Sexual Health Serious Issues Flashcards
When can a child consent to sexual intercourse?
Over 14
Remind the child that sexual intercourse under 16 is illegal
Can a child under 14 give consent for sexual intercourse?
No
Even if they have capacity this is classed as rape
Must inform social services if disclosed (may inform the police)
How is fraser guidance applied to sexual activity & contraceptives?
UnProtected Sex Is Silly:
- Understands: Young person understands the advice with sufficient maturity to understand what is involved
- Parents: Do not need to inform parents
- Sexual intercourse: Young person very likely to begin/continue having sex with/without contraception
- Interest: In the young person’s interest to give treatment/advice without parental consent
- Suffer: Without contraception advice/treatment the young person’s physical/mental health would suffer
What are a person’s immediate needs following sexual assault?
- Safety
- Treatment of injuries
- Baseline screening (STIs, HIV)
- Prevention of pregnancy (cuIUD or Levonelle)
- Prophylaxis for STIs, HIV, Hep B (vaccination)
- Self-harm risk assessment
- Referral for forensic medical examination in local SARC for DNA evidence
What are a person’s intermediate needs following sexual assault?
- Pregnancy test
- Screening for STIs
- Hep B vaccination
- Assess coping abilities
- Practical & psychosocial support
- Identify symptoms of PTSD
What are a person’s long-term needs following sexual assault?
- STI screen offered
- Counselling/therapy
What are the risks of domestic violence in pregnancy?
Miscarriage
Infection
Premature birth
Injury/death to the foetus
What tests should be offered to a woman with symptoms who requires a speculum examination?
- Vulvovaginal swab (chlamydia & Gonorrhoea NAAT)
- HSV (TV, BV, candida)
- Endocervical swab (Gonorrhoea culture)
- Bloods (HIV & Syphilis)
What tests should be offered to a woman without symptoms who doesn’t requires a speculum examination?
-Vulvovaginal (Chlamydia & Gonorrhoea)
Patient/clinician taken
-Bloods (HIV & Syphilis)
What tests should be offered to a heterosexual man with symptoms?
- Urine (Chlamydia & Gonorrhoea NAAT)
- Urethral swab (Gonorrhoea culture)
- Bloods (HIV & Syphilis)
What tests should be offered to a heterosexual man without symptoms?
- Urine (Chlamydia & Gonorrhoea NAAT)
- Bloods (HIV & Syphilis)
What tests should be offered to a homosexual man with symptoms?
- Urine (Chlamydia & Gonorrhoea NAAT)
- Urethral swab (Gonorrhoea culture)
- Pharyngeal swab (Chlamydia & Gonorrhoea) & culture
- Rectal swab (Chlamydia & Gonorrhoea NAAT) & culture
- Bloods (HIV & Syphilis & Hep B)
- Offer Hep B vaccine
What tests should be offered to a homosexual man without symptoms?
- Urine for chlamydia & gonorrhoea NAAT
- Pharyngeal swab for chlamydia & gonorrhoea NAAT
- Rectal swab for chlamydia & gonorrhoea NAAT
- Blood for HIV and syphilis and hepatitis B
- Offer Hepatitis B vaccine
What are the 2 subtypes of Reiter’s syndrome?
GI: Salmonella, Shigella, Campylobacter
GU: Chlamydia, Gonorrhoea
What is the most likely diagnosis?
A 45yo HIV +ve lady w/multiple lesions on her face. Lesions are raised, swing, non-tender, non-erythematous, approx 3mm, umbilicated centres
Molluscum Contagiosum
Develop on face, abdomen, buttocks, genitalia
Latent period of 3-12weeks
Extensive & persistent in immunocompromised
Who is genital candidiasis most commonly seen in?
Diabetics
Pregnancy
HIV
Those on immunosuppressants
What is the presentation of lymphogranuloma venereum?
Presents between 3-21days infection 3rd develop small painless papule which ulcerates & heals after days Unilateral lymphadenopathy Inguinal abscesses (buboes) Proctitis when rectal mucosa infected
What are the different stages of Syphilis?
Primary: 10-90d post-infection, dull red papule on external genitalia forming single well-demarcated painless ulcer heals 3-10w, bilateral inguinal lymphadenopathy
Secondary: 6-8w after primary infection, malaise, mild fever, headache, pruritic skin rash, hoarseness, swollen lymph nodes, patchy diffuse hair loss, bone pain, arthralgia
Latent: No clinical evidence of disease, detectable by serology
Gummatous: Late stage, host resistance begins to fail, areas of granulation tissue on scalp, upper leg, sternoclavicular area, copper coloured lesions, can also occur internally
Neurosyphilis: Detectable in CSF, headache, CN palsy, general paralysis of the insane, tabes dorsals, trophic ulcers, Charcot’s joints, Argyll Robertson pupils
How does Trichomoniasis present?
Offensive greenish-grey discharge vulval soreness Dyspareunia Dysuria Vaginitis vulvitis Cervix: Punctate erythematous/strawberry appearance
What is PID?
Polymicrobial infection
Spectrum of inflammatory disorders of the upper GU tract
What are the causes of PID?
N. Gonorrhoeae Chlamydia Anaerobes Gardnerella vagnalis H. Influenzae Strep Agalactiae
What are Sx of PID?
Bilateral pelvic/abdo pain Deep dyspareunia Abnormal vaginal bleeding Mucopurulent discharge Adnexal tenderness
Pyrexia
Adnexal pain
Leukocytosis
In PID what is RUQ associated with?
Fitz-Hugh-Curtis Syndrome
Peri-hepatitis
Adhesions between the liver & peritoneum
How is PID diagnosed?
Pregnancy test Bimanual: Rule Out Ectopic! VV swab: NAAT EC swab & culture High vaginal swab Bloods: WCC, ESR, CRP, HIV
How is PID treated?
Analgesia
Abx - Doxcycline & Metronidazole & Ceftriaxone
Refrain from sexual intercourse
What are the complications of PID?
Fitz-Hugh-Curtis Syndrome Chronic pelvic pain Infertility Ectopic Hydrosaphinx Dyspareunia
