Sexually Health + Transmitted Infections Flashcards
+ sexual health lecture
What are the risk groups of who gets STI’s
- Young age (<20 years) - lower age at 1st intercourse, ‘coitarche’
- Frequent partner change, high no. lifetime partners, concurrency (simultaneous partners)
- Sexual orientation
- Ethnicity for some STIs
- Residence in inner-city/ deprivation
- Use of non-barrier contraception
- History of previous STI
What makes young people at risk of STI’s?
- Early age associated with poor subsequent sexual health
- Behaviourally more vulnerable to STI acquisition
- higher numbers of sexual partners/partners change
- greater numbers of concurrent partners
- yet to develop skills and confidence to use condoms, negotiate safe sex
- more risk-taking behaviour/ experimentation
- poor awareness contraception
- Physiology
- risk of infection via HPV
What vulnerabilities are associated with early intercourse?
- leaving home / not living with parents before 16 years
- leaving school early
- poorer sexual education
- family disruption & disadvantage
- lack of nurturing relationships
- those whose main source of information on sex was not school or parents
What are the main messages to get across to young people?
- Don’t rush into it – avoid peer pressure
- Use condoms with all new partners
- Get a STI screen when you have a new partner
- Sort out contraception
- Avoid overlapping sexual relationships
- GBM* should also get vaccinated for hepatitis A/B and HPV & consider HIV PrEP
*gay and bisexual men
How does Sexual Orientation play as a risk factor to STI’s?
- gay and bisexual men are more likely to duffer from bacterial infections
- syphilis is a lot higher in men
What are the GMC guidelines for STI examinations
- Offer a chaperone
- Explain to patient why examination is necessary & what it will involve
- Give patient privacy to undress & dress
- Obtain patient’s permission before the examination
- Discontinue if patient asks you to
- Keep discussion relevant - avoid unnecessary comments
Explain the process of a female genital examination
- Inspect & palpate inguinal region
- feel for any lymph nodes
- Leg rests - allow better visualisation
- Inspect pubic area, vulva & perianal area
- Look between skin folds
- any gritty lumps
- Speculum examination (use water as lubricant-gels can interfere with tests)
- Bimanual examination (if indicated)
- A - mons pubis
- B - clitoral hood and anterior fourchette
- C - clitoris
- D - vestibule
- E - anus
- F - labia majora
- G - labia minora
- H - urethra
- I - hymen / hymenal remnants
- J - introitus
- K - bartholins glands
- L – posterior fourchette
- M – perineum
- S – shaft
- F – foreskin
- COS – coronal sulcus
- G – glans
- M – meatus
- Fr – frenulum
- GC – glans corona - corona of glans
Explain the process of a male genital examination
- Inspect pubic area, inguinal region
- Inspect scrotum & perianal area
- Palpate scrotal contents – note presence of testes, any lumps/ tenderness
- ask patients if they inspect their own scrotum - once a mont, make sure that there are no gritty lumps
- Inspect penis - record whether circumcised - if not inspect under the foreskin
- Particular attention to coronal sulcus, frenulum & meatus
- warts would be seen there
- Note presence of urethral discharge
What are normal appearances seen on male genitalia?
- Pearly penile papules
- aka Coronal papillae
- Fordyce spots
- visible sebaceous glands, present in most individuals
- epidermoid cysts
- not ‘normal’ but not infections
What are normal appearances on the female genitalia?
- Vulval papules/ papollimatosis
- smooth and not palpable - not gritty
- enlarged sebaceous glands
What other conditions can present in the genital area?
- malignant melanoma
- can be benign pigmentation - needs to be monitored
- Psoriasis
- dry and scally on dermal skin
- maybe more red in the genital area
- review the rest of the body: dry scalp and elbows, nail changes
- Tinea cruris
- dermatophyte (fungal infection)
- Scabies
- pruritic papules are seen on the penis/genitals
- Lesions & burrows in finger webs & wrist, creates little tracts
Give examples of Bacterial/ protozoal infections
- general presentation and management
- Chlamydia, gonorrhoea, syphilis, TV* (trichomonal vaginalis)
- more often florid symptoms
- early presentation
- rapid diagnosis
- effective treatment available
- curative
- reservoirs can be controlled
Give examples of viral STI’s
- general presentation and management
- Herpes, warts, HIV, hepatitis
- many unaware of the infection
- delayed presentation
- diagnostic tests may be unreliable
- symptomatic treatment only
- often life-long
- expanding reservoirs
What is the presentation of Gonorrhoea/chlamydia?
- wise gritty discharge
- feels like passing razor blades
- the incubation period of 2-30 days
- most symptoms presenting 4-6 days after being infected
- microscopy would show
- intracellular gram-negative diplo-cocci
What is the presentation of primary syphilis?
- 1-3 weeks after contact (9-90 days),
- red mark –> raised spot –> ulcer at the site of contact
- Enlarged lymph nodes in the groin/neck
- bacteria continues to travel through the body leading to 2y syphilis
- Heals within 1-3 weeks (with or without treatment)
- usually painless
What is the presentation of Secondary Syphilis?
- 2-6 weeks after 10 stage - lasts for 2-4 weeks
- Systemic dissemination - millions of spirochaetes
- Flu-like illness, headache, lymphadenopathy
- Mouth ulcers - “snail track” painless
- Condylomata lata - white/grey lumps in moist areas
- Arthritis
- Rapid resolution with effective treatment
- if not treated can eventually resolve it self may lead to tertiary syphilis –> much more serious
- Particularly suspect if rash involves palms & soles
- scalp affected - patchy alopecia
What is the differential diagnosis for the following symptoms
- rash involves palms & soles
- Non-itchy
- Symmetrical, generalised
- Palms & soles
- Macular - papular - scaly
- Reddish-brown
- Symphilis
- Pityriasis rosea (no herald patch)
- Psoriasis
- HIV
What is the presentation for Trichomonal vaginalis?
- diagnosis
- treatment
- Single cell protozoan parasite
- Infects vagina & urethra
- causes Dysuria, discharge
- Causes frothy discharge, “strawberry cervix”
- Diagnosed by seeing motile organisms on microscopy
- Responds well to metronidazole
What are the most common viral STI’s?
- HIV
- Hepatitis
- HPV
- 6 & 11 cause warts and are most common
- 16, 18, 3, 33… more severe and can cause cervical cancer
- Herpes
What would the presentation of molluscum contagiosum indicate?
- viral infection
- widespread in kids from swimming pools, seen int eh genitals and upper thigh
- if it presents widely in adults and above the neck then is a sign of severe immune suppression
- indicative of a HIV, a test needs to be done
What is the presentation of Herpes simplex type 1 &2?
- symptoms
- signs
-
Symptoms
- painful ulceration, dysuria, vaginal discharge
- external dysuria when it leaves the urethra and touches the ulcer
- systemic symptoms e.g. fever and myalgia (more common in the first occurrence)
- shooting pain on the back of the legs
- neurotropic virus, latent in the nerve root ganglion - can cause a prodrome (paraesthesia pins and needles, pain) upon reinfection before the ulceration is seen in the skin
-
recurrences generally less severe
- if a prodrome is present, a high dose of acyclovir can be taken to prevent formation of ulcers
- painful ulceration, dysuria, vaginal discharge
-
Signs
- blistering & ulceration (+/- cervix/rectum)
- painful inguinal lymphadenopathy
- heals after 5-14 days
Give two examples of non-sexually transmitted genital infections
- Candida/thrush
- fungal infection
- Bacterial vaginosis
- imbalance of vaginal flora –> overgrowth of anaerobes
- due to overwashing/ bubble baths
What are the symptoms and treatment for candida/thrush?
- itching, discharge, swelling
- papular rash in males
- topical antifungals
What are the symptoms and treatment for bacterial vaginosis?
- discharge
- “fishy” odour
- responds to metronidazole
What are the complications for Chlamydia/ gonorrhoea?
- Pelvic Inflammotry Disease (PID)
- Epididymitis,
- Infertility
- due to inflammation in the area
- chronic pain,
- seronegative arthritis +/- urethritis and conjunctivitis
- for certain genotypes
What are the complications of HPV/ Warts?
- cervical cancer,
- anal/vulval/penile intraepithelial neoplasia (AIN/VIN/PIN)
What are the complications of bacterial vaginosis?
- miscarriage,
- early labour,
- low-birth weight
What are the complications of Trichomonal vaginalis?
- miscarriage,
- early labour,
- low-birth weight
What are the complications of Syphilis?
- Dementia
- Cardiac abnormalities
when they progress to tertiary infection
What are the complications of Hepatitis B & C
- Cirrohosis
- Liver cancer
due to chronic inflammation
What are the complications of HIV?
- opportunistic infections,
- lymphoma,
- non-AIDS malignancies
What is Sexual Health?
A state of physical, emotional, mental and social well-being in relation to sexuality: it is not merely the absence of disease dysfunction or infirmity.
Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence
frequency
What sexual difficulties do both men and women face when it comes to sex?
- both groups would like to have sex more frequently than they currently do
- mean frequency is 1.5 times per week
- only 15% of women and 26% of men report a match between the ideal and actual frequency of sex
- 16% of men and 17% of women were anxious about their ability to perform
What sexual difficulties do women report about their experience of sex?
- 55% lacked interest in sex
- 29% unable to orgasm
- 27% experienced pain during intercourse
- 24% vaginal dryness
What sexual difficulties do men report about their sexual experience?
- 25% lacked interest in sex
- 24% orgasmed too quickly
What can low sexual function be related to?
- greater age
- depression
- poor physical health
- cardiovascular health
- lower relationship satisfaction
- inability to talk about sex with partners
What is sexual coercion and what are the effects of on an individual?
- occurrence
- being forced or frightened into unwanted sexual activity
- 5% of men and 20% of women
Has long-lasting effects on
- psychological well-being
- higher prevalence of depression and anxiety
- physical well-being
- lower overall well being, greater cigarette/drug/alcohol use
- sexual well-being
- more STI’s more negative attitudes towards sex
What are the sexual health concerns among young people?
- avoiding unintended pregnancy
- avoiding STIs
- treating STIs to protect reproductive health
What are the sexual health concerns in adulthood?
- optimising reproductive health
- optimising sexual satisfaction
What are the sexual health concerns in older age?
- optimising sexual function
- limiting imapact of physical health on sexual health
- CVD
Give an overview of the epidemiology of sexual activity and the effect this has
- age of first oral and vaginal sex has dramatically reduced
- now down to 16/17 for both men and women
- having sex earlier in life increases the time of potential exposure to STI’s
- experience more forms of sexual activity when they do being having sex
- also means earlier exposure to STI’s and increased risk of unplanned pregnancy
- people are sexually active later in life also
- longer potential STI exposure
What are two key sexual problems among men, how do they are with age?
- anxiety
- erectile problems
- not only physical problems it is related to relationship satisfaction, and ability to talk about sex with partners
What are two key sexual problems amongst women and how does this vary with age?
- Pain during sex
- vaginal dryness
- may not have education how to prevent this and may it better
- not only physical problems it is related to relationship satisfaction, and the ability to talk about sex with partners
How are condoms used, how do people engage with condom use?
- they are not used as consistently or correctly of those who use condoms
- in heterosexual couples is influenced by concerns about pregnancy rather than STI’s
- dual use of the pill and condoms is uncommon
- having the skill and the knowledge on how to use a condom appropriately is important, however, it’s the ability to communicate about using a condom with the sexual partner that is very important
- it’s far more useful giving people the skills to use condoms - also the communication skills
What is PEP and PrEP?
- Anti-retroviral therapy drugs can be used to prevent the sexual transmission of HIV through
- post-exposure prophylaxis (PEP) immediately after high-risk events
- pre-exposure prophylaxis (PrEP)
- prevents infection
- does not protect against other STI’s, so it is important to use a condom
What is the purpose of sexual health screening?
- collect data
- raise awareness
- treat people
- notify partners
