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Phase 3A Conditions > Sexual health key facts > Flashcards

Sexual health key facts Flashcards

1
Q

What is bacterial vaginosis?

A

Overgrowth of anaerobic bacteria in the vagina, caused by loss of lactobacilli in the vagina.

It is NOT an STI

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2
Q

What is the most common bacteria to cause bacterial vaginosis?

A

Gardnerella vaginalis

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3
Q

What is the key risk factor for bacterial vaginosis?

A

Excessive cleaning/douching of the vagina.

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4
Q

How does bacterial vaginosis present?

A

fishy-smelling, watery, grey or white vaginal discharge.

Itching irritation or pain suggest another cause as NOT caused by BV.

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5
Q

What are the investigations for Bacterial vaginosis? What are the associated findings for each?

A
  • Speculum examination. Fishy grey/white thin discharge.
  • Vaginal pH test. Shows a raised vaginal pH (over 4.5)
  • High vaginal swab w/ microscopy. Shows clue cells.
  • Positive whiff test.
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6
Q

What is the management for Bacterial vaginosis?

A

Usually no treatment required - self-resolving.
Advise the patient to reduce vaginal douching/using soaps that disrupt the natural vaginal flora.
If symptomatic or pregnant, metronidazole.

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7
Q

What is important to advise patients taking metronidazole?

A

Do not drink alcohol whilst taking.

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8
Q

What is the alternative name for “thrush”?

A

Candidiasis.

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9
Q

What is the most common pathogen responsible for candidiasis?

A

Candida albicans.

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10
Q

What are the risk factors for developing candidiasis?

A

Post-broad spectrum antibiotic treatment.
Immunosuppressive treatment.
Pregnancy.

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11
Q

How does candidiasis present?

A

Thick white discharge that DOES NOT smell.
Vulval/vaginal itching.

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12
Q

What investigations are used in the context of vaginal candidiasis?

A
  • Vaginal pH (will be under 4.5)
  • High vaginal swab (diagnostic). Only indicated if clinical doubt.
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13
Q

What is the management for vaginal candidiasis?

A

Single dose (150mg) of fluconazole is first line.

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14
Q

What is the management for recurrent vaginal candidiasis?

A

Induction and maintenance therapy:
- 3 doses of 150mg fluconazole 72 hrs apart.
- 1 dose of fluconazole 150mg weekly for 6 months.

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15
Q

What kind of organism causes trichomonas vaginalis?

A

Protozoan - single cell with a flagella.
A type of parasite.

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16
Q

What is the typical presentation of trichomonas vaginalis?

A

Frothy green-yellow discharge.
May smell fishy.
There will be a strawberry cervix on speculum examination.

Upto 50% are asymptomatic.

Vaginal pH will be over 4.5 (similar to BV)

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17
Q

What are the investigations for trichomonas vaginalis?

A

High vaginal Charcoal swab with microscopy.

Urethral swab or first-catch urine in men.

Remember that a speculum will show a strawberry red cervix.

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18
Q

What is the management for trichomonas vaginalis?

A

Contact tracing.
Metronidazole.

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19
Q

How does chlamydia present?

A

Most cases are asymptomatic. Can present with:
- Painful sex (women)
- Painful urination (men and women)
- Abnormal discharge (men and women)

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20
Q

What is the most common STI in the UK?

A

Chlamydia

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21
Q

What are the findings on examination for chlamydia?

A
  • Painful abdomen/pelvis
  • Cervical motion tenderness
  • Purulent discharge.
  • Dysuria
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22
Q

What investigations are used in suspected chlamydia?

A
  • VULVOVAGINAL swab (women) with NAAT test.
  • Urethral swab or first catch urine sample with NAAT.
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23
Q

What is the first line treatment for chlamydia?

A

doxycycline 2x per day 100mg for 7 days.

24
Q

How does a being pregnant/breastfeeding change the management of chlamydia?

A

If pregnant, doxycycline is contraindicated. Instead use:
- Azithromycin
- Erythromycin.

25
What non-medical management is required after a diagnosis of chlamydia?
- Contact tracing and notification of sexual partners. - Abstain from sex until treatment completed.
26
What are some complications of chlamydia?
PID (Fitz-Hugh Curtis syndrome) Infertility Ectopic pregnancy Conjunctivitis In pregnancy: Pre-term labour Premature rupture of membranes Low birthweight Neonatal infection
27
What is Fitz-Hugh Curtis syndrome? What is the most common STI cause of Fitz-Hugh Curtis syndrome?
When PID causes perihepatic inflammation, leading to RUQ pain and shouldertip pain. Chlamydia is a common cause. Can also be caused by gonorrhoea.
28
What is the bacteria that causes syphilis?
Treponema pallidum (T. pallidum)
29
What is the incubation period for syphilis?
21 days (3 weeks)
30
What are the main methods of transmission for syphilis?
Oral, vaginal or anal sex. Vertical transmission (mother to baby) IV drugs
31
What are the 4 stages of syphilis?
Primary syphilis - Painless ulcer at the sight of infection. Secondary syphilis - systemic symptoms of the skin and mucous membranes. Latent syphilis - Symptoms disappear after the secondary stage, but the patient is still infected. Tertiary syphilis - Years after the initial infection, patient develops gummas in organs of the body. CV and neuro symptoms.
32
What is neurosyphilis?
Syphilis has reached the CNS. Can cause: - Headache - Altered behaviour - Dementia - Tables dorsalis
33
What is the diagnostic test for syphilis?
Antibody testing (T. pallidum) is screening assessment. Refer to GUM for further testing.
34
What is the first line standard treatment for syphilis?
Single dose of deep IM intramuscular benzypenicillin
35
Which pathogen causes herpes?
HSV-1 and HSV-2
36
How does genital Herpes present?
Painful genital ulceration. Headache, fever, malaise Lymphadenopathy Urinary retention.
37
What is the test of choice for suspected genital herpes?
Viral PCR swab from lesion/ulcer.
38
What is the treatment for genital herpes?
Orla aciclovir. Paracetamol/topical lidocaine for the pain.
39
How is herpes in pregnancy treated?
Also use aciclovir - not known to be harmful to the baby.
40
What pathogen causes gonorrhoea? How does this look under the microscope?
Neisseria gonorrhoeae - a gram negative diplococci.
41
What are the symptoms of gonorrhoea?
Odourless discharge, possibly green or yellow. Dysuria. Pelvic pain.
42
What is the test for suspected gonorrhoea?
- VULVOVAGINAL swab (women) with NAAT test. - Urethral swab or first catch urine sample with NAAT. Additionally, endocervical charcoal swab should be sent for culture and be sent for susceptibility testing.
43
What is the treatment for gonorrhoea?
First line - single dose of IM ceftriaxone. If sensitivities known, can use single dose of oral ciprofloxacin.
44
What is the treatment for genital warts?
Topical podophyllum if multiple. Cryotherapy if one wart.
45
What is the difference between genital warts and genital herpes?
Genital herpes will be painfuland also cause systemic unwellness. Warts might be itchy but are painless, and no systemic illness.
46
What is AIDS?
Occurs when HIV is untreated and the disease progresses, leading to the patient becoming immunocompromised.
47
What is the microbiological composition of HIV?
An RNA retrovirus. Most common type is HIV-1. Virus destroys CD4 T-helper cells.
48
How is HIV spread?
Unprotected vaginal, anal or oral sex. Vertical transmission. Bodily fluids (sharing needles, open wound exposure etc.)
49
What are the common AIDS defining illnesses?
PCP CMV Candidiasis (oesophageal or bronchial) Lymphoma TB
50
What is the test used to diagnose HIV? What is the window period?
HIV antibody testing and p24 antigen testing. 45 day window period (can take up to 45 days after exposure for the test to become positive).
51
What tests are used to monitor the viral load of HIV? How do the readings relate to the patient's condition?
CD4 count and viral load (HIV RNA). Low CD4 means the patient is at high risk of opportunistic infections. Low viral load (under 20 copies/ml) indicates an undetectable viral load.
52
What is the management for HIV? What is the aim of treatment?
All patients should be started on ART immediately after diagnosis, irrespective of viral load/CD4. Aim is to achieve a normal CD4 count and an undetectable viral load.
53
What is the management of delivery for a mother with HIV?
Depends on viral load: - Under 50 copies/ml, normal vaginal delivery. - Over 50 copies, consider pre-labour C-section. - Over 400 copies, definitely do a pre-labour C-section.
54
What is the recommendation for breastfeeding for a mother with HIV?
- Avoid if possible. - If she is adamant, can be considered if the viral load is undetectable with close monitoring.
55
When is PrEP used (HIV)?
- HIV negative men (or trans-men) having condomless sex with other men. - HIV negative patients having sex with HIV +ve partners
56
What is PEP and when is it used (HIV)? What is the timeframe for PEP?
After potential exposure to HIV. Has to be given within 72 hours, ideally within 24. Is a medical emergency.

Phase 3A Conditions (13 decks)

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