Sexual history and HIV risk assessment Flashcards
What key symptoms do you need to ask about in a sexual history for someone with a vagina?
SOCRATES
- Abdominal and pelvic pain
- Post-coital PV bleeding
- IMB
- Post-menopausal bleeding
- Abnormal vaginal discharge
- Dyspareunia
- Vulval skin changes and itching
- Systemic symptoms
- Dysuria
What are the potential causes of abdominal and pelvic pain in a female (sexual health specific)?
- Ectopic pregnancy
- Ruptured ovarian cyst
- Endometriosis
- PID
- Ovarian torsion
What are the potential causes of post-coital PV bleeding?
- Cervical ectropion
- Cervical cancer
- Gonorrhoea
- Chlamydia
- Vaginitis
What are the potential causes of IMB?
- Contraception (Mirena coil)
- Ovulation
- Miscarriage
- Gonorrhoea
- Chlamydia
- Uterine fibroids
- Perimenopause
- Malignancy
What are the potential causes of post-menopausal bleeding?
- Gonorrhoea
- Chlamydia
- Vaginal atrophy
- HRT
- Malignancy
What are the potential causes of abnormal vaginal discharge?
- Bacterial vaginosis
- Chlamydia
- Gonorrhoea
- Trichomonas vaginalis
What are the potential causes of dyspareunia?
- Endometriosis
- Vaginal atrophy
- Gonorrhoea
- Chlamydia
What are the potential causes of vulval skin changes and itching?
- Vaginal thrush
- Gonorrhoea
- Genital herpes
- Chlamydia
- Vaginal atrophy
- Lichen sclerosis
What systemic symptoms might you want to ask about when taking a sexual history?
- Fever (secondary to PID)
- Malaise
- Weight loss (e.g. HIV)
- Rash
- Swelling of large joints, conjunctivitis, and cervicitis (reactive arthritis secondary to chlamydia)
What other information must you ask people with vaginas about?
- Menstrual history
- Past gynaecological history (previous infections/procedures/cervical smears/STI screens)
- Obstetric history
What are key symptoms to ask people with a penis when taking a sexual health history?
- Abdominal and pelvic pain
- Testicular pain or swelling
- Itching or sore skin
- Skin lesions
- Urethral discharge
- Dysuria
- Systemic symptoms
What are potential causes of abdominal and pelvic pain in males?
- Orchitis/epididymo-orchitis
- Prostatitis
What are potential causes of testicular pain and/or swelling?
- Orchitis/epididymo-orchitis (secondary to chlamydia, gonorrhoea)
What are potential causes of itching or sore skin in males (sexual health specific)?
- Genital herpes
- Thrush
- Gonorrhoea
- Chlamydia
What are potential causes of skin lesions in males (sexual health specific)?
- HSV
- HPV
- Syphilis (chancre)
What are potential causes of urethral discharge from the penis?
- Chlamydia
- Gonorrhoea
What are potential causes of dysuria in males (sexual health specific)?
- Chlamydia
- Gonorrhoea
- HSV
What questions are important to ask regarding the sexual encounter?
- Sign-post
- Timing
- Consent
- Relationship (casual, regular partner)
- Patient demographics (sex)
- Type of sex
- Contraception (inc problems with the contraception; do they always use contraception?)
- Sexual partners in the last 3 months
What questions do you need to ask as part of a HIV risk assessment?
- “Have you ever had a partner who is known to be HIV positive?”
- “Have you ever had sex with a bisexual man/engaged in male homosexual activity?”
- “Have you ever had sex with someone abroad, or who was born in a different country?”
- “Have you ever injected drugs?”
- “Are you aware of any of your previous partners having ever injected drugs?”
- “Have you ever paid someone for sex, or been paid for sex?”
What medications might interact with contraception or cause sexual health issues?
- St John’s Wart increases the metabolism of the COCP reducing its effectiveness
- Abx may cause secondary vaginal thrush
What is first and second line treatment for chlamydia?
- Doxycycline 100mg oral BD for 7 days (contraindicated in pregnancy)
- Azithromycin 1g oral, followed by 500mg daily for 2 days
What is 1st and 2nd line treatment for gonorrhoea?
- Ceftriaxone 1g IM injection as a single dose
- Ciprofloxacin 500mg orally as a single dose (only where antimicrobial sensitivities are known)
- Cefixime 400mg orally as a single dose with azithromycin 2g orally as a single dose (if IM injection contraindicated)
What is the treatment for primary, secondary, and early latent syphilis?
Benzathene benzylpenicillin 2.4 million units IM injection as a single dose
What is the treatment for late latent, cardiovascular, and gummatous syphilis?
Benzathene benzylpenicillin 2.4 million units IM injection weekly for 3 weeks (i.e. 3 doses)
What is the treatment for primary episode of genital herpes?
Aciclovir 400mg PO TDS for 5 days
What is the treatment for recurrent episodes of genital herpes?
Aciclovir 800mg PO TDS for 2 days
What is genital herpes prophylaxis in patients with >5 episodes per year?
Aciclovir 400mg BD
What is the 1st and 2nd line treatment for trichomonas vaginalis?
- Metronidazole 400-500mg BD for 5-7 days
2. Metronidazole 2g oral as a single dose
What is the treatment for cervicitis/urethritis caused my mycoplasma genitalium?
Doxycycline 100mg BD for 7 days followed by azithromycin 1g as a single dose then 500mg daily for 2 days (10 days abx treatment)
What is the treatment for PID/epididymo-orchitis caused by mycoplasma genitalium?
Moxifloxacin 400mg daily for 14 days
