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Sexual Medicine Flashcards

1
Q

What spirochete causes syphilis

A

Treponema Pallidum

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2
Q

Transmission routes of syphillis

A
  1. Sexual
  2. Accidental infection
  3. Blood bourne
  4. Transplacental
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3
Q

Describe the three types of stages that occur with syphilis

A
  1. Regional lymphadenopathy - resolves in 3-8 weeks
  2. If untreated, virus spreads

LATENT:
1. Asymptomatic

LATE:
1. Spreads to MSK, mucosa, CV and neurosyphilis

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4
Q

Presentation of early syphilis (primary)

A
  1. Painless papule at inoculation site
  2. Spreads and ulcerates (painful chancre with clear margins, moist base and serous exudate on pressure
  3. Bilateral painless regional lymphadenopathy
  4. Oral sex =oropharyngeal ulceration
  5. Balanitis
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5
Q

Where else are chancre sites found

A
  1. Lips
  2. Tongue
  3. Tonsils
  4. Pharynx
  5. Anal margin
  6. Rectum
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6
Q

What is secondary syphilis

A
  1. Heamatogenous dissemination of infection
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7
Q

Clinical features of secondary syphilis

A

1, Macular, papular and hypo-pigmented lesions

  1. Lymphadenopathy
  2. Mucous membrane lesions (white/grey border may coalesce oral cavity, larynx, nasal mucosa, genitalia, anus and rectum)
  3. Alopecia (telogen effluvium)
  4. Periostitis, bursitis (bone pain)
  5. Hepatitis
  6. Glomurulonephirits/nephrotic syndrome
  7. Meningism
  8. Iritis/ anterior uveitis/ optic atrophy
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8
Q

Differentials of secondary syphilis

A
  1. Measles
  2. Rubella (cervical lymphadenopathy)
  3. Psoriasis (papular rash)
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9
Q

What is gummatous syphilis

A
  1. Gumata is syphilitic granulation tissue, nodules with central scarring
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10
Q

Where are gummatous syphilis found

A
  1. Skin
  2. Bones
  3. Mouth and throat
  4. Liver, testis
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11
Q

Clinical features of late syphilis

A
  1. Gummata
  2. CV: Aortic aneurysm, regurgitation
  3. Neurosyphilis: Meningovascular, general paralysis, rabes dorsals
    Tabes Dorsalis: degenration of posterior columns and posterior root(difficulty walking etc)
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12
Q

Clinical features of babies with suyphilis

A
  1. Failure to thrive
  2. Skin lesions around mouth and body orifices
  3. Sparse hair and brittle, atrophic nails
  4. Hepatosplenomegaly
  5. Oesteochondritis and later periostitis
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13
Q

How is syphilis diagnosed

A
  1. Serum from chancres
  2. Cardiolipin antigen test
  3. Treponema pallidum PCR
  4. CSF test if neurosyphilis
  5. X-ray
  6. CT angio
  7. Ophthalmic slit lamp examination
    NEUROIMAGING
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14
Q

What is seen on a syphilis serological test

A
  1. EIA positive, TPPA positive, VDRL positive, IgM positive
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15
Q

How i early syphilis treated

A
  1. Benzathine benzylpenecillin
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16
Q

treatment of late, latent, CV or gummatous syphilis

A
  1. Banzethine benzyl penicillin
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17
Q

Treatment of neurosyphilis

A
  1. Procaine benzylpenecilin
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18
Q

Histology of neisseria gonorrhoea

A
  1. Grame negative

2. Diplococci

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19
Q

Clinical features of n.gonnorheoa in males

A

Incubation: 2-5 days

  1. Urtehral discharge
  2. Dysuria
  3. Yellow/green discharge
  4. Erythema of the urethral meatus + oedema
  5. Anterior uveitis
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20
Q

Clinical features of n.gonnorheoa in females

A
  1. Asymptomatic
  2. Vaginal discharge
  3. Syduria without frequency
  4. lower abdo pain
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21
Q

Complications of n/gonnorhea

A

Male:

  1. Urethral stricture/fistula
  2. Prostatitis
  3. Epididymitis

Inflammation of scene’s glands in women
Pelvic inflammatory disease

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22
Q

Clinical features of disseminated gonococcal infection (systemic spread of infection)

A
  1. Gonococcal dermatitis
  2. Tenosynovitis
  3. Endocarditis
  4. Hepatitis
  5. Meningitis
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23
Q

Diagnosis of n.gonorrhoea

A

VUlvovaginalr, urethral smear for NAAT

Endocervical smear microscopy

Mid-stream microscopy: urethrl sample

Swab from area that seems infected basically

Blood culture

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24
Q

Treatment of n.gonnorheoa

A
  1. Ceftriaxone 1g IM single dose
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25
Clinical Features of c.trachomatis
ONLY 60% have signs 1. INCREASED vaginal discharge 2. Dysuria without frequency MALE: 1. Urethral discharge 2. Dysuria
26
Complications of c.trachomatis in males
1. Reiter's syndrome 2. Prostatitis/urethritis Pelvic inflammatory disease
27
Diagnostics of c.tracheomatis
1. NAAT 2. Light microscopy 3. Sterile pyuria in MSM
28
Treatment of c.tracheomatis
1. Doxycycline
29
What can cause orgasmic dysfunction and low arousal
1. Partner conflict 2. Ignorance 3. Anxiety/depression
30
Management of orgasmic dysfunction
1. Sensate focus | 2. Testosterone gel when both ovaries removed
31
What is dyspareunia
1, Genital pain just before or after sexual intercourse
32
What is vaginismus
1. Learned response secondary to dyspareunia - involuntary contraction of muscular of OUTER THIRD of vagina cueing distress
33
Factors that contribute to vaginismus
1. Pregnancy 2. Loss of control 3. Sexual abuse
34
Management of vaginismus
1. Encourage inserting finger in vagina 2. Proceed to more fingers and use librication 3. Kegel escercise 4. Suggest partner involvement
35
What score system is used for erectile dysfunction
1. IIEF-5
36
How does the IIEF-5 work
Confidence in getting and keeping an erection (1->5) Erections on sexual stimulation hard enough for penetration (1->5) Maintaining erection after penetration Maintaining erection to completion of intercourse Satisfactory intercourse
37
Main causes of ED
1. Lifestyle factors 2. Trauma and Iatrogenic 3. Drugs 4. Vascular 5. Endocrine 6. Neuro: MS, Parkinson's 7. Psychogenic (depression/anziety
38
First line management for ED
1. Psychosexual therapy 2. Sildenafil (PDE 5 inhibitor) 2. Tadalafil 4. Prostaglandin E1 agent: Alprostadil 5. Implants and vacuum devices
39
What can cause premature ejaculation
1. Anxiety, deep sexual concerns, sexual assault
40
Primary vs secondary premature ejacultation
1. Primary: ALWAYS been problem | SECONDARY: Performance anxiety, previous control
41
How is Premature EJ work
1. Ejaculation 1-2 hours before 2. Deep breath before ejacultaion (reduce stimulation) 3/ Distraction techniques 4. Reduce sensation
42
What is delayed ejaculation
1. Difficulty having an orgasm
43
1. What can cause delayed ejaculation
1. Decreased sensitivity 2. Prostatectomy 3. MS 4. Alcohol 5. DM
44
Management of delayed ejaculation
1. Reduce masturbation 2. Resolve underlying anxiety 3.
45
What is retrograde ejaculation
1. Semen enter the bladder instead of through the penis during orgasm (dry orgasm)
46
What can cause retrograde ejaculation
1. Dysautonomia | 2. Operation on prostate - transurethral resection of the prostate
47
How is retrograde ejaculation diagnosed
1. Urinalysis
48
What is vulvodynia
1. Affects vulvar area, chronic pain syndrome (burning)
49
How is vulvodynia diagnosed
Symptoms must last 3 months
50
Clinical features of vulvodynia
1. Burning at entrance to vagina that happens when touched (tampons etc)
51
Causes of vulvodynia
1. Sjogren syndrome 2. Neuropathy 3. SLE
52
How is vulvodynia treated
1. Lubricant during sex 2. Cotton underwear 3. Counselling
53
What is peyronie's disease
1. disease causes plaques to form after chronic inflammation of tunica albuginea 2. Causes abnormal curvature of penis
54
Diagnosis of peyronie's disease
1. penile ultrasonography
55
Clinical features of peyrnoie's disease
Sexual intercourse is painful
56
What causes aspermia
``` Retrograde ejaculation Alpha blockers (tamsulosin) ```
57
What is hypospadias
1. Congenital where urethra does no open in its usual location
58
Clinical feature of hypospadias
1. Foreskin less developed (hooded) 2. Chordee (downward bending of penis) 3. Undescended testicles 4. Pain on ejculation or weak ejaculation
59
Treatment of hypospadias
1. Urethroplasty
60
What can cause anejaculation
1. Spinal cord injury
61
What is female sexual arousal disorder
1. Inability to attain sexual arousal
62
Diagnosis of female sexual arousal disorder
1. Inadequate lubrication swelling response normally present during arousal
63
Diagnosis of female sexual arousal disorder
1. Little interest in sex 2. Few thought related to sex 3. Decreased start and rejecting of sex 4. Little genital sensations during sex MOST OF THE TIME
64
Treatment of female sexual arousal disorder
1. Flibanserin
65
What is hypoactive sexual desire disorder
1. Lack of sexual fantasies and desire for sexual activity in MALES
66
How is hypoactive sexual desire disorder treated
``` COUNSELLING FLIBANSERIN (this increases libido ```
67
What is sexual aversion disorder
IN FEMALES
68
What is a paraphilia
1. INTENSE sexual arousal to atypical objects, situations fantasies or individuals
69
What causes pelvic inflammatory disease
1. C.trachomatis 2. N.gonnroheoa 3. M.genitalium
70
What factors can facilitate ascending infection of PID
1. Uterine contractions 2. Loss of cervical mucus plug 3. Carriage of bacteria by spermatozoa
71
Risk factors for PID
1. YOUNG 2. NEW PARTER within 3 months 3 .Past history of PID 4. Vaginal douching 5. SMOKING
72
Symptoms of Acute PID
1. Lower abdo pain 2. Deep dyspareunia 3. Menstrual regularity 4. Vaginal discharge 5. Nausea
73
Signs of Acute PID
1. Lower abdo tenderness with guarding 2. Fever 3. Adnexal mass 4. Abdo distention
74
Complications of chronic PID
1. Peri-Appendicitis 2. Infertility 3. Ectopic pregnancy 4. Perihepatitis
75
What is Fitz-Hugh-Curtis syndrome
1. Violin string adhesions between anterior surface of liver and abdo wall
76
Investigations of PID
1. SWABS 2. FBC, CRP, ESR, chlamydial antibody 3. MSSU 4. Pelvic Imaging 5. Lapsoscopy GOLD STANDARD
77
Differentials of PID
1. Ectopic pregnancy 2. Appendicitis 3. Ovarian cyst 4. IBS
78
Management of PID
1. AVOID sexual intercourse and give CEFTRIOXONE + doxycycline
79
Symptoms of Acute prostatitis
1. Prostatic pain 2. LUTS 3. Pyrexia, arthralgia
80
Diagnosis of prostatitis
1. MSSU 2. DRE 3. BLOOD TESTS 4. Prostatic specific antigen 5. MRI of pelvis and lumbar spine 6. STI screening
81
Management of prostatitis
1. ORAL CIPROFLOXCIN or TRIMETHOPRIM | 2. Paracteromal and ibuprofen
82
three causes of haematospermia
1. Trauma 2. Inflammation 3. Hypertension 4. Warfarin 5. Haematological disorders - laekaemia
83
What classifies a UTI
10^5 in Urinalysis
84
Management of Prostatitis
1. Ciprofloxacin 2. Tamsulosin 3. NSAIDs 4. Finasteride
85
What class of drug is finasteride
5-alpha reductase inhibitor
86
What causes epipidymo-orchitis
1. c tract or n.gonnorheoa
87
Where does infection spread from in epididymoorchitis
1. urethra or bladder | 2. Lymphatics or blood vessels
88
Causes of UTIs
1. Sex | 2. Catheters
89
What causes UTIs
1. E coli 2. Klebsiella 3. Pseudomonas 4. Shigella 5. Salmonella
90
Clinical features of epididymo-orchitis
1. Pyrexia 2. arthritis 3. Scrotal erythema 4. Swelling of epididymis 5. UNILATERAL scrotal pain and swelling
91
Complications of epididymo-orchitis
1. Hydrocele 2. Abscess 3. Infertility 4. Chronic prostatitis
92
Investigation for epididymo-orhcitis
1. MSSU 2. Microscopu 3. FBC, CRP 4. NAAT swab 5. Doppler ultrasonography to exclude differentials 6. Epididymal aspiration
93
Differentials for epididymo-orchitis
1. Torsion 2. Epididymitis 3. Testicular cancer
94
Management of epididymo-orchitis
1. NSAID | 2. Doxycycline + ceftriaxone
95
What can cause reactive arthritis
1. C trachematis 2. Ureaplasma urealyticum 3. N.gonnorheoa 4. Shigella 5. Salmonella
96
Clinical features of reactive arthritis
1. Urethritis/iritis/episcleritis 2. Dysuria 3. Arthritis (asymmetrical polyarthritis)/enthesistis 4. keratodemra blennorhagica 5. Erythema nodosum 6. Balantis/oral lesions
97
Where is arthritis seen in reactive arthritis
1. Lower limbs | 2. Sacroilitis
98
Diagnosis for reactive arthritis
1. Stool culture 2. ESR.CRP 3. Urinalysis 4. Radiology for periostitis/sacrolilitis 5. ECG 6. Syonivial tipsy 7. HLA-B27 test RF negative ANA test negative
99
How is arthritis and enthesistis in reactive arthritis
1. NCOX-2 NSAID, pred, STI antibiotics
100
What organism causes bacterial vaginosis
g.vaginalis
101
histology of g.vaginalis
Gram negative bacillus
102
Clinical features of g.vaginalis
1. Vaginal discharge 2. Moderate volume, grey->white->yellow Frothy Irritation
103
Complication of g.vaginalis
1. PID | 2. Pots-Hysterectomy vaginal cuff cellulitis
104
Treatment of g.vaginalis
1. Metronidazol e | 2. Clindamycin
105
How is trichomoniasis infection treated
ORAL metronidazole
106
Histology of trichomoniasis
1. Flagella, hydrogenosomes, axostyle
107
Most common organism that causes genitalcandidiasis
1. Candid albicans
108
Pre-disposing factors to genital candidiasis
1. DM 2. CHild-bearing years: luteal phase of menstruation, 3rd trimester 3. HIV and drugs that impair immunity 4. Contraceptives
109
Clinical features of genital candidiasis
1. Vulval pruritus 2. Burning 3. External dysuria 4. Dyspareunia 5. Vulval erythema
110
What can cause recurrent vulvovaginal candidiasis
1. Hypersensitivity | 2. Sex
111
Clinical features of men wit genital candidiasis
1. Balantis | 2. Balanoposthitis
112
Diagnosis of genital candidiasis
1. SWABS and microscopy 2. Latex agglutination test 3. PCR 4. Vaginal pH should be normal 5. Urinalysis
113
Management of genital candidiasis
1. Bathing in saline or Nabicarbonate | 2. Clotrimazole or oral Fluconazole
114
Causes of UTI (organisms)
1. Staphylococcus saprophysticus 2. Ecoli 3. Proteus mirabilis 4. Enterococci Klebsiella and enterobacter
115
Diagnostics of UTi
1. CLOUDY urine 2. leucocyte esterase 3. Nitrate reductase 4. Protein and haematuria 5. MSSU (10^5)
116
How are UTIs treated
1. Fluids | 2. Nitrofurantoin or trimethoprim
117
Complicated vs uncomplicated UTI
1.Uncomplciated are caused by a predictable group of organisms, complicated are not
118
Course of progression of HSV
1. Primary infection 2. Latency in dorsal root ganglion 3. Reactivation upon nerve stimulation 4. Recurrence (peripheral lesions) 5. Viral shedding
119
Clinical features of HSV
1. Pain 2. Irritation 3. Regional node lymphadenopathy 4. Vaginal/urethral discharge 5. crusting 6. Urinary retention, micturition
120
Complications of HSV
1. aSeptic meningiti s 2. Sacral radiluopathy 3. PHARYNGITIS
121
Diagnosis of HSV
1. PCR swabs from lesions 2. Viral cell culture 3. IgM and western blot serology 4. Cervical cytology
122
Treatment of HSV
1. Saline washes to reduce risk of superinfection 2. Drink plenty of flud 3. Codeine phosphate 4. Acyclovir (5 days)
123
How to prevent HSV
1. Circumcision 2. Condom 3. Antiviral drugs
124
Clinical features of HPV
1. Genital warts found in areas likely to be traumatised udirng sex (prepuce, urethral meatus, scrotum)
125
Treatment of HPV
1. Podophyllotoxin 2. Cryotherapy 3. Trichloroacetic acid 4. Electrosurgery
126
Machoism of action of combined pill, vaginal ring and patch
Inhabit ovulation | 2. Alter cervical mucus to stop spermatozoa penetration
127
ADVANTAGES of combined hormonal contraceptives
1. Improve acne 2. Protects against PID 3. Reduces risk of ovarian cancer 4. Reduce large bowel cancer
128
DISADVANTAGES of combined hormonal contrraceptive
1. Needs constant use | 2. No protection against STI
129
IF Combine spill is missed what should the patient do
Take forgotten and take next pill when due | 2. If missed two,do the same but abstain for 7 days/codnoms
130
First choice of COC
1. Levonorgestrel
131
Side effects of COC/oestrogen
1. Headaches 2. Nausea 3. Breast tenderness 4. Leg Cramps
132
Side effects of COC/progesterone
1. Mood change 2. Bloating 3. Greasy skin
133
What should be given to women postpartum contraception
POP
134
Prior to surgery what should be done to the oral contraceptive pill
Stop IMMEDIATELY and switch to POP
135
How doe the UKMEC system work for COC
1. More than 35 and smoking less than 15 cigs 2. BMI >35 3. Fmaily history of thromboembolic disease 4. Controlled HTN 5. Immobility 6. Gallbladder disease UKMEC 3 UKMEC 4: 1. Migraine with aura 2. Uncontrolled HTn 3. Current breast cancer
136
What is the time frame of using a copper inauterine device
1. Inserted for emergency contraception within 5 days after unprotected sex
137
Clinical features of PID
INFLAMMATION OF UTERUS, FALLOPIAN TUBES< OVARUES AND CERVIX 1. Lower sbdo pain 2. Post coital bleeding Intermenstrual bleeding Chornic: Low grade fever Weight Loss ABdo pain
138
Extra genital symptoms of Chlamidya and Gonnorheoa
1. Contact with eyes - conjunctivitis 2. Contact with anal or rectal mucosa - Proctitis (tenesmus, anorectal pain and bleeding, constipation) 3. Pharyngitis
139
Treatment of PID
1. IV Cefoxitin -> doxycycline for 14 days
140
Name three cancers caused by HPV
1. Penile, anorectal, oropharyngeal | 2. Carvical, vulvar, vaginal
141
What serotypes of HPV cause anogenital warts
6 and 11
142
How is HPv diagnosed
Appearance of warts or biopsy
143
Treatment of anogenital warts
1, Cryotherapy or TOPICAL IMIQUIMOD
144
CF of trichomona vaginalis
1. Bad smelling prurulent discharge 2. Burning 3. Pruritus LRTI symptoms and lower abod pain
145
DIagnosis of trichomona vaginalis
1. NAAT or microsocpy of vaginal secretion
146
Symptoms of Crabs (pediculosis pubis) and SCabies (sarcoptes scabiei)
1. BOTH PRURITIS Lice and nits in crabs can be seen Scbaies show erythematous papules Microsocpic examination of hair shafts or skin
147
Treatment of Crabs
1. Topical Permethrin | 2. Nits should be removed with tweezers
148
Treatment of Scabies
Oral Ivermectin
149
Primary infection of HSV what does this mean
``` No previous anti HSV virus antibodies 1. Painful vesicles Pruritus Dysuria Ignuinal lymphadenopathy Fever, headahces myaglgia ```
150
Diagnosis of HSV
1. Viral culture 2. HSV PCR 3. Serology - anti HSV antibodies
151
Treatment of HSV
1, Oral acyclovir
152
How does haemophilus decreyi cause infection
Micraabrasions in the askin -> ulcers (chancres - bleed when scraped)
153
Diagnosis of haemophilus decreyi
PCR Culture Gram Stain
154
Treatment of haemophilus decreyi
Ceftriaxone IM
155
Primary vs Secondary syphilis (both early syphilis)
Primary: Chancres Resolves and cause systemic infection ``` Secondary: Comes back but no chancre Systemic infection: lymphadenopathy in inguinal and femoral regions and cervical Symmetrical maculapapular rash Heptatitis Oliguria Arterial Hypertension ```
156
What defines AIDS
CD4 cell count less than 200 mol /ml | Or presence of aids defining illness: pneuomocystic jiroveci
157
Diagnosis of HIV
1. Enzyme-linked immunoassays 2. Western Blot 3. HIV viral load test (RNA) If 1 is negative and 3 is positive - early infection If both are positive - early or established infection
158
Symptoms of acute hepatitis
Nausea Vomtiing Upper RQ pain Jaundice, puritis, dark urine
159
SYmptpoms of chronic hepatiti s
1. Extrahepatic symptoms: Arthlagia Skin rashes
160
Blood test results in Hep B
HBs antigen Pos
161
Blood test results in Hep C
Anti-HCV Igg - positive
162
Treatment of Hep B
Pegylated INF | Tenofovor
163
Treatment of Hep C
1. Velpatisvir
164
After what time can sexual disorders be diagnsoed
6 months
165
Three characteristics of played ejactulation
1. Marked DELAY 2. MARKED infrequency 3. ABSENCE
166
What is Male hypoactive sexual desire disorder
1. Few or no sexual thoughts | 2. Low or absent desire for sexua activity
167
What diagnosis premature ejaculation
1. Within 1 min of penetration | 2. BEFORE they wish to
168
Three features of female orgasmic disorder
1. Delay 2. Infrequency 3. Absence of orgasm
169
When is sildenafil taken before sex
30 mins to 1 hour BEFORE
170
How is alprostadil delivered
Intracacvernous injection
171
How is vaginismus treated
Botox injection A 2. Vulvar vestibulectomy 3. Lidocaine
172
Gender identity vs expression
1. Own sense of gender vs how they present themselves to the world
173
Define transgender
GI is discordant from sex assigned at birth
174
What Hep B serology is seen if positive
1. HepBsAg HepBcAb AntiHBs - vaccination
175
What Microbe causes warts
HPV 6 and 11
176
Symptoms of anogenital warts
1. Single or multiple lumps 2. irritation or discomfort 3. Bleeding 4. Rarely, secondary infection or maceration
177
Appearance of genital warts
Soft cauliflower-like growths of varying size but can be flat, plaque-like or pigmented. Lesions can be BOTH moist and non-keratinised and also firm and keratinised
178
Anogenital warts diagnosis
Just the appearance
179
Management of genital warts
1. Podophyllotoxin twice daily Or cryotherapy
180
Management of a pregnant mown with Hep B
Only give immunoglobulins and vaccinations DO NOT OFFER C-SECTION

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