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sexual health FCM Flashcards

1
Q

what are the signs and symptoms of chlamydia?

A

a lot of the time asymptomatic

women - dyspareunia, IMB, PCB, dysuria and changes in vaginal discharge
men - penile discharge and dysuria

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2
Q

what investigations are done for chlamydia?

A

endocervical/vulvovaginal swabs in women (or FCU)
FCU sample from men

NAAT - nucleic acid amplification test

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3
Q

what are the primary pharmacological management options for chlamydia?

A
  1. Doxycyline 100mg BD - 7days

2. Azithromycin 1g (1/7) then 500mg (2/7) - preferred in pregnancy

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4
Q

what does non-pharmacological management of chlamydia involve?

A
  1. partner-led notification
  2. sexual abstinence at least for a week
  3. sexual health education
  4. further screening
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5
Q

what are the signs and symptoms of gonorrhoea?

A

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

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6
Q

what investigations are done in gonorrhoea?

A

FCU urine for men
low vaginal swab for women

NAAT test - must do culture if test is positive

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7
Q

what is the management for gonorrhoea?

A
  1. Ceftriaxone 1g IM
  2. Azithromycin 2g PO

advise to

  1. partner-led notification
  2. sexual abstinence at least for a week
  3. sexual health education
  4. further screening
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8
Q

How does primary syphilis present?

A

painless chancre & lymphadenopathy

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9
Q

How does secondary syphilis present?

A

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)
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10
Q

How does tertiary syphilis present?

A

granulomatous lesions with necrotic centre
CVD
chronic inflammation of arteries
neurosyphilis - tabes dorsalis and genital paresis

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11
Q

what are investigations for syphilis?

A
  1. dark-field microscopy - swab from chancre/ulceration
  2. serology (lifelong positive)
  3. consider HIV screen
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12
Q

What does management of syphilis involve?

A
  1. IM benzylthine benzylpenicilin single dose OR Doxycycline

1 week at least sexual abstinence and further screening

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13
Q

How does the first episode Herpes Simplex Virus (HSV) infection present?

A

multiple painful blisters - may burst and become crusty

vaginal/urethral discharge

local oedema

tingling/neuropathic pain in the genital, lower back, buttocks and legs

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14
Q

How does recurrent HSV present?

A

usually is preceded by prodormal burning/tingling, malaise, fever

the lesion may become crusty and then heal in 10 days

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15
Q

what investigations are done for HSV?

A

swab from lesion/ulcer - culture or PCR

mainly based on physical examination

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16
Q

What does the management of HSV comprise of?

A

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!)

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17
Q

what are the different types of Human papilloma virus (HPV)?

A

HPV 6 & 11 = oncogenic

HPV16 & 18 = cervical

18
Q

How does HPV present?

A

painless, small, flat, smooth papules - can become painful or irritated

described as soft cauliflower like growths

19
Q

what investigations are involved?

A

diagnosis is based mainly on physical examination of external genitalia

can do a biopsy if unsure

20
Q

what does the management of HPV involve?

A

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

21
Q

what are the 2 main forms of male sexual dysfunction?

A
  1. erectile dysfunction - persistent inability to attain and maintain an erection sufficient to permit satisfactory performance.
  2. premature ejaculation - regular ejaculation within a minute of vaginal penetration (average being 5.5mins)
22
Q

what are potential causes/RFs of erectile dysfunction?

A
  1. Organic - T2DM, Obesity, HTN, hyperlipidaemia, CVD, hypogonadism, SC injury/pelvic surgery, Pyronie’s disease
  2. Drugs - excess alcohol, anti-HTNs, anti-psychotics, cannabis/cocaine
  3. Psychogenic - anxiety/depression, distress, performance-induced anxiety.
23
Q

how is erectile dysfunction investigated?

A

focused physical exam to rule out any other visible causes

bloods - HbA1c, lipids, morning testosterone and FSH/LH

CVD risk stratification

24
Q

what does management of erectile dysfunction involve?

A

dependent of history and potential underlying causes

  1. offer lifestyle advice
  2. psychosexual therapy
  3. PDE5 inhibitors - sildenafil/Viagra
  4. specialist treatments
25
Q

what causes should be considered when someone presents with premature ejaculation?

A

consider prostatitis, thyroid disease as well as psychological distress

26
Q

how is premature ejaculation investigated?

A

bloods - TSH, CRP, PSA, ESR (rule in/out differentials)

27
Q

How is premature ejaculation managed?

A

psychosexual conselling
CBT

pharmacological = SSRIs, tramadol, terazosin (a-blocker) & sildenafil
specialist treatments

28
Q

what does female sexual dysfunction refer to?

A

umbrella term for multiple disorders

  • sexual interest arousal disorder
  • female orgasmic disorder
  • genito-pelvic penetration pain disorder (vaginismus & dyspareunia)
29
Q

how do we investigate female sexual dysfunction?

A

mainly based on the history

vaginal dryness/vulvovaginal atrophy - may be due to low oestrogen

30
Q

how is female sexual dysfunction managed?

A

dependent on the type of FSD they have

some include…
psychotherapy
topical oestrogen

31
Q

How does trichomoniasis present?

A 
vulval itching
dysuria
offensive fishy discharge 
frothy green/yellow discharge 
vulval/lower abdominal pain
32
Q

How is trichomoniasis investigated?

A

microscopy of high vaginal swabs (women) or tip of the penis (males)
pH of vaginal wall
gram stain

33
Q

What does management of trichomoniasis involve?

A

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

34
Q

What is seroconversion in regards to HIV?

A

seroconversion = the primary HIV infection
10days to 6 weeks and mimics flu-like symptoms

it is the stage at which HIV is HIGHLY CONTAGIOUS!

35
Q

How does seroconversion present?

A

fever, sore throat, malaise, mucopaplar rash, arthralgia, myalgia, lymphadneopathy, oral/genital/perianal ulcers

36
Q

How is HIV investigated?

A

serology - capillary/venous sample which can be done at home (using a specific kit) or at a clinic.

37
Q

What does the management of HIV comprise of?

A

Treatment is a combination of antiretrovirals

Emtricitabine and Tenofovir dispoproxil OD

38
Q

What are causes of infertility in women?

A 
ovulation disorders 
PCOS 
Endometriosis 
premature ovarian insufficiency
premature menopaise 
Fibroids 
tubal issues 
uterine deformaties 
age
39
Q

How is infertility in males investigated?

A

LH & FSH
progesterone levels
Transvaginal US
hysterosalpingogram

40
Q

What are causes of infertility in males

A

SPERM - sperm count, motility and morphology

Ejaculation - premature, delayed or retrograde

Testicular - damage, scarring or undescended

Genetic - cystic fibrosis and kleinfelters

41
Q

How is infertility investigated in females?

A

semen analysis - volume, total number, concentration, motility, morphology and vitality

FCM (8 decks)

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