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
