Sexual Health - ICM Flashcards
How do you test for gonorrhoea?
Urethral / vaginal swab with gram staining
Beside Gonorrhoea, what other STI can NAAT testing check for?
Chlamydia
Besides NAAT, what two other investigations can you do to check for Gonorrhoea if a male presents with symptoms?
Urethral Microscopy & Gram Staining
Urine testing - first void (or 1 hour)
A patient gets the following results for their gonorrhoea equivocal test:
Screening test - positive
Confirmatory test - negative
Have they got gonorrhoea?
The person is negative for gonorrhoea
What must you do before treating gonorrhoea after doing a NAAT test and what would it tell you?
Cultures
- Causative bacteria
- Antibiotic resistance
What is a complication of untreated gonorrhoea in women?
Pelvic inflammatory disease
What is a complication of untreated gonorrhoea in males? (2 marks)
Epididymitis
Prostatitis
What is the first line treatment for someone positive for gonorrhoea?
Ceftriaxone 500mg IM stat & Azithromycin 1g PO
What else would you prescribe to a patient who has also tested positive for chlamydia alongside gonorrhoea?
Doxycycline 100mg BD 7 days
If a patient has gonorrhoea but is allergic to penicillin, what alternative antibiotic would you give?
Azithromycin 2g
What is the first line treatment for chlamydia?
Doxycycline 100mg BD 7 days
If a patient is pregnant/breastfeeding and has chlamydia, what would you prescribe her?
Azithromycin 1g STAT
THEN
Azithromycin 500mg OD 2 days
What is the first line investigation for trichomonas?
NAAT on vaginal/urethral swab
What type of sample would you take for a vaginal swab to test for trichonomas?
Wet mount sample
How does a patient present with trichonomas and what would you see on inspection of the cervix?
Frothy/bubbly yellow/green discharge with fishy smell
Itching and dysuria
Strawberry looking cervix
What is the treatment for trichomonas?
Metronidazole 400-500mg BD for 7 days
How would a patient present with bacterial vaginosis?
Grey/white discharge
Fishy smell
How would you investigate for BV?
Charcoal swab for microscopy
What would you see under the microscopy for BV? (2 marks)
Clue cells
Reduce lactobacilli and increased Gardnerella
What is the treatment for BV?
Metronidazole 400mg BD 5-7 days
What pH would you expect for trichomonas and BV?
> 4.5
What pH would you expect for vaginal candidiasis?
<4.5
What is the treatment for vaginal candidiasis?
Clotrimazole 500mg Pessary STAT
Fluconazole 150mg STAT oral (not if pregnant)
How soon after treatment should you do a test of cure for trichonomas?
1 week after treatment?
After a test of cure for trichonomas, the patient still has the infection present, what do you do next and what do you advise the patient?
Re-start the abx and then do another test of cure until the patient has no symptoms
Advise no sexual intercourse
What is the first line investigation for testing HIV, what does it look for and when should it be done?
Antibody testing (blood test)
Detection of HIV-1 p24 antigen and HIV antibodies (depending when done)
Antibodies can take up to 12 weeks to be made post infection
What other investigations besides a blood test can you do to detect HIV and what does it look for?
Fingerprick & Oral test
Mostly only detects HIV antibodies
What is the normal CD4 count?
500-1200
What CD4 count would you expect to see in someone with end stage HIV?
<200
What is the treatment for HIV?
Anti-retroviral treatment
In hepatitis B, what does HbsAg represent and what would it mean if it was positive/negative?
Represents if there is active infection
Positive = patient has hepatitis B Negative = patient doesn't have active hepatitis B
What does HbcAB represent and what does it mean if its positive or negative?
HbcAB = core antibody made in response to active or past infection (tells you someone has been in contact with hep B)
Positive = either had a past / current infection Negative = no past / current infection
What does HbsAB represent and what does it mean if its positive or negative?
Represents if someone is vaccinated against Hepatitis B
Positive = vaccinated against hep B Negative = not vaccinated against hep B
What do the below results show and what two other things would you test for and what do they show?
HbsAg - Positive
HbcAB - positive
HbsAB - negative
Results show that the patient is unvaccinated against hep B, but currently has an active infection
Would want to test for HbeAg and HBV-DNA to check for viral replication and viral load
How is hepatitis B treated?
Combination therapy of interferon A & lamivudine
What investigation would you do to detect if a patient has been in contact with hepatitis C?
Antibody test - HCV Igg
What investigation would you do to test if someone has a current infection of hepatitis C?
Viral load test - HCV RNA
How long can it take for the HSV-Igg (hep C) test to become positive if a patient has an acute HCV infection?
6-24 weeks
How long can it take for HSC-RNA (hep B) to become detectable if someone has an acute hep C infection?
1-2 weeks
What is the treatment for hepatitis C?
Combination therapy - pegylated interferon and ribavirin
What does syphilis look like under a dark ground microscopy?
Spiral shaped coils
What investigations would you do for syphilis and what do they mean? (2 marks)
Serology
- IgG –> if they have been in contact / 12 weeks
- IgM –> detect early infection
What is the treatment for syphilis?
Primary, Secondary, Early Latent:
Benzathine Penicillin G 2.4MU single dose
Doxycyline 100mg BD 14 days
Late Latent:
Benzathine Penicillin 2.4MU weekly for 3 week
What is the investigation for herpes and how would you collect it?
Viral PCR –> rub swab onto wart and gain the fluid to determine what type of HSV
What is the treatment for herpes?
Aciclovir 400mg TDS 5 days
How do you investigate for genital warts/molloscum?
You don’t - visual
How do gential warts differ to molloscum?
Warts - cauliflower appearance
Molloscum - umbilicated lesions
What is the treatment for genital warts or molloscum?
0.5% podophyllotoxin solution gel/cream
