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PHA 332 > sexual health in practice > Flashcards

sexual health in practice Flashcards

1
Q

what is the difference between STI and STD?

A

The term “sexually transmitted infection” (STI) refers
to a pathogen that causes infection through sexual
contact, whereas the term “sexually transmitted
disease” (STD) refers to a recognisable disease state
that has developed from an infection.

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2
Q

how are STIs acquired?

A

STI’s are infections transmitted from one person to another
during unprotected sexual intercourse or intimate contact.
The organisms pass from person to person in blood, semen,
vaginal and other bodily fluids

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3
Q

how can STIs be passed non-sexually?

A

–From mother to infant during pregnancy or childbirth.
•Gonnorhoea, HIV, syphilis and chlamydia.
–Through blood transfusions or shared needles.

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4
Q

what are the most common bacterial infections?

A
  • Neisseria gonorrhoea (gonorrhoea)
  • Chlamydia trachomatis (chlamydia)
  • Treponema pallidum (syphilis)
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5
Q

what are the most common Viral STIs?

A
  • Human immunodeficiency virus (HIV/AIDS)
  • Herpes simplex virus type 1 and type 2 (genital herpes)
  • Human papillomavirus HPV (genital warts, cervical dysplasia, cancer)
  • Hepatitis B virus (hepatitis)
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6
Q

what are the most common paracitic viruses?

A
  • Trichomonas vaginalis (trichomoniasis)
  • Pediculus humanus (lice)
  • Sarcoptes scabei (scabies) .
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7
Q

what is the most common fungal STI?

A

Candida Albicans (thrush)

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8
Q

what are some of the long term problems that can arise if STIs are not treated?

A

–pelvic inflammatory disease, ectopic pregnancy, postpartum
endometriosis, infertility, and chronic abdominal pain in women
–adverse pregnancy outcomes - including abortion, intrauterine death,
and premature delivery
–neonatal and infant infections and blindness
–urethral strictures and epididymitis in men
–cardiovascular and neurological damage
–Cancers- HPV associated cervical and rectal cancer.
–Arthritis

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9
Q

what is the most common STI in the UK?

A

Chlamydia

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10
Q

what STI is the highest risk of antimicrobial resistance?

A
  • Gonorrhoea highest risk of resistance

* AMR in chlamydia and syphilis also exists

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11
Q

who offers sexual health services?

A

There are three levels of sexual health service provision.
–Level 1 (asymptomatic), Level 2 (symptomatic) and Level 3
(complex/specialist).

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12
Q

who offer level 3 SHSs?

A 
Genitourinary medicine (GUM) and integrated GUM and sexual and 
reproductive health (SRH) services.
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13
Q

who offers level 1 and 2 SHSs?

A 
–GP’s
–Some pharmacies (depends on local area)
–SRH services
–Young people's services
–online sexual health services
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14
Q

what are the general services offered for SHSs?

A

–Sexual history taking and risk assessment
–STI screening and treatment
–Advice and supply of regular and emergency contraception.
–Condom distribution
–Signposting to appropriate sexual health services
–Sexual assault services/referral
–Hepatitis A and hepatitis B vaccination and screening
–HIV screening
–Cervical screening.
–Post-exposure prophylaxis (PEP) –specialist

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15
Q

what SHSs do most pharmacies offer?

A

•Sexual health advice, signposting and campaigns
•Emergency hormonal contraception (EHC)
•Ongoing contraception via PGD or OTC
•Chlamydia screening and treatment from age 15 to 24 Condom
distribution via sale or C-Card
•STI kit “click and collect” service
•Pregnancy testing
•Preconception care
•Supply of erectile dysfunction treatment
•HPV vaccination

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16
Q

who are the at risk groups for STIs?

A

•Adolescents – 15-24 years
•People from, or who have visited countries with high
rates of HIV and/or other STIs
•Men who have sex with men (MSM)
•People with multiple or concurrent partners
•Early onset sexual activity previous bacterial STI
•Attendance as a contact of STI
•People with sexual partners from groups mentioned
above
•Alcohol or substance abuse
•IV drug use

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17
Q

what education about STIs is availible?

A

•Education in Schools - evidence that relationships and sex education
(RSE) protects young people from STIs and unplanned pregnancy
–From September 2020, all schools in England need to provide:
•Relationships education at primary level
•Relationships and sex education (RSE) at secondary level
•Health education in both
•National level - sexual health promotion and campaigns
•Safe sex advice

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18
Q

what do the principles of safe sex advice include?

A 
–Education
•On transmission of STI’s
–Partner reduction
•The spread of STI’s depends on the rate of change of sexual partners, 
particularly concurrent partners.
–Condom
–Repeat testing
•Screening for asymptomatic STIs should be recommended at least 
annually and 3 monthly if high risk of HIV.
–Vaccination
•HPV, hepatitis
–HIV Pre-exposure Prophylaxis (PrEP),
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19
Q

what should the disucssion about condom use entail?

A 
all patients unless exclusively (WSW) and should include:
–Condom efficacy and limitations 
–Condom types, sizes 
–Determinants of condom effectiveness 
–Motivation for condom use
98% effective
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20
Q

how does the condom distribution service work?

A

•C-card is the most common CDS.
–target young people up to the age of 19 years, (or 24 years
in some areas)
–Multicomponent service - as well as condom distribution it
involves:
•discussion around condoms (as well as how to use),
•Safe sex,
•Contraception
•STIs.
if you have a C- card you can obtain free condoms at a pharmacy

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21
Q

when should you consider safeguarding?

A

In any sexual health consultation consider safeguarding, and if
necessary, manage any safeguarding issue.
•Fraser guidance should always be assessed under 16.

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22
Q

should safeguarding be considered for 16-17 year olds?

A

–Over 16’s have the right to independence
–However, the law defines a child as <18 years old
–Even though over the age of consent they should be
treated as children and offer children safeguarding support
if needed.

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23
Q

when should safeguarding be considered for someone who is over 18?

A

Assumed to be competent with capacity to consent unless

otherwise suggested.

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24
Q

what would signs of vulnerability and alterative features be when safeguarding?

A
  • Learning disability;
  • Older “boyfriend”;
  • Young person not permitted to be seen without partner;
  • Use of drugs and/or alcohol;
  • Homelessness;
  • Association with other young people believed to be in exploitative relationships;
  • Young people in care;
  • Young person presented with gift/cash by partner after accessing pharmacy;
  • Multiple presentations for EHC/STD treatment/pregnancy tests;
  • Any features of abuse or coercion within relationship;
  • Migrant children (potential for trafficking);
  • Any evidence that sexual activity was not consensual.
25
Q

how should you manage STIs?

A
  • Sexual history taking
  • Screening
  • Testing
  • Treatment
  • Contact tracing and notification
  • Lifestyle advice and STI prevention
26
Q

when Screening for STIs what do you take history about?

A

–Reason for attendance.
–History of presenting problem (if symptomatic)
–Full sexual history
–Relevant past medical history, including previous STIs
–Vaccination history -Hep B (refer to guideline on hepatitis testing)
–Drug history (including recreational)
–Allergies
–Females –menstrual, contraceptive & obstetric history. Date &
outcome of last cervical cytology

27
Q

what should a sexual history involve an assessment of?

A

•STI risk
•Symptoms to guide the examination and testing
•Contraception use and risk of pregnancy
•Other sexual health related issues
•HIV, viral hepatitis risk for both testing and prevention
•Risk behaviours, which will then facilitate health promotion
activity including partner notification and sexual health promotion
•Safeguarding concerns
•Use of recreational drugs (including alcohol and chemsex) to
facilitate appropriate referral.
•Symptom review – if appropriate

28
Q

what should you discuss about a patients sexual history if asymptomatic?

A

•Confirm lack of symptoms
•Establish competency, safeguarding children/vulnerable adults
•Date of last sexual contact (LSC) and number of partners in the last
three months
•Gender of partner(s), anatomic sites of exposure, condom use and any
suspected infection, infection risk or symptoms in partners
•Previous STIs
•Women: Last menstrual period (LMP), contraceptive and cervical
cytology history where indicated
•Blood borne virus risk assessment and vaccination history for those at
risk
•Alcohol and recreational drug history
•Agree the method of giving results

29
Q

what should you discuss if a person is symptomatic during their sexual history?

A

Additional questions for symptomatic patients.
•Symptoms/reason for attendance
•Pregnancy and gynaecological history if indicated
•Past medical and surgical history
•Medication history and history of drug allergies
•Agree the method of giving results

30
Q

what bacteria causes Chlamydia?

A

Chlamydia trachomatis.

31
Q

how is chlamydia transmitted?

A

–Primarily through penetrative sex
–Contact with infected genital secretions
–Autoinoculation of infected secretions onto mucous membranes
–Splash from genital fluids
–From mother to baby at delivery.

32
Q

where does c. trachomatis infect?

A

endocervix, urethra, rectum and also the

conjunctiva, and nasopharynx.

33
Q

what does infection of the urogenetial tract cause in men and women?

A

typically causes inflammation of the:
–Urethra in men.
–Cervix and/or urethra in women.

34
Q

what are the complications of chlamydia?

A

–Pelvic inflammatory disease (PID) (women)
–Epididymo-orchitis (swelling of testicles and/or epididymis) (men)
–Conjunctivitis
–Lymphogranuloma venereum (LGV) (men)
–Sexually acquired reactive arthritis (SARA)
–Adverse outcomes in pregnancy
•Premature delivery, low birth weight, infections in neonates
–Anxiety and psychological distress

35
Q

what are the risk factors for Chlamydia?

A
  • Age under 25 years.
  • A new sexual partner.
  • More than one sexual partner in the last year.
  • Lack of consistent condom use.
36
Q

what are the symptoms of chlamydia in females?

A 
•Vaginal discharge.
•Dysuria 
•Vague lower abdominal pain.
•Fever.
•Intermenstrual or postcoital 
bleeding.
•Deep dyspareunia.
•Pelvic pain/tenderness
•Cervical motion tenderness.
•Inflamed or friable cervix
37
Q

what are the symptoms of chlamydia in men?

A 
•Men tend to have either 
classical urethritis with 
dysuria and urethral discharge 
or
•Epididymo-orchitis presenting 
as unilateral testicular pain ±
swelling. 
•Fever may also be a 
presenting feature in men.
•Reactive arthritis
38
Q

when would you screen for chlamydia?

A
  • Asymptomatic patients who are high risk

* Symptomatic patients

39
Q

how do you screen for chlamydia?

A 
•Nucleic acid amplification tests (NAATs)
–Highly specific and sensitive
–Women
•Vulvovaginal swab - first line
•Alternatives: First void urine  sample or endocervical 
swab
–Men
•First void urine sample – first line
40
Q

what is the treatment for chlamydia?

A

•Doxycycline 100 mg twice a day for 7 days
–CI in pregnancy and breast-feeding.
–GI side effects are common.
–Photosensitivity

41
Q

what are the alternatives if doxycycline is CI for chlamydia?

A

–Azithromycin 1 g orally as a single dose for 1 day, followed by 500 mg
orally once daily for 2 days.
–Erythromycin 500 mg twice daily for 10–14 days.
–Ofloxacin 200 mg twice daily for 7 days,

42
Q

what is recommended for chamydia in pregnancy?

A

Doxycycline and ofloxacin are CI in pregnancy

43
Q

what are the recommended regimens for chlamydia treatment?

A

–Azithromycin 1g stat followed by 500mg for 2 days
–Erythromycin 500mg twice daily for 14 days
–Amoxicillin 500 mg three times a day for 7 days.

44
Q

what follow up should be done for chlamydia?

A

Avoid sexual intercourse (including oral sex) until the person
and their partner(s) have completed treatment (or waited 7
days after treatment with azithromycin).
–Failure of treatment can be due to re-infection
•Screen for other STIs
•Refer to a GUM clinic for partner notification.

45
Q

when should partner notification be done for chlamydia?

A

•Refer to a GUM clinic for partner notification.
–Symptomatic males – all partners within 2 weeks
–Asymptomatic - preceding three months should be
notified.

46
Q

what causes gonorrhoea?

A

Neisseria gonorrhoeae

47
Q

how is gonorrhoea transmitted?

A

–Sexual contact where infected secretions are passed from one mucous
membrane to another.
–During childbirth

48
Q

where does gonorrhoea affect?

A

the mucous membranes of the urethra, endocervix,

rectum, pharynx, and conjunctiva

49
Q

what could happen if gonorrhoea is not treated?

A

skin lesions, arthralgia, tenosynovitis or arthritis.

50
Q

what complications occur in gonorrhoea?

A

–Men – Epididymitis, prostatitis, infertility
–Women – PID + dangers in pregnancy
–Babies – blindness

51
Q

what are the female symptoms of gonorrhoea?

A 
Urogenital gonorrhoea is 
asymptomatic in up to 50% of 
women.
•Increased or alterered vaginal 
discharge
•Lower abdominal pain
•Dysuria
•Intermenstrual bleeding or 
menorrhagia
•Dyspareunia
Rectal and pharyngeal –
asymptomatic
52
Q

what are the male symptoms of gonorrhoea?

A 
Genital gonorrhoea infection is 
usually symptomatic in men
•Urethral discharge 
•Dysuria
Rectal and pharyngeal –
asymptomatic
53
Q

how do you screen for gonorrhoea?

A 
•A NAAT for the presence of N. Gonorrhoea
•Women:
–vulvovaginal swab
•Men
–First pass urine sample
54
Q

what is the difference between chylmydia and gonorrhoea screening?

A

•Culture required if patient is NAAT positive for gonorrhoea- for everyone where as only some in chylamida

55
Q

what is first line treatment for gonorrhoea ?

A

•Ceftriaxone 1 g intramuscular (IM) injection as a single dose

56
Q

what is the first line treatment when antimicrobial susceptibility is known prior to treatment?

A

•Ciprofloxacin 500mg orally as a single dose
Pregnancy/breastfeeding
•Azithromycin 2g orally as a single dose.

57
Q

what is the treatment for disseminated gonorrhoea?

A
  • Ceftriaxone 1g IM or IV every 24 hours
  • Cefotaxime 1g intravenous every eight hours
  • 24-48 hours after symptoms begin to improve switch to
  • Cefixime 400 mg twice daily; or
  • Ciprofloxacin 500 mg twice daily;
  • Switch should be made guided by sensitivities
58
Q

what follow up should be arranged with gonorrhoea?

A

•Avoid sexual intercourse (including oral sex) until the person
and their partner(s) have completed treatment (or waited 7
days after treatment with azithromycin).
•Follow up about 1 week after treatment to:
•Confirm adherence to treatment and symptom resolution.
•Ask about adverse reactions.
•Confirm that partner notification has been carried out.
•Ask about recent sexual history (and the possibility of re-
infection)
•Reinforce advice about safe sexual practice

59
Q

who is a cure test recommended for with gonorrhoea?

A

•A test of cure is recommended for all people who have been
treated for gonorrhoea.
•Asymptomatic - test with NAAT at least 2 weeks after
completion of treatment.
•If signs or symptoms persist, test with culture, at least 3 days
after completion of treatment.
•Consider additional testing with NAAT after one week if culture is
negative.

PHA 332 (42 decks)

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