and treat partners (CONTACT TRACING)
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26
Q

What sort of bacteria is neisseria gonorrhoeae?

Where is primary site of infection and how is it spread?

A

Gram negative diplococcus (neisseria gonorrhoea)

-Primary site of infection is mucous membranes and spread by secretions from one mucous membrane to another
(urethra, endocervix, rectum, conjunctiva, pharynx)

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27
Q

What are some symptoms of people who have gonorrhoea?

A

Gonorrhoea

  • Pain
  • Purulent discharge (more purulent/ green than chlamydia)
  • PCB, IMB or menorrhagia** (less common than chlamydia)
  • Lower abdomen pain
  • Dysuria if urethral infection (uthritis)

***might be endocervical bleeding, can lead to PID

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28
Q

What investigations should be done in someone who has suspected gonorrhoea?

A
  • VVS NAAT AND endocervical swab (M+C-resistance) and urine for men
  • Consider multi site testing in MSM (rectum and throat)
29
Q

How should we manage cases of gonorrhoea ?(think about follow up)

What about sex?

A

IM injection of CEFTRIAXONE

-Do swabs 3 weeks later FOR ALL to check it has been cleared (resistance)

Avoid sex for 1/52 and contact trace partners

30
Q

Name some physiological skin changes on the penis?

A
  • Pearly, penile, papules
  • Fordyce spots (bumps around the base of the glans)
  • Parafrenular glands
  • Vestibular papillae (women’s vulva)
31
Q

What causes genital warts?

Are warts painful?

A

HUMAN PAPILLOMA VIRUS

  • 90% are caused by strains 6-11
  • remaining are caused by 16 and 18 (more concerning because oncogenic)

WARTS ARE PAINLESS

32
Q

Is HPV sexually transmitted and what is the incubation period?

A
  • Yes it is

- Incubation period can be any time between 3 weeks and 8 months meaning it can be very hard to contact trace

33
Q

What managements can be offered for HPV warts?

A
  • Some may resolve spontaneously (within 1 year)
  • DO speculum/proctoscopy to see if they are present other places

Physical ablation

  • cryotherapy (liquid nitrogen)
  • excision
  • electrocautery

Topical

  • podophyllotoxin cream if soft
  • imiquimod cream if keratinised (aldara)
34
Q

What other lumps on the penis are commonly mistaken for HPV warts?

A
  • Molloscum contagiosum can be sexually transmitted (umbilicate)
  • Lymphoceles (swelling caused by vigorous sex)
  • Sebaceous cysts are also not uncommon on the penis
  • Scabies can also occur on the penis
35
Q

What causes genital ulcers?

What is pathogenisis of reactivation?

A

Herpes virus (HSV1/2 but usually HSV-2)

  • After primary infection the virus is latent in the local sensory ganglion
  • Periodically reactivates (symptomatic or asymptomatic) but INFECTIOUS
36
Q

How will herpes ulcers look?

What are the symptoms?

A

-Multiple or single shallow ulcers

  • PAINFUL ulcers
  • Pain on urination (urine goes on ulcers)
  • Vaginal/urethral discharge

Systemic: fever and aches

37
Q

How do we investigate possible cases of herpes?

A

Take a viral PCR swab of the ulcers (might be difficult given how painful they are)

38
Q

How do we manage herpes ulcers and can we cure then?

Any advice to patient about sex?

A

-Aciclovir PO 5 days when first infection or symptomatic
(recurrences are normally short lived-can be treated with saline baths and topical anaesthetic agents)

  • It is a lifelong infection that we can’t clear
  • Should not have sex when symptomatic
  • Can spread even if no lesion (although v low chance)
  • **always contact trace
39
Q

How does syphilis often present?

A

Primary syphilis infection
-SINGLE, LARGE, PAINLESS lesion>CHANCRES
(although can be multiple and painful)

Secondary syphilis infection (2 to 8 weeks after)

  • MacPap rashes on soles of hands and palms of feet
  • Ulceration of skin
40
Q

If you think a chancre might be syphilitic what is the best way to investigate?

A
  • Viral PCR of chancre
  • Blood test (serology) for syphilis

Cardiolipin (negetive with treatment)
TPPA (remains +ve after treatment)

41
Q

What organism causes syphilis? Who is highest risk?

A
  • Treponema Pallidum (gram neg)

- Highest risk is MSM between 25-34 (40% of which are also infected with HIV)

42
Q

What are the stages of syphilis?

A
  1. Primary
  2. Secondary (2 to 8 weeks after)
  3. Latent (early lasts <2 years and late lasts >2 years)
  4. Late (tertiary)
    - neuro-syphilis (loss of proprioception and vibration)
    - cardiovascular (aortic aneurysms)
    - gummatous
43
Q

Primary syphilis

  • incubation period
  • when does it ressolve?
A

PRIMARY SYPHILIS
-Incubation period of 9-90 days (average 21)

-Should resolve around 3-8 weeks

44
Q

How often do primary syphilis progress to secondary?

How long after chancre does it happen?

What symptoms do you get with secondary syphilis?

A
  • 25% of patients with primary will go on to develop secondary (if untreated)
  • Occurs 4-10 weeks after initial chancre
  • Multisystem symptoms*
  • Most noticeable symptoms is SYPHILIS RASH condylomata lata (hands and feet, and genitals). NOT ITCHY

-Can also get systemic vasculitis

45
Q

How long do the early and late LATENT PHASE of syphilis last for?

A 
Early latent (2 years)
Late latent - anything longer than 2 years
46
Q

What symptoms can we expect in the late (tertiary) phase of syphilis?

A

NEURO - wide-stepping gait, delusions of grandeur, loss of vibration/proprioception
CARDIO - Dilation of aortic root
GUMMATOUS - Ulceration of limbs

47
Q

How can we manage syphilis ?

Primary, secondary and early latent
vs
Late latent, cardiovascular, gummatous:

A
  • Refer to sexual health
  • For primary, secondary and early latent: IM Benzathine penicillin (pen G) 2.4MU single dose

Late latent, cardiovascular, gummatous: IM Benzathine penicillin (pen G) 2.4MU weekly, for 3 weeks (3 doses)

**longer treatment courses for neuro/opthalmic syphilis

Pen allergy: doxycycline

48
Q

What questions do you ask males vs females in Presenting complaint?

A

Males

  • Pain passing urine?
  • Discharge?
  • Testicular pain or swelling
Females 
3 pains 
-pain urinating 
-pain sex 
-abdo pain

3 other things

  • discharge changes
  • bleeding (IMB and PCB)
  • urine problems

SKIN: lumps/ bumps/blisters anywhere?

ANAL: pain or discharge

Ask about partners

49
Q

What is balanoposthitis?

Symptoms?

Whats the most common cause?

A

Balanitis- inflammation of the glans penis

Prosthitis- inflammation of the glans and foreskin

Local rash, soreness, itch, odour, can’t retract foreskin, sometimes discharge

Poor hygiene- however CANDIDA is common cause when found (swab for this)
(can be premalignant)

50
Q

What are some symptoms of lichen sclerosis?

A

Lichen sclerosis

  • itch/irritation
  • soreness
  • dyspareunia
  • urinary symptoms
51
Q

What investigations would you do for a woman presenting with genital blisters?

A

SWABS

  • vaginal swab (chlamydia and gonorrhoea NAAT test)
  • blister swab (HSV and syphilis PCR)

BLOODS
-HIV and syphilis serology

52
Q

What patient factors affect clearance of genital warts?

A

Smoking/HIV/pregnancy affect clearance of genital warts

53
Q

If a patient has HIV but WONT tell partner what can you do?

A

INSERT answer

54
Q

How do you treat BV in pregnancy?

How do you treat Candida in pregnancy?

How do you treat chlamydia in pregnancy

A

BV in pregnancy
-metronidazol (5-7 days)

Candida in pregnancy
-7 days TOPICAL antifuncal therapy e.g. clotrimoxasol (not oral as CI)

Chlamydia in pregnancy

  • azithromycin (usually doxycycline)
  • retest after 3-5 weeks to confirm cleared infection
55
Q

What causes trichomonas vaginalis?

What is the pathophysiology?

How is it spread?

A
  • trichomonas vaginalis is caused by a flagellated protozoon
  • it infects the vagina, urethra and paraurethral glands
  • almost exclusively sexually transmitted
56
Q

What is Fitz-Hugh Curtis Syndrom?

Common causes?

Symptoms?

A

Perihepatitis (complication of chronic PID)

  • clamydia and gonnorhea most common causes
  • Right upper quadrant pain and plural effusion
57
Q

What is urethritis?

A
  • dysuria
  • urethral discharge
  • urethral discomfort
58
Q

What causes urethritis?

A

Either gonococcal or non gonococcal (chlamydia, mycoplasma genitalium)

59
Q

What colour is urethral discharge in gonorrhoea vs chlamydia?

A

gonorrhoea: yellow urethral discharge
chlamydia: clear/white

60
Q

Complications of gonorrhoea?

A

Complications of gonorrhoea

  • epididymo-orchititis (men)
  • proctitis
  • disseminated gonorrhoea
61
Q

What is Lymphogranuloma venereum (and cause)
What are the symptoms?
What population does this effect?

A

Lymphogranuloma venereum

  • ulcerative disease in genital area
  • caused by chlamyida

Symptoms

  • small painless blister (can be multiple) (then turns more painful)
  • proctitis (rectal pain/discharge)
  • swollen lymph nodes
  • swollen genitals

Affects gay men predominantly

62
Q

What screening tests are done for STIs

A

STI SCREENING

  • Chlamydia, gonorrhoea NAAT (urine or vaginal swab)
  • HIV, syphilis (serology)
63
Q

What tests are tailored based on population risk?

A

Standard screening plus:
-3 site screen for chlamydia and gonorrhoea for MSM (urine, rectum, pharynx)

-Hepatitis B and C serology screening (sexual or endemic risk)

64
Q

What do you do if patient reducesIM ceftriaxone for gonorrhoea?

A

For patients with gonorrhoea, a combination of oral CEFIXIME + oral AZITHROMYCIN is used if the patient refuses IM ceftriaxone

65
Q

Effects of chlamidya for neonates?

A
  • Opthalmia neonatorum (conjuctivitis of newborn)

- Pneumonia

66
Q

Effects of gonorrhea for neonates?

A 
Opthalmia neonatorum (conjuctivitis of newborn)  (40-50%)
Can develop vaginal infection
67
Q

Whats the most common cause of Uthritis?

A

Gonorroea most common

68
Q

How far back should you contact trace for chlamidia? (men and women)

A

MEN

  • go back 6 months if asymptomatic
  • go back 4 weeks if symptomatic

WOMEN
-go back 6 months

69
Q

Most common cause of Reiter’s syndrome?

A

Chlamidia

cant see cant pee cant climb tree

GOSH (29 decks)

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