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Phase 3a Everything > sexual_health_20231205142345 > Flashcards

sexual_health_20231205142345 Flashcards

1
Q

What kind of bacteria is chlamydia trachomatis?

A

Gram negative bacteria

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2
Q

What are the risk factors for chlamydia infection?

A

Under 25 Multiple sexual partners New sexual partnerA partner with other partners History of STIsUnprotected sex

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3
Q

What are the two types of swabs used in sexual health testing?

A

Charcoal swab - from endocervical or high vaginal areaNucleic acid amplification test

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4
Q

What is the purpose of a charcoal swab?

A

Allows for microscopy, culture and sensitivity

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5
Q

What is NAAT testing?

A

Checks for the DNA or RNA of the organism - Only used for chlamydia and gonorrhoea

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6
Q

What specimens can NAAT testing be performed on?

A

Low vaginal swab First catch urine - men and women Endocervical swab

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7
Q

What is the presentation of chlamydia?

A

Abnormal vaginal discharge Pelvic pain Dyspareunia Dysuria Post coital bleeding Intermenstrual bleedingPenile discharge

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8
Q

What is the first line investigation for chlamydia?

A

NAAT swab

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9
Q

What are the differentials of chlamydia?

A

Gonorrhoea Bacterial vaginosis Thrush Trichomonas Mycoplasma infectionPID

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10
Q

What is the first line management of chlamydia?

A

100mg doxycycline BD for 7 days

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11
Q

What is the first line management of chlamydia in pregnant women?

A

Oral Azithromycin 1g single dose

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12
Q

What are the complications of chlamydia infection?

A

PID
Chronic pelvic pain
Infertility
Ectopic pregnancy
Epididymo-orchitis
Conjunctivitis
Reactive arthritis
Lymphogranuloma venereum

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13
Q

What are the pregnancy related complications of chlamydia?

A

Premature delivery
Premature ROM
Low birthweight
Postpartum endometritis
Neonatal conjunctivitis
Neonatal pneumonia Chorioamnionitis

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14
Q

What is lymphogranuloma venereum?

A

A lesion affecting the lymphoid tissue around the site of infection with chlamydia Most commonly occurs in MSM

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15
Q

What bacteria is gonorrhoea caused by?

A

Neisseria gonorrhoeae

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16
Q

What type of bacteria is neisseria gonorrhoeae?

A

Gram negative diplococci

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17
Q

What antibiotics are many strains of gonorrhoea now resistant to?

A

Azithromycin and ciprofloxacin

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18
Q

What is the presentation of gonorrheoa infection?

A

Female:- Odourless purulent discharge - green or yellow - Dysuria - Pelvic pain Male:- Dysuria - Odourless purulent discharge - green or yellow - Testicular painWomen more likely to be asymptomatic

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19
Q

What are the risk factors for gonorrhoea infection?

A

Age 15-24 Black ancestryCurrent/prior history of STIMultiple recent sexual partnersInconsistent condom use MSM Partner with risk factors History of sexual or physical abuse

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20
Q

What are the differentials of gonorrhoea?

A

ChlamydiaTrichomonas Mycoplasma PIDCandidiasisUTI

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21
Q

What is the first line investigation for diagnosis of gonorrhoea?

A

NAAT testingStandard charcoal swab for microscopy, culture and sensitivity

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22
Q

What type of swabs can be used for NAAT diagnosis of gonorrhoea?

A

Endocervical Urethral VulvovaginalRectal Pharyngeal

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23
Q

How else can gonorrhoea be diagnosed?

A

First catch urine

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24
Q

What is the first line management of gonorrhoea?

A

1g IM ceftriaxone

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25
Q

What follow up does the patient require after gonorrhoea infection?

A

The patient needs follow up ‘test of cure’- After 72 for culture - After 7 days for DNA NAAT- After 14 days for RNA NAAT

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26
Q

What are the complications of gonorrhoea?

A

PID Chronic pelvic pain InfertilityConjunctivitis Epididymo-orchitis Disseminated gonorrheal infection Urethral stricture

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27
Q

What does disseminated gonorrheal infection cause?

A

Non-specific skin lesions
Polyarthralgia
Migratory polyarthritis
Systemic systems - fever and fatigue

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28
Q

What is the key complication of gonorrhoea in a neonate?

A

Neonatal conjunctivitis - opthalmia neonatorum

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29
Q

What is bacterial vaginosis?

A

BV is an overgrowth of anaerobic bacteria in the vagina, and a loss of lactobacilli

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30
Q

What bacteria are associated with BV?

A

Gardenella vaginalis Mycoplasma hominisPrevotella

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31
Q

What are the risk factors for BV?

A

Multiple sexual partnersExcessive vaginal cleaning Recent antibioticsSmoking Copper coil

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32
Q

What is the presentation of BV?

A

Grey or white watery discharge Fishy smelling odour 50% of women are asymptomatic

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33
Q

What is Amsel’s criteria for BV?

A

3 out of 4 symptoms must be present:- Positive whiff test - fishy smell when potassium hydroxide is added - Grey or white discharge - Clue cells on microscopy - Vaginal pH > 4.5

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34
Q

What is the normal vaginal pH?

A

3.5-4.5

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35
Q

What are the first line investigations for BV?

A

Vaginal pH using swab and pH paperCharcoal vaginal swab for microscopy

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36
Q

What are clue cells?

A

Epithelial cells from the cervix that have bacteria stuck inside of them

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37
Q

What is the first line treatment of BV?

A

Asymptomatic BV does not require treatment If symptomatic:- Oral metronidazole for 5-7 days

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38
Q

What are the complications of BV?

A

Increased risk of catching STIsComplications in pregnant women:- Miscarriage - Preterm delivery - Premature ROM - Low birthweight - Chorioamnionitis

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39
Q

What is candidiasis?

A

Vaginal infection with yeast of the candida family

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40
Q

What is the most common organism that causes thrush?

A

Candida albicans

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41
Q

What are the risk factors for thrush?

A

Increased oestrogen - COCPPoorly controlled diabetesImmunosuppression Broad-spectrum antibioticsHIV

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42
Q

What is the presentation of thrush?

A

Non-offensive ‘cottage cheese’ discharge Vuval and vaginal itching Dysuria Superficial dyspareuniaVulval erythema

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43
Q

What is the first line investigation of thrush?

A

Usually clinically diagnosed Vaginal pH Charcoal swab - microscopy, culture

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44
Q

What is the first line management of thrush?

A

Single oral 150mg fluconazole Single 500mg clotrimazole vaginal pessary External clotrimazole cream for vulval symptoms

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45
Q

What is classed as recurrent thrush?

A

More than 4 episodes in one year

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46
Q

What is the treatment of recurrent thrush?

A

Induction-maintenance regime - Oral fluconazole every 3 days for 3 doses- Oral fluconazole weekly for 6 months

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47
Q

What is the first line of candidiasis in pregnanct women?

A

Clotrimazole pessary - oral fluconazole is contraindicated in pregnancy

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48
Q

What is mycoplasma genitalium?

A

A bacteria that causes non-gonococcal urethritis

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49
Q

What is the presentation of mycoplasma genitalium?

A

Urethritis Epididymitis Cervicitis Endometritis PID Reactive arthritis Most cases are asymptomatic

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50
Q

What is the first line investigation for mycoplasma genitalium?

A

NAAT testing First catch urine in men Vaginal swab in women (can be self taken)

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51
Q

What is the treatment of mycoplasma genitalium?

A

Doxycycline 100mg BD for 7 days then Azithromycin 1g stat and 500mg OD for 2 days

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52
Q

What is the treatment of mycoplasma genitalium in pregnancy?

A

Azithromycin alone - doxycycline is contraindicated in pregnancy

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53
Q

What is used as an alternative medication if mycoplasma is resistant to macrolides?

A

Moxifloxacin

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54
Q

What is trichomoniasis?

A

Trichomoniasis is an STI caused by the protozoa trichomonas vaginalis

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55
Q

What are the complications of trichomonas infection?

A

Contracting HIV by damage to the vaginal mucosa
BV
Cervical cancer
PID
Pregnancy related complications eg preterm delivery

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56
Q

What is the presentation of trichomoniasis?

A

Vaginal discharge - frothy and yellow Itching Dysuria Dyspareunia Balanitis - inflammation to the glans penis Strawberry cervixRaised vaginal pH

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57
Q

How is trichomoniasis diagnosed?

A

Charcoal swab with microscopy Women - posterior fornix swab, or low vaginal swab Men - First catch urine or urethral swab

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58
Q

What is the management of trichomoniasis?

A

Oral metronidazole for 5-7 daysOR 2g PO metronidazole stat

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59
Q

What strain of herpes virus typically causes genital herpes?

A

HSV-2

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60
Q

How can HSV-1 be contracted as genital herpes?

A

Through oro-genital sex

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61
Q

Where does the herpes virus become latent in after infection?

A

Sensory nerve ganglia- Trigeminal nerve ganglia in cold sores - Sacral nerve ganglia in genital herpes

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62
Q

What strain of herpes virus usually causes cold sores?

A

HSV-1

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63
Q

What is the presentation of genital herpes?

A

Ulcers or blistering lesions affecting the genital areaNeuropathic pain - burning, shooting Flu-like symptoms Dysuria Inguinal lymphadenopathy

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64
Q

How long can symptoms last during the primary infection?

A

Up to 3 weeks

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65
Q

How is diagnosis of genital herpes made?

A

Clinical diagnosis - Ask about contacts - Can be confirmed with a viral PCR swab or NAAT testing

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66
Q

What measures can be used to manage the symptoms of genital herpes?

A

Paracetamol Topical lidocaine gel Cleaning with warm salt waterAdditional oral fluids Wear loose clothing Avoid intercourse

67
Q

What is the main medicla treatment of genital herpes?

A

Oral acyclovir

68
Q

What is the risk of genital herpes during pregnancy?

A

Risk of neonatal herpes simplex infection, which has high morbidity and mortality

69
Q

How is herpes passed on from mother to baby?

A

The antibodies that the woman develops to the virus can pass across the placenta

70
Q

What is the treatment of primary genital herpes before 28 weeks?

A

Initial infection treated with acyclovir
Prophylactic acyclovir started at 36 weeks gestation
Women that are asymptomatic can have a normal vaginal delivery

71
Q

What is the treatment of primary genital herpes after 28 weeks

A

Initial infection treated with acyclovir, and prophylactic acyclovir is started immediately C-section recommended

72
Q

What bacteria is syphilis caused by?

A

Syphilis is caused by Treponema pallidum, a spiral shaped bacteria (spirochete)

73
Q

How can syphilis be contracted?

A

Oral, vaginal or anal sexVertical transmission from mother to baby IV drug use Blood transfusion

74
Q

What are the symptoms of primary syphilis?

A

Chancre on the genitals (lesion may not be seen in women)Non-tender lymphadenopathy

75
Q

What are the symptoms of secondary syphilis?

A

Systemic symptoms - fever, lymphadenopathy Rash on trunk, palms and soles Buccal ‘snail track’ ulcers

76
Q

How long after the primary stage does secondary syphilis develop?

A

6-10 weeks

77
Q

What is the latent stage of syphilis?

A

Occurs after the secondary stage - the patient becomes asymptomatic despite still being infected with syphilis

78
Q

When is the early latent stage of syphilis?

A

Within 2 years of initial infection

79
Q

How long do secondary syphilis symptoms last for?

A

3-12 weeks

80
Q

When is the late latent stage of syphilis?

A

From two years after the initial infection onwards

81
Q

What are the features of tertiary syphilis?

A

Gummas Ascending aortic aneurysms General paralysis of the insane Tabes dorsalis Argyll-Robertson pupil

82
Q

What is tabes dorsalis?

A

Degeneration of the dorsal nerve roots of the spinal cord

83
Q

What is Argyll-Robertson pupil?

A

Bilaterally small pupils that do not constrict in response to bright light but do constrict when focussed on a close object (accommodation)

84
Q

What are the features of congenital syphilis?

A

Blunted upper incisor teeth Rhagades (linear scars in the skin around the mouth and nose)KeratitisDeafnessSaber shinsSaddle nose

85
Q

What is the first line investigation for syphilis?

A

Screening test - antibody test for antibodies to T. palladium

86
Q

What further testing can be done in patients suspected of having syphilis?

A

Swabs from infected sites can be processed through: - Dark field microscopy - PCR

87
Q

What is the first line management of syphilis?

A

IM benzanthine benzylpenicillin

88
Q

What is an alternative antibiotic in the treatment of syphilis?

A

Doxycycline

89
Q

What is the Jarisch-Herxheimer reaction?

A

A reaction seen due to the release of endotoxins following bacterial death:- Fever, rash and tachycardia

90
Q

What are the signs of congenital syphilis?

A

Generalised lympadenopathyHepatosplenomegaly Rash Skeletal malformations

91
Q

What type of virus is HIV?

A

HIV is an RNA retrovirus

92
Q

What is the most common type of HIV?

A

HIV-1

93
Q

What type of HIV is mainly found in Western Africa?

A

HIV-2

94
Q

What is the pathophysiology of HIV?

A

The virus enters and destroys the CD4 T helper cells of the immune system

95
Q

How can HIV be transmitted?

A

Unprotected anal, vaginal or oral sex Vertical transmission Exposure to infected bodily fluids

96
Q

How does HIV replicate inside the body?

A

Once in the T helper cells, it uses the enzyme reverse transcriptase to convert viral RNA into a DNA copy

97
Q

What is HIV seroconversion?

A

When the body starts to produce antibodies to HIV- After seroconversion, HIV can be tested for

98
Q

What are the symptoms of HIV seroconversion?

A

Flu-like illness symptoms - Sore throat- Lymphadenopathy - Diarrhoea - Malaise, myalgia - Maculopapular rash - Mouth ulcers

99
Q

How long after infection does seroconversion occur?

A

3-12 weeks

100
Q

What are the risk factors for HIV infection?

A

IV drug use Homo and heterosexual unprotected intercourse Percutaneous needlestick injuryHaving another STI

101
Q

What methods are used to diagnose HIV?

A

HIV antibodies p24 antigen

102
Q

How are HIV antibodies used to diagnose HIV?

A

ELISA test and a confirmatory Western Blot assay are used to detect antibodies to HIV

103
Q

After how long can HIV antibodies be detected in the blood?

A

Most people have antibodies by 4-6 weeks, but 99% of people have antibodies by 3 months

104
Q

How are p24 antigens used to diagnose HIV?

A

A viral core protein can be detected as RNA viral levels increase in the blood

105
Q

When can p24 antigens be detected in the blood?

A

Between 1 weeks and 3-4 weeks after infection

106
Q

How are most people diagnosed with HIV?

A

A test combining p24 antigen testing and HIV antibodies

107
Q

When should an asymptomatic patient be offered testing after a possible exposure?

A

4 weeks after the exposure - Repeated at 12 weeks if first test is negative

108
Q

What are the differentials of HIV infection?

A

Infectious mononucleosis CMV InfluenzaViral hepatitis Secondary syphilis

109
Q

What is the normal CD4 count range?

A

500-1200 cells/mm3

110
Q

Under what CD4 count puts a patient at risk of opportunistic infections?

A

200

111
Q

What is the main treatment of HIV?

A

Anti-retroviral treatment

112
Q

Who is antiretroviral treatment offered to?

A

All patients regardless of CD4 count - ART should be started as soon as a HIV diagnosis is made

113
Q

What are the classes of ART?

A

Protease inhibitors Integrase inhibitors Nucleoside reverse transcriptase inhibitors Non-nucleoside reverse transcriptase inhibitorsEntry inhibitors

114
Q

What is the usual starting regime for HIV treatment?

A

Two NRTIs plus an additional drug

115
Q

What additional management is required in HIV?

A

Prophylactic co-trimoxazole for patients with CD4 count under 200Yearly cervical smears Up to date vaccinations

116
Q

When can a woman with HIV have a normal vaginal birth?

A

If viral load is under 50

117
Q

What drug can be given to a woman in labour to prevent vertical transmission?

A

IV zidovudine

118
Q

What prophylaxis may be given to a baby with a HIV positive mother?

A

Zidovudine, lamivudine and nevirapine for 4 weeks

119
Q

What is the safest advice to breastfeeding mothers that are HIV positive?

A

To avoid breastfeeding - HIV can be transmitted through breast milk

120
Q

What is PEP?

A

Post exposure prophylaxis - Given within 72 hours to patients who have been exposed to HIV

121
Q

What is the current combination of drugs used in PEP?

A

emtricitabine/tenofovir (Truvada) and raltegravir for 28 days

122
Q

What is PrEP?

A

Pre-exposure prophylaxis for HIV

123
Q

What is the current combination of drugs used in PrEP?

A

emtricitabine/tenofovir (Truvada)

124
Q

What are the most common AIDS defining illnesses?

A

Kaposi’s sarcoma Pneumocystis jirovecii pneumonia Cytomegalovirus infection Candidiasis Lymphomas TB

125
Q

When should children be tested for HIV?

A

Babies to HIV positive parents When immunodeficiency is suspected Young people who are sexually active and there are concerns Needle stick injuries Sexual abuse IV drug use

126
Q

What eye conditions may be seen in someone with HIV?

A

CMV retinitis Kaposi’s sarcoma HSV infection VSV infection Tuberculosis

127
Q

What is the presentation of CMV retinitis?

A

Reduced visual acuity
Pizza pie appearance on fundoscopy - areas of thick white infiltrate accompanied by retinal haemorrhages

128
Q

What is the treatment of CMV retinitis?

A

Intra-ocular ganciclovir Oral valganciclovir

129
Q

What is Kaposi’s sarcoma?

A

A cancer caused by HSV-8 commonly seen in patients with HIV

130
Q

Where does Kaposi’s sarcoma develop from?

A

Endothelial cells - It is seen in the skin

131
Q

What is the appearance of Kaposi’s sarcoma?

A

Purple papules or plaques on the skin

132
Q

What is the treatment of Kaposi’s sarcoma?

A

Radiotherapy Resection

133
Q

What types of cancers is HIV associated with?

A

AnalLiverLung Hodgkin’s lymphoma Burkitt’s lymphoma Kaposi’s sarcoma

134
Q

What is the treatment of pneumocystis jiroveci pneumonia?

A

Co-trimoxazole

135
Q

What are the features of pneumocystis jiroveci pneumonia?

A

Bilateral bihilar interstitial infiltrates Desaturating on exertion Non-productive cough Poorly controlled HIV

136
Q

How should anti-retrovirals be taken?

A

They should be taken at the same time every day

137
Q

What are genital warts caused by?

A

HPV infection

138
Q

Which types of HPV most commonly cause genital warts?

A

HPV 6 and 11

139
Q

What are the features of genital warts?

A

Small fleshy protuberences that are slightly pigmented Lesions may bleed or itch

140
Q

What are the risk factors for genital warts?

A

Not vaccinated against HPV Earlier sexual intercourse Increasing number of lifetime sexual partners Immunocompromised Unprotected sex

141
Q

How are genital warts transmitted?

A

Mostly through skin to skin contact during sexual intercourse

142
Q

How are genital warts diagnosed?

A

Mostly clinical diagnosis - can be confirmed with a biopsy

143
Q

What is the first line treatment of genital warts?

A

Topical podophyllum Cyrotherapy

144
Q

What is the second line treatment of genital warts?

A

Imiquimod cream

145
Q

What is balanitis?

A

Inflammation of the glans penis and prepuce (foreskin)

146
Q

What are the causes of balanitis?

A

Atopic eczema
Allergic contact eczema
Psoriasis
Lichen sclerosis
Candidosis
Gonorrhoea
Carcinoma in situ
Bacterial causes

147
Q

What bacteria most commonly causes balanitis?

A

Staphylococcus species

148
Q

What are the risk factors for balanitis?

A

Uncircumsised
Congenital or acquired dysfuntional foreskin
Poor hygeine
Overwashing
HPV infection
Multiple partners
High risk sexual behaviours

149
Q

What are the features of balanitis?

A

Candidiasis - White non-urethral discharge - Itching Dermatitis - Itching - Pain - Clear non-urethral discharge Bacterial - Painful - Yellow non-urethral dischargeLichen sclerosus - Itching - White plaques

150
Q

How is balanitis diagnosed?

A

Mostly clinically diagnosed- Can confirm with swab microscopy and culture for candida albicans or bacteria

151
Q

What is the general treatment of balanitis?

A

Gentle saline washesWashing properly under the foreskin 1% hydrocortisone cream

152
Q

What is the treatment of balanitis caused by candida?

A

Topical clotrimazole for two weeks

153
Q

What is the treatment of balanitis caused by staphylococcus?

A

Oral flucloxacillin or clarithromycin

154
Q

What is the treatment of balanitis caused by lichen sclerosis?

A

High potency topical steroids

155
Q

What is chancroid?

A

An STI caused by Haemophilus ducreyi

156
Q

Where is chancroid common?

A

Most common in tropical and subtropical resource poor countries

157
Q

What type of bacteria is Haemophilus ducreyi?

A

Gram negative coccobacillus

158
Q

What are the risk factors for chancroid?

A

Unprotected sex High number of sexual partnersSex work Cocaine use Uncircumsised

159
Q

How long after exposure do symptoms take to develop?

A

4-10 days

160
Q

What is the presentation of chancroid?

A

Painful genital papules Genital ulcers Bleeding from lesionsPainful lymphadenopathy

161
Q

What are the differentials of chancroid?

A

Syphilis Herpes simplexLymphogranuloma venerum

162
Q

What investigations can be used to confirm a diagnosis of chancroid?

A

Culture PCRLymph node aspirate culture

163
Q

What is the management of chancroid?

A

Antibiotic treatment - options include:- Azithromycin - Ciprofloxacin - Ceftriaxone

Phase 3a Everything (10 decks)

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