Sexual health Flashcards
Gram negative diplococci on microscopy with STI symptoms= ?
Neisseria gonorrhoea
First line treatment for keratinised HPV anogenital warts?
Topical imiquimod for 8 weeks
Second line treatment for keratinised HPV anogenital warts?
Ablative cryotherapy
Dark ground microscopy is used for the diagnosis of which STD?
Syphilis
A 28-year-old female attends your GP surgery complaining of a 2-week history of change in vaginal discharge. Her LMP was 2 weeks ago, her period are regular and of moderate flow. She is sexually active with her regular male partner of 2 years. She has an intra-uterine device in place that was fitted 2 years ago. She denies other partners. The discharge is clear to grey, watery and malodorous. She denies any symptoms of itch, pain, dysuria or abnormal bleeding. Most likely diagnosis?
Bacterial vaginosis
Name 3 RFs for BV
Afro-Caribbean race, IUD, presence of other STI, douching, new sexual partner, receptive cunnilingus, smoking
First line treatment of BV?
PO metronidazole
Either 2g stat or 400mg BD for 5 days
If allergic to metronidazole, what is second line treatment for BV?
Clindamycin
2 risks associated with BV in pregnancy?
Late miscarriage
Post-partum endometritis
Premature rupture of membranes
Pre-term birth
Posterior fornix swab for wet mount is the investigation to diagnose what?
Trichomonas vaginalas
A male patient presents to Sexual Health Sheffield due to the presence of an indurated ulcer on his penis, with lymphadenopathy of the inguinal lymphnodes. He has had 8 sexual encounters in the last 6 months, all with men, some using protection but some without.
Given the likely diagnosis, what is the causative organism?
What Ix should you do?
What Ix is most sensitive and specific for this condition?
What is the first line treatment?
Second line?
Treponema pallidum
Full STI screen including HIV. For syphilis: Treponemal Enzyme Immunoassay. If these indicate syphilis, would do VDRL or RPR tests.
Dark field microscopy is most sens and spec
IM benzathine penicillin
2nd line = azithromycin
On average, how long after primary infection does secondary syphilis occur?
How does it present?
6 weeks
Variable presentation e.g. fever, myalgia, lymphadenopathy, generalised maculopapular rash over palms, soles, trunk and face.
What is condylomata lata?
Possible characteristic of 2ndary syphilis. Buccal ‘snail-track’ ulcers and warty genital lesions.
What is latent syphilis?
Positive serology without clinical features, with infection being acquired less than 2 yrs preior.
What proportion of untreated syphilis will go on to have tertiary syphilis?
What are possible manifestations?
1/3
Syphilitic gummas, cardiovascular sequelae (aortitis, aortic regurgitation, aortic aneurysm), neuro (Argyll-Robertson pupils, tabes dorsalis, ataxia, behavioural disturbance, paralysis, seizures)
What is tabes dorsalis?
Demyelinating disorder of the dorsal columns related to syphilis. Features = loss of proprioception and vibration, weakness, ataxia, positive Romberg sign.
What is first line investigation for gonorrhoea?
What else would you do with a specimen?
NAAT of urine or gential specifimes
Culture and sensitivities
What is the treatment for gonorrhoea and what follow up is required?
Ceftriaxone 1g IM
What is the classic triad of symptoms of disseminated gonococcal infection?
Tenosynovitis, migratory arthritis and dermatitis
A male patient presents to GUM clinic with dysuria, discharge and testicle pain. You suspect gonorrhoea and/or chlamydia. What Ix would you do to confirm this?
NAAT of urine (or genital for girls), and MC+S.
What is first line method of NAAT in a) F and b) M?
a) Vulvovaginal swab
b) First void urine sample
When should chlamydia screening take place following potential exposure?
2 weeks after
First line treatment of chlamydia?
Alternative if CI?
7 days 100mg BD doxycycline
1g azithromycin stat
Which types of HPV are responsible for the majority of anogenital warts?
6 and 11
First line treatment for anogenital warts
Topical podophyllum or cryotherapy
What is the causative organism in trichomoniasis, and how does it appear on microscopy?
What is seen on speculum in trichomoniasis?
Trichomonas vaginals - motile, flagellated protozoa
Strawberry cervix
What testing is recommended first line for trichomoniasis and what is the treatment?
NAAT testing
PO metronidazole
Describe the discharge in trichomoniasis?
What is the vaginal pH?
Offensive, yellow/green, frothy
>4.5
Once infected with HSV1 or 2, patients carry it for life. Why is this?
Viral DNA remains latent in the dorsal root ganglion
The majority of herpes encephalitis is caused by: HSV1 or HSV2?
HSV-1
How does genital herpes present?
What is first line investigation?
Painful blistering vesicular lesions with flu-like symptoms, tender lymphadenopathy.
PCR swab
Management of genital herpes?
Warm baths, topical lidocaine, PO valacyclovir
Which of HSV1 and HSV-2 has a higher rate of recurrance?
HSV-2
What virus causes chickenpox?
How is chickenpox spread?
Varicella zoster virus
Droplet spread
Describe the presentation of chickenpox.
Management?
Fever initially, then itchy, cropped macular–>papular–>vesicular rash that scabs. Starts on head/trunk and spreads
Supportive - hydration, anti-pyretics and emollients
What is the period of infectivity of chickenpox?
4 days before rash, until 5 days after rash first appeared
What is the rule for school exclusion with chickenpox?
Until all lesions are dry and crusted over, usually ~5 days after the start of the rash
A 65 year old man presents with a painful, blistering rash occurring in a band from the centre of his chest across the top of his right nipple.
What is the likely diagnosis?
What are 3 possible triggers?
Shingles/Herpes Zoster
Immunosuppression, acute stress, trauma
What is the most common site affects by shingles?
What is the second most common?
Trunk
Ophthalmic division of trigeminal nerve= herpes zoster ophthalmicus
Treatment of shingles? In what timeframe should this be given?
What is first-line analgesic options during an outbreak of shingles?
Valciclovir/aciclovir - within 72 hours of rash. Tell pt they are infectious until 5-7 days after rash appeared, and should avoid contact with pregnant women and immunosuppressed.
Paracetamol/NSAIDs first line
What does NICE recommend prescribing for the management of post-herpetic neuralgia?
Amitriptyline, duloxetine or gabapentin
What should you do if a pregnant woman is exposed to chickenpox?
- Ask if she has had chickenpox before
- If no, or unsure, check varicella antibodies
- If no antibodies then give varicella immunoglobulin within 10 days of exposure
If >=20 weeks gestation, what are the options for treatment of varicella exposure?
Either VZIg or antivirals (given 7-14 days post exposure)
A 3 year old comes to the GP with his mother. He has had a recent high fever, and now has come out in a non-itchy maculopapular rash which the mother is worried is meningitis. It had spread from the trunk to the face and limbs. The fever has resolved, and there are no other signs of meningism.
What is the likely diagnosis and cause?
Roseola infantum, HHV-6 (and possivby HHV-7)
