SEXUAL HEALTH Flashcards
what are the clinical features of lymphogranuloma venereum?
- Inguinal lymphadenopathy
- Non-specific symptoms of proctocolitis (anorectal pain, rectal bleeding, mucopurulent discharge and tensesmus
- Groove sign of Greenblatt (femoral and inguinal node involvement)
- Genital elephantiasis, saxophone penis, esthiomene
- Fever, malaise, arthralgias
- Lower abdominal or lower back pain
how is lymphogranuloma venereum diagnosed?
- clinical features
- positive NAAT for chlamydia
how is lymphogranuloma venereum managed?
- oral doxycycline
- oral erythromycin in pregnant women
- pus aspiration from bubonuli to prevent rupture and sinus tract formation
what are the risk factors for developing syphilis?
- Unprotected sex.
- Multiple or anonymous sexual partners.
- Substance use.
- Transactional sex.
- Social vulnerability.
- Needle-sharing contact.
what are the clinical features of primary syphilis?
-painless genital chancre
what are the clinical features of secondary syphilis?
- A maculopapular rash.
- Condylomata lata (moist wart-like lesions).
- Buccal ulceration.
- Generalised lymphadenopathy
- Fever, headache and malaise.
what are the clinical features of tertiary syphilis?
- Loss of proprioception and vibration sensation
- Tabes dorsalis
- Argyll-Robertson pupil (accommodation but absent pupillary light reflex).
- Abdominal aortic aneurysm.
- Gummatous lesions.
what are the clinical features of congenital syphilis?
- Blunted upper incisor teeth (Hutchinson’s teeth) and mulberry molars.
- Keratitis.
- Saddle nose.
how is syphilis diagnosed?
- dark-field microscopy
- specific serological tests: EIA/TPHA/TPPA (stay positive after treatment)
- non-specific serology: VDRL/RPR (negative after treatment
how is syphilis treated?
- Offer full screening for other STIs (including HIV).
- Perform contact tracing to help limit ongoing transmission.
- Offer benzathine benzylpenicillin intramuscularly as first line management:
- Given as a single dose for primary and secondary syphilis.
- Given as three doses over 2 weeks (day 0, 7, 14) in latent late syphilis.
- Offer doxocycline for 14 days as first line treatment in patients with a penicillin allergy.
- Offer intravenous aqueous benzylpenicillin sodium for suspected neurosyphilis.
what are the clinical features of gonorrhoea in men?
- Mucopurulent or purulent urethral discharge.
- Dysuria.
- Tender epididymis in epididymitis.
- Anal discharge.
- Perianal and anal pain.
what are the clinical features of gonorrhoea in women?
- Increased or altered vaginal discharge.
- Lower abdominal and pelvic pain.
- Dysuria.
- Intermenstrual bleeding.
- Painful intercourse (dyspareunia) if the infection spreads to the endocervix.
how is gonorrhoea diagnosed?
- NAAT
- vulvovaginal swab in women
- first pass urine sample in men
how is gonorrhoea managed?
- Offer intramuscular ceftriaxone and oral azithromycin as single doses.
- Offer oral cefixime instead of intramuscular ceftriaxone if the patient refuses intramuscular injection.
- metronidazole if history of sexual abuse
what are the clinical features of genital herpes?
- Painful bilateral blisters on the external genitalia.
- Fever and malaise.
- Dysuria.
- Inguinal lymphadenopathy.
- Tingling and burning symptoms (recurrent)
what are the clinical features of oral herpes?
- Cold sores.
- Sore throat.
- Fever.
- Cervical lymphadenopathy.
how are genital herpes treated?
- Prescribe oral aciclovir (400 mg three times daily for 5 - 10 days) as first line treatment of primary genital herpes.
- Prescribe topical lidocaine and recommend sitz baths for pain relief.
- Advise abstinence from sexual intercourse until the lesions have cleared.
- Offer episodic antiviral treatment (oral aciclovir) for infrequent episodic attacks.
- Offer suppressive antiviral treatment (oral aciclovir) for frequent episodic attacks.
how is oral herpes managed?
- Recommend paracetamol and ibuprofen to treat symptoms of pain and fever.
- Prescribe oral aciclovir (200 mg five times daily for 7 - 10 days) for severe, frequent or persistent disease.
how is genital herpes treated in pregnant women?
- oral acyclovir
- c-section delivery
what are the risk factors for developing chlamydia?
- A new sexual partner.
- More than one sexual partner in the last year.
- Lack of consistent condom use.
- Social deprivation.
what are the clinical features of chlamydia in women?
- Increased vaginal discharge.
- Post-coital or intermenstrual bleeding.
- Purulent vaginal discharge.
- Mucopurulent cervical discharge.
- Deep dyspareunia.
- Dysuria,
- Pelvic pain and tenderness.
what are the clinical features of chlamydia in men?
- Dysuria.
- Mucoid or mucopurulent urethral discharge.
- Urethral discomfort.
- Epididymo-orchitis.
how is chlamydia diagnosed?
-NAAT: first pass urine in men, vulvovaginal swab in women
how is chlamydia treated?
- Prescribe oral doxocycline (100 mg twice daily for 7 days) as the first line treatment.
- Prescribe azithromycin (1 g orally for one day, then 500 mg one daily for two days) as the first line treatment in pregnant women (doxycycline causes foetal tooth discolouration)
what are the clinical features of genital warts?
- Asymptomatic.
- Pruritus is uncommon.
- Urinary symptoms are uncommon and are caused by lesions in the distal urethra and meatus.
- Bleeding is uncommon and is due to local trauma.
how are genital warts treated?
- Offer topical podophyllotoxin or imiquimod for non-keratinised warts.
- Offer cryotherapy for keratinised or internal warts (urethral meatus or vaginal warts).
when should levonorgestrel be given for emergency contraception?
-within 72 hours of UPSI
when should ulipristal acetate be given for emergency contraception?
-within 120 hours of UPSI
when should Cu-IUD be given for emergency contraception?
- to 120 hours after first UPSI
- up to 5 days after the earliest expected date of ovulation
