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PHA223 > sexual health in practice (Carlie) > Flashcards

sexual health in practice (Carlie) Flashcards

1
Q

difference between STI and STD

A

STI is the pathogen that causes infection through sexual contact

STD refers to the disease state that has developed from an infetion

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2
Q

How are STIs transmitte?

A

unprotected sexual intercourse or intimate contact

organism passes from person to person in blood, semen, vaginal/bodily fluids

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3
Q

How can STIs be transmitted non-sexually?

A

mother to child during pregnancy/childbirth

blood transfusions

shared needles

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4
Q

bacterial STIs

A

gonorrhoea
chlamydia
syphilis

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5
Q

viral STIs

A

HIV/AIDS
genital herpes
HPV - genital warts, cervical cancer
hepatitis B

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6
Q

parasites that can cause STIs

A

trichomoniasis
lice
scabies

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7
Q

fungal causes of STIs

A

thrush (can get it not as an STI also)

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8
Q

long term health problems from STIs

A 
pelvic inflam diseases
ectopic pregnancy
chronic abdominal pain
adverse pregnancy outcomes
CV/neurological damage
cancers
arthritis
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9
Q

What STI has the strongest resistance to antibiotics?

A

gonorrhoea

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10
Q

3 levels of sexual health services

A

level 1 - asymptomatic
level 2 - symptomatic
level 3 - complex/specialist

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11
Q

What are level 3 SHS?

A

GUM - genitourinary medicine services

integrated GUM and sexual and reproductive health (SRH) services

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12
Q

What are level 1 and 2 SHS?

A

GPs
some pharmacies
SRH services (sexual reproductive health services)
online sexual health services

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13
Q

What services do community pharmaies offer?

A
  • sexual health advice/signoosting
  • EHC
  • contraception PGD/OTC
  • chlamydia screening 15-24yrs
  • condom distribution
  • STI kit collection
  • pregnancy testing
  • pre-conception care
  • ED treatment
  • HPV vaccination
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14
Q

at risk grooups for STIs

A
  • adolecents 15-24
  • from country/visited with high HIV/STI rates
  • men who have sex with men
  • multiple/concurrent partners
  • early onset of sexual activity (less educated)
  • people with sexual partners from these groups
  • alcohol/substance abuse
  • IV drug use
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15
Q

safe sex advice

A
  • education on STIs
  • partner reduction
  • condoms
  • repeat testing
  • vaccination (HIV, hepatitis)
  • HIV pe-exposure prophylaxis
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16
Q

condom advice

A
  • most effective against HIV/STIs
  • 95% if perfect use
  • encourage use
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17
Q

CDS - condom distribution services

A

C-card most common CDS
targets young people
discussion around condoms/safe sex/contraception/STIs

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18
Q

Fraser guidance with safegurading

A

Fraser guidance always assessed in under 16

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19
Q

under 13 and safeguarding

A
  • not legally able to consent to sexual activity
  • documanet circumstances
  • discuss with child protection and record conversation
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20
Q

safeguarding in 13-16 years

A

consider potential harm to child

consider informing child protection lead

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21
Q

safeguarding in 16-17 years

A
  • over 16 has the right to independence
  • child is U18
  • offer safeguarding if needed
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22
Q

safeguarding in over 18s

A

assumed to be competent unless there’s a reason they are not

- don’t need to consider safeguarding unless there are any issues with capacity

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23
Q

signs to be aware of for safeguarding

A
  • learning disability
  • older boyfriend
  • alcohol/drug use
  • multiple presentations EHC/STD/pregnancy tests
  • features of abuse
  • not consensual
  • migrant child (trafficing)
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24
Q

What needs to be taken for the history taking of STI screening?

A
  • reason for attendance
  • history of proplem (if symptomatic)
  • full sexual history
  • PMH, previous STIs
  • vaccination Hx
  • drug Hx
  • allergies
  • females - menstrual, contraceptive Hx
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25
Q

What does sexual Hx allow for?

A
  • STI risk
  • symptoms
  • contraception use/pregnancy risk
  • HIV/hepatitis risk
  • safeguarding concerns
  • recreational drugs/alcohol
  • symptom review
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26
Q

sexual Hx - asymptomatic

A
  • confirm lack of symptoms
  • competency/safeguarding
  • date of last sexual contact (LSC) and no. partners in last 3 mths
  • gender of partners, sites of exposure, condom use, suspected infection
  • previous STIs
  • women - LMP, contraception
  • vaccine Hx
  • alcohol/drug Hx
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27
Q

sexual Hx - symptomatic (additional questions)

A
  • symptoms
  • pregnancy Hx
  • PMH/surgical Hx
  • med Hx, drug allergies
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28
Q

What is the bacterial cause of chlamydia?

A

chlamydia trachomatis

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29
Q

How is chlamydia transmitted?

A
  • primarily penetrative sex
  • contact with infected genital secretions
  • infected secretions onto mucous membranes
  • splash from genital fluids
  • mother to baby at delivery
30
Q

Where can chlamydia infect?

A 
endocervix
urethra
rectum
conjunctiva (mother to baby)
nasopharynx
31
Q

symptoms of chlamydia

A

men - inflammation of the urethra

women - inflammation of the cervix/urethra

32
Q

What can happen in untreated chlamydia?

A
  • pelvic inflam disease (women)
  • epididymo-orchitis
  • conjunctivitis
  • LGV (men)
  • SARA (sexually acquired reactive arthritis)
  • adverse outcomes in pregnancy (premature, low weight, infections)
  • anxiety/psychological distress
33
Q

risk factors for chlamydia

A
  • under 25yrs
  • new sexual partner
  • more than 1 sexual partner in last year
  • lack of consistent condom use
34
Q

symptoms of chlamydia in females

A
  • vaginal discharge
  • dysuria
  • lower abdominal pain
  • fever
  • intermenstrual/postcoital bleeding
  • deep dyspareunia (pain during SI)
  • pelvic pain/tenderness
  • cervical tenderness
  • inflamed/friable cervix
35
Q

symptoms of chlamydia in men

A
  • urethritis with dysuria and urethral discharge
  • epididymo-orchitis presenting as unilateral testicular pain and swelling
  • fever
  • reactive arthritis (pain in joints)
36
Q

What people are screened for chlamydia?

A
  • asymptomatic who are high risk

- symptomatic patients

37
Q

How to screen for chlamydia

A

nucleic acid amplification tests (NAATs)
- highly specific/sensitive

  • women - vulvovaginal swab (1st line) OR first void urine sample/endocarvical swab
  • men - first void urine sample (1st line)
38
Q

What is MGen?

A

mycoplasmic genitalium

emerging sexually transmitted pathogen

can have co-infection with chlamydia

has increasing macrolide resistance because of SDA

39
Q

What used to be used for chlamydia treatment but now there’s increased resistance?

A

1g single dose of azithromycin (SDA)

40
Q

What is first line treatment for chlaymdia?

A

doxycycline 100mg BD for 7 days

41
Q

When is doxycycline contraindicated?

A

pregnancy

breast feeding

children under 12 years (can’t give tetracyclines, risk of deposition in bones and discolouration of teeth)

42
Q

side effects of doxycycline

A

GI (n&v, GI discomfort, diarrhoea)

photosensitivity (avoid direct sunlight, esp in summer)

43
Q

alternatives if doxycycline is contraindicated

A
  • azithromycin 1g orally as a single dose
    followed by 500mg orally OD for 2 days
  • erythromycin 500mg BD for 10-14 days
  • ofloxacin 200mg BD for 7 days
44
Q

What treatment is used for chlamydia in pregnancy?

A
  • azithromycin 1g stat
    followed by 500mg for 2 days
  • erythromycin 500mg BD for 14 days
  • amoxicillan 500mg TDS for 7 days
45
Q

What drugs for chlamydia are c/i in pregnancy?

A

doxycycline

ofloxacin

46
Q

follow up/guidance for chlamydia

A
  • avoid sexual intercourse/oral until treatment completed (or 7 days after treatment for azithromycin)
  • screen for other STIs
  • refer to GUM clinic for partner notification
47
Q

Why can chlamydia teatment fail?

A

re-infection

48
Q

What partners should symptomatic males notify?

A

all partners within 2 weeks

49
Q

Who should asymptomatic patients notify?

A

partners in last 3 months

50
Q

What is the bacterial cause of gonorrhoea?

A

Neisseria gonorrhoeae

51
Q

How is gonorrhoea transmitted?

A

sexual contact where infected secretiong are passed from one mucous membrane to another

during childbirth

52
Q

What body parts does gonorrhoea infect?

A

mucous membranes of the

  • urethra
  • endocervix
  • rectum
  • pharynx
  • conjunctiva
53
Q

What is disseminated gonorrhoea?

A

complication of gonorrhoea is it’s not mamaged properly

bacteria invades the blood stream and spreads to different areas

skin lesions, arthralgia, tenosynovitis, arthritis

54
Q

What are the complications of gonorrhoea?

A

men - epididymitis, prostatitis, infertility

women - PID, pregnancy problems

babies - blindness

55
Q

symptoms of gonorrhoea in females (urogenital)

A

50% asymptomatic

  • increased/altered vaginal discharge
  • lower abdominal pain
  • dysuria
  • intermenstrual bleeding/menorrhagia
  • dyspareunia (pain on SI)
56
Q

symptoms of rectal/pharyngeal gonorrhoea in females

A

asymptomatic

57
Q

symptoms of genital gonorrhoea in men

A

usually symptomatic

  • urethral discharge
  • dysuria
58
Q

symptoms of rectal/pharyngeal gonorrhoea in men

A

asymptomatic

59
Q

What is used to screen for gonorrhoea?

A

NAAT (nucleic acid amplification test)

women - vulvovaginal swab
men - first pass urine sample

60
Q

What is required is patient’s NAAT positive for gonorrhoea?

A

culture required

to test for susceptibility and ID resistant strains

61
Q

What is a difference between screening for chlamydia and gonorrhoea?

A

need to do a culture for gonorrhoea to test for susceptibility/ID resistant strains

62
Q

What is super gonorrhoea?

A

resistant to the most common antibiotics

63
Q

What used to be used for gonorrhoea treatment?

A

dual therapy of ceftriaxone and azithromycin

64
Q

What treatmens is used for gonorrhoea when antimicrobial susceptibility is not known?

A

ceftriaxone 1g IM injection as a single dose

65
Q

Can ceftriaxone be given in pregnancy/BF?

A

yes it’s safe

66
Q

What treatment is used for gonorrhoea when antimicrobial susceptibility IS KNOWN?

A

ciprofloxacin 500mg orally as a single dose

pregnancy/BF
- azithromycin 2g orally as a single dose

67
Q

How to treat disseminated gonorrhoea

A

ceftriaxone 1g IM/IV every 24hrs

cefotaxime 1g IV every 8hrs

after 24/48hrs switch to oral form

68
Q

What treatment is given after 24/48hrs when disseminated gonorrhoea symptoms improve?

A

cefixime 400mg BD

or

ciprofloxacin 500mg BD

-> guided by sensitivity

69
Q

guidance for gonorrhoea

A
  • avoid SI/oral until person/partner finished treatment (or 7 days after azithromycin)
  • follow up 1 week after treatment
70
Q

follow up after gonorrhoea

A
  • confirm adherance to treatment and symptm resolution
  • ask about adverse reactions
  • confirm partner notification
  • ask about recent sexual activity (re-infection?)
  • reinforce safe sexual practices
71
Q

What test of cure is used for gonorrhoea?

A

asymptomatic - NAAT at least 2 weeks after finishing treatment

symptoms - test with culture, at least 3 days after finishing treatment
-> additional NAAT after 1 week if culture negative

PHA223 (43 decks)

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