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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
Q

What non-medical management is required after a diagnosis of chlamydia?

A
  • Contact tracing and notification of sexual partners.
  • Abstain from sex until treatment completed.
26
Q

What are some complications of chlamydia?

A

PID (Fitz-Hugh Curtis syndrome)
Infertility
Ectopic pregnancy
Conjunctivitis

In pregnancy:
Pre-term labour
Premature rupture of membranes
Low birthweight
Neonatal infection

27
Q

What is Fitz-Hugh Curtis syndrome?

What is the most common STI cause of Fitz-Hugh Curtis syndrome?

A

When PID causes perihepatic inflammation, leading to RUQ pain and shouldertip pain.

Chlamydia is a common cause.
Can also be caused by gonorrhoea.

28
Q

What is the bacteria that causes syphilis?

A

Treponema pallidum
(T. pallidum)

29
Q

What is the incubation period for syphilis?

A

21 days (3 weeks)

30
Q

What are the main methods of transmission for syphilis?

A

Oral, vaginal or anal sex.
Vertical transmission (mother to baby)
IV drugs

31
Q

What are the 4 stages of syphilis?

A

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
Q

What is neurosyphilis?

A

Syphilis has reached the CNS. Can cause:
- Headache
- Altered behaviour
- Dementia
- Tables dorsalis

33
Q

What is the diagnostic test for syphilis?

A

Antibody testing (T. pallidum) is screening assessment.

Refer to GUM for further testing.

34
Q

What is the first line standard treatment for syphilis?

A

Single dose of deep IM intramuscular benzypenicillin

35
Q

Which pathogen causes herpes?

A

HSV-1 and HSV-2

36
Q

How does genital Herpes present?

A

Painful genital ulceration.
Headache, fever, malaise
Lymphadenopathy
Urinary retention.

37
Q

What is the test of choice for suspected genital herpes?

A

Viral PCR swab from lesion/ulcer.

38
Q

What is the treatment for genital herpes?

A

Orla aciclovir.
Paracetamol/topical lidocaine for the pain.

39
Q

How is herpes in pregnancy treated?

A

Also use aciclovir - not known to be harmful to the baby.

40
Q

What pathogen causes gonorrhoea? How does this look under the microscope?

A

Neisseria gonorrhoeae - a gram negative diplococci.

41
Q

What are the symptoms of gonorrhoea?

A

Odourless discharge, possibly green or yellow.
Dysuria.
Pelvic pain.

42
Q

What is the test for suspected gonorrhoea?

A
  • 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
Q

What is the treatment for gonorrhoea?

A

First line - single dose of IM ceftriaxone.
If sensitivities known, can use single dose of oral ciprofloxacin.

44
Q

What is the treatment for genital warts?

A

Topical podophyllum if multiple.
Cryotherapy if one wart.

45
Q

What is the difference between genital warts and genital herpes?

A

Genital herpes will be painfuland also cause systemic unwellness.
Warts might be itchy but are painless, and no systemic illness.

46
Q

What is AIDS?

A

Occurs when HIV is untreated and the disease progresses, leading to the patient becoming immunocompromised.

47
Q

What is the microbiological composition of HIV?

A

An RNA retrovirus. Most common type is HIV-1.

Virus destroys CD4 T-helper cells.

48
Q

How is HIV spread?

A

Unprotected vaginal, anal or oral sex.
Vertical transmission.
Bodily fluids (sharing needles, open wound exposure etc.)

49
Q

What are the common AIDS defining illnesses?

A

PCP
CMV
Candidiasis (oesophageal or bronchial)
Lymphoma
TB

50
Q

What is the test used to diagnose HIV?
What is the window period?

A

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
Q

What tests are used to monitor the viral load of HIV?

How do the readings relate to the patient’s condition?

A

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
Q

What is the management for HIV?

What is the aim of treatment?

A

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
Q

What is the management of delivery for a mother with HIV?

A

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
Q

What is the recommendation for breastfeeding for a mother with HIV?

A
  • Avoid if possible.
  • If she is adamant, can be considered if the viral load is undetectable with close monitoring.
55
Q

When is PrEP used (HIV)?

A
  • HIV negative men (or trans-men) having condomless sex with other men.
  • HIV negative patients having sex with HIV +ve partners
56
Q

What is PEP and when is it used (HIV)?

What is the timeframe for PEP?

A

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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