Sexual medicine & STI's Flashcards
A 58yr old poorly controlled diabetic presents with increased D/C that is white and thick. She also has itching and superficial dyspareunia.
What investigation would you do and how would you treat?
Thursh
Ix: vaginal swab for microcopy and culture
Rx: Fluclonazole - pessary and capsules
A 24 year old presents with increased vaginal D/C which is a white/grey colour and is very perfuse.
What investigation would you request and what would you suspect would be the cause?
Bacteria vaginosis
Cause: Gardnella vagunalis
Dx: Wet microscopy - clue cells, +ve whiff cells, pH >4.5
How do you treat bacteria vaginosis?
Metronidazole
Describe how trichomoniasis would present?
V bad
Yellow frothy D/C, offensive smell
Itching, soreness, dyuria, abdopain, superficial dyspareunia
What is trichomoniasis caused by?
Tricomonas vaginalis
How do you diagnose and treat gonorrhoea?
Dx: Charcoal swabs NAAT
Rx: Im Ceftriaxone and PO azithromycin
How do you diagnose and treat chlamydia?
Dx: 1st void urine or endocervcical swabs NATT tets
Rx: Doxycycline
How do you diagnose and treat HSV?
Dx: swabs for DNA PCR
Rx: Acyclovir
A 34yr old female presents with very foul d/c that is mucopurulent. O/E she has a fever and has cervical motion tenderness and bilateral pelvic pain.
What do you think is the causes and how would you treat?
PID - from chlamydia or gonococcus
Dx: endocervical swabs / laparoscopy with fimbiral biopsy
Rx: IM cefriaxone then doxycycline +/- metronidazole
What are the complications associated with chlamydia?
Pelvic infection
Tubual damage - sub fertility + chronic pelvic pain
Reiters syndrome - 1) urethritis 2) conjunctivitis 3) arthritis
What are the complications associated with gonorrhoea?
Bacteraemia
Acute monoarticular septic arthritis
What are the differentials for genital ulceration?
Genital herpes (HSV1 & 2) Syphyilis Trauma Candidia Neoplasm
When would you suspect syphilis?
How would you treat it?
Painless ulcers that are thicker and with a negative herpes test
Send them for a syphilis blood test
Rx: Benzylpenicillin
What causes genital warts and how are they prevented?
Human papillomavirus HPV
Prevented with HPV vaccine given to 12-13year old school girls
A 19 year old presents with some warty type things on his buttock. They are painful vesicles and he also has a lump in his groin. What could be the cause and how would you treat?
Genital herpes from HSV
Rx: Acyclovir
How long should someone live in their preffered gender to receive a diagnosis of gender dysphoria?
2 years
What is the treatment for male to female conversion?
Hormonal
Oestrogen’s, facial hair removal and vaginoplasty
What is the treatment for female to male conversion
Hormonal
Testosterone (patch/injection)
Oestrogen blocker
Surgery - bilateral mastectomy then phalloplasty
What is hypoactive sexual desire disorder?
Hypoactive sexual desire disorder (HSDD) or inhibited sexual desire (ISD) is considered a sexual dysfunction and is characterized as a lack or absence of sexual fantasies and desire for sexual activity, as judged by a clinician.
What is a sexual growth program?
Enabes patients to overcome their own sexual needs through exploration of physical responses - works with a therapist to understand and overcome negative beliefs and unhelpful thinking patterns
What is erectile dysfunction?
Difficulty in developing/maintaining an erection suitable for satisfactory intercourse
RF for ED
CVD, DM, neurological disorders
Iatrogenic anti hypertensives, post prostate surgery, antidepressents
Causes for ED
Age related, ineffective sexual stimuli, pain,
veno-occulsive disorder
What are the non-pharmacological treatments options of ED?
Vaccum device, scrotal ring, enhancing lubricants/vibrators
What medications for ED
Sildenafil (viagra)
Tadalafil (SE: headaches, flushing) weekend one
Treatment for female sexual arousal disorder
couples psychosexual therapy - CBT, psychodynamic
Behavioural intervention device which is proven for orgasmic disorder
The Eros therapy device - greater clitoral and genital engorgement - increased vaginal lubrication and enhanced ability to achieve and orgasm
Causes of dyspareunia (S+D)
PID (D), Endometriosis (D),
Thursh (S), Herpes (S), vaginismus (S)
Causes of rapid ejaculaiton
Genetic susceptibility, penile hypersensitivity, hyperthyroidism, prostasis
Psychological causes of rapid ejaculation
Lack of experience, anxiety states, early learned experience, relationship issues
Treatment options for rapid ejaculation
Couple psychosexual therapy, behavioural interventions and topical local anaesthetic spray
What medication can you give someone who is change from man into a woman?
Synthetic oestrogen = ethinylestradiol
Anti-androgen = finesteride
What medication can you give someone who is change from woman into a man?
Testosterone
