sexual health FCM Flashcards
what are the signs and symptoms of chlamydia?
a lot of the time asymptomatic
women - dyspareunia, IMB, PCB, dysuria and changes in vaginal discharge
men - penile discharge and dysuria
what investigations are done for chlamydia?
endocervical/vulvovaginal swabs in women (or FCU)
FCU sample from men
NAAT - nucleic acid amplification test
what are the primary pharmacological management options for chlamydia?
- Doxycyline 100mg BD - 7days
2. Azithromycin 1g (1/7) then 500mg (2/7) - preferred in pregnancy
what does non-pharmacological management of chlamydia involve?
- partner-led notification
- sexual abstinence at least for a week
- sexual health education
- further screening
what are the signs and symptoms of gonorrhoea?
more symptomatic than chlamydia but can also be asymptomatic in women
women - dyspareunia, IMB, PCB, dysuria and changes in vaginal discharge
men - penile discharge and dysuria
what investigations are done in gonorrhoea?
FCU urine for men
low vaginal swab for women
NAAT test - must do culture if test is positive
what is the management for gonorrhoea?
- Ceftriaxone 1g IM
- Azithromycin 2g PO
advise to
- partner-led notification
- sexual abstinence at least for a week
- sexual health education
- further screening
How does primary syphilis present?
painless chancre & lymphadenopathy
How does secondary syphilis present?
more systemic features
- fever
- malaise
- headache
- generalised lymphadenpathy
- skin lesions and alopecia
- mucous patches
- early neurosyphilis (focal neurological signs and CN palsies, hearing loss, optic diseases and dementia)
How does tertiary syphilis present?
granulomatous lesions with necrotic centre
CVD
chronic inflammation of arteries
neurosyphilis - tabes dorsalis and genital paresis
what are investigations for syphilis?
- dark-field microscopy - swab from chancre/ulceration
- serology (lifelong positive)
- consider HIV screen
What does management of syphilis involve?
- IM benzylthine benzylpenicilin single dose OR Doxycycline
1 week at least sexual abstinence and further screening
How does the first episode Herpes Simplex Virus (HSV) infection present?
multiple painful blisters - may burst and become crusty
vaginal/urethral discharge
local oedema
tingling/neuropathic pain in the genital, lower back, buttocks and legs
How does recurrent HSV present?
usually is preceded by prodormal burning/tingling, malaise, fever
the lesion may become crusty and then heal in 10 days
what investigations are done for HSV?
swab from lesion/ulcer - culture or PCR
mainly based on physical examination
What does the management of HSV comprise of?
for a primary infection…
Acyclovir 400mg TDS 5-10 days OR 200mg 5x a day for 5-10 days
supportive management includes…
- analgesia
- bathing in salt water
- lidocaine gel/ vaseline
- increased fluids
(NO CURE TO HSV!)
what are the different types of Human papilloma virus (HPV)?
HPV 6 & 11 = oncogenic
HPV16 & 18 = cervical
How does HPV present?
painless, small, flat, smooth papules - can become painful or irritated
described as soft cauliflower like growths
what investigations are involved?
diagnosis is based mainly on physical examination of external genitalia
can do a biopsy if unsure
what does the management of HPV involve?
Treatment takes 3-4 weeks during which you consider immunosuppression (offer HIV screen if indicated)
Podophyllotoxin topical (0.5%) - apply BD for 3/7 then review after 4/7 of no cream OR
imiquimod (5%) TDS at night for 16/52
can also turn to cryotherapy, surgical excision or specialist treatments
what are the 2 main forms of male sexual dysfunction?
- erectile dysfunction - persistent inability to attain and maintain an erection sufficient to permit satisfactory performance.
- premature ejaculation - regular ejaculation within a minute of vaginal penetration (average being 5.5mins)
what are potential causes/RFs of erectile dysfunction?
- Organic - T2DM, Obesity, HTN, hyperlipidaemia, CVD, hypogonadism, SC injury/pelvic surgery, Pyronie’s disease
- Drugs - excess alcohol, anti-HTNs, anti-psychotics, cannabis/cocaine
- Psychogenic - anxiety/depression, distress, performance-induced anxiety.
how is erectile dysfunction investigated?
focused physical exam to rule out any other visible causes
bloods - HbA1c, lipids, morning testosterone and FSH/LH
CVD risk stratification
what does management of erectile dysfunction involve?
dependent of history and potential underlying causes
- offer lifestyle advice
- psychosexual therapy
- PDE5 inhibitors - sildenafil/Viagra
- specialist treatments
what causes should be considered when someone presents with premature ejaculation?
consider prostatitis, thyroid disease as well as psychological distress
how is premature ejaculation investigated?
bloods - TSH, CRP, PSA, ESR (rule in/out differentials)
How is premature ejaculation managed?
psychosexual conselling
CBT
pharmacological = SSRIs, tramadol, terazosin (a-blocker) & sildenafil
specialist treatments
what does female sexual dysfunction refer to?
umbrella term for multiple disorders
- sexual interest arousal disorder
- female orgasmic disorder
- genito-pelvic penetration pain disorder (vaginismus & dyspareunia)
how do we investigate female sexual dysfunction?
mainly based on the history
vaginal dryness/vulvovaginal atrophy - may be due to low oestrogen
how is female sexual dysfunction managed?
dependent on the type of FSD they have
some include…
psychotherapy
topical oestrogen
How does trichomoniasis present?
vulval itching dysuria offensive fishy discharge frothy green/yellow discharge vulval/lower abdominal pain
How is trichomoniasis investigated?
microscopy of high vaginal swabs (women) or tip of the penis (males)
pH of vaginal wall
gram stain
What does management of trichomoniasis involve?
Metronidazole 400-500mg BD for 5-7 days OR
2g as a single dose
offer further screening
advise sexual abstinence for at least a week
What is seroconversion in regards to HIV?
seroconversion = the primary HIV infection
10days to 6 weeks and mimics flu-like symptoms
it is the stage at which HIV is HIGHLY CONTAGIOUS!
How does seroconversion present?
fever, sore throat, malaise, mucopaplar rash, arthralgia, myalgia, lymphadneopathy, oral/genital/perianal ulcers
How is HIV investigated?
serology - capillary/venous sample which can be done at home (using a specific kit) or at a clinic.
What does the management of HIV comprise of?
Treatment is a combination of antiretrovirals
Emtricitabine and Tenofovir dispoproxil OD
What are causes of infertility in women?
ovulation disorders PCOS Endometriosis premature ovarian insufficiency premature menopaise Fibroids tubal issues uterine deformaties age
How is infertility in males investigated?
LH & FSH
progesterone levels
Transvaginal US
hysterosalpingogram
What are causes of infertility in males
SPERM - sperm count, motility and morphology
Ejaculation - premature, delayed or retrograde
Testicular - damage, scarring or undescended
Genetic - cystic fibrosis and kleinfelters
How is infertility investigated in females?
semen analysis - volume, total number, concentration, motility, morphology and vitality
