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203: Theme 3 > Sexually Health + Transmitted Infections > Flashcards

Sexually Health + Transmitted Infections Flashcards

+ sexual health lecture

1
Q

What are the risk groups of who gets STI’s

A
  • 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
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2
Q

What makes young people at risk of STI’s?

A
  • 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
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3
Q

What vulnerabilities are associated with early intercourse?

A
  • 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
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4
Q

What are the main messages to get across to young people?

A
  • 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

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5
Q

How does Sexual Orientation play as a risk factor to STI’s?

A
  • gay and bisexual men are more likely to duffer from bacterial infections
    • syphilis is a lot higher in men
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6
Q

What are the GMC guidelines for STI examinations

A
  • 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
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7
Q

Explain the process of a female genital examination

A
  • 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)
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8
Q
A
  • 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
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9
Q
A
  • S – shaft
  • F – foreskin
  • COS – coronal sulcus
  • G – glans
  • M – meatus
  • Fr – frenulum
  • GC – glans corona - corona of glans
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10
Q

Explain the process of a male genital examination

A
  • 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
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11
Q

What are normal appearances seen on male genitalia?

A
  • Pearly penile papules
    • aka Coronal papillae
  • Fordyce spots
    • visible sebaceous glands, present in most individuals
  • epidermoid cysts
    • not ‘normal’ but not infections
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12
Q

What are normal appearances on the female genitalia?

A
  • Vulval papules/ papollimatosis
    • smooth and not palpable - not gritty
  • enlarged sebaceous glands
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13
Q

What other conditions can present in the genital area?

A
  • 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
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14
Q

Give examples of Bacterial/ protozoal infections

  • general presentation and management
A
  • Chlamydia, gonorrhoea, syphilis, TV* (trichomonal vaginalis)
  • more often florid symptoms
  • early presentation
  • rapid diagnosis
  • effective treatment available
  • curative
  • reservoirs can be controlled
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15
Q

Give examples of viral STI’s

  • general presentation and management
A
  • Herpes, warts, HIV, hepatitis
  • many unaware of the infection
  • delayed presentation
  • diagnostic tests may be unreliable
  • symptomatic treatment only
  • often life-long
  • expanding reservoirs
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16
Q

What is the presentation of Gonorrhoea/chlamydia?

A
  • 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
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17
Q

What is the presentation of primary syphilis?

A
  • 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
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18
Q

What is the presentation of Secondary Syphilis?

A
  • 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
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19
Q

What is the differential diagnosis for the following symptoms

  • rash involves palms & soles
  • Non-itchy
  • Symmetrical, generalised
  • Palms & soles
  • Macular - papular - scaly
  • Reddish-brown
A
  • Symphilis
  • Pityriasis rosea (no herald patch)
  • Psoriasis
  • HIV
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20
Q

What is the presentation for Trichomonal vaginalis?

  • diagnosis
  • treatment
A
  • 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
21
Q

What are the most common viral STI’s?

A
  • HIV
  • Hepatitis
  • HPV
    • 6 & 11 cause warts and are most common
    • 16, 18, 3, 33… more severe and can cause cervical cancer
  • Herpes
22
Q

What would the presentation of molluscum contagiosum indicate?

A
  • 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
23
Q

What is the presentation of Herpes simplex type 1 &2?

  • symptoms
  • signs
A
  • 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
  • Signs
    • blistering & ulceration (+/- cervix/rectum)
    • painful inguinal lymphadenopathy
    • heals after 5-14 days
24
Q

Give two examples of non-sexually transmitted genital infections

A
  • Candida/thrush
    • fungal infection
  • Bacterial vaginosis
    • imbalance of vaginal flora –> overgrowth of anaerobes
    • due to overwashing/ bubble baths
25
Q

What are the symptoms and treatment for candida/thrush?

A
  • itching, discharge, swelling
  • papular rash in males
  • topical antifungals
26
Q

What are the symptoms and treatment for bacterial vaginosis?

A
  • discharge
  • “fishy” odour
  • responds to metronidazole
27
Q

What are the complications for Chlamydia/ gonorrhoea?

A
  • Pelvic Inflammotry Disease (PID)
  • Epididymitis,
  • Infertility
    • due to inflammation in the area
  • chronic pain,
  • seronegative arthritis +/- urethritis and conjunctivitis
    • for certain genotypes
28
Q

What are the complications of HPV/ Warts?

A
  • cervical cancer,
  • anal/vulval/penile intraepithelial neoplasia (AIN/VIN/PIN)
29
Q

What are the complications of bacterial vaginosis?

A
  • miscarriage,
  • early labour,
  • low-birth weight
30
Q

What are the complications of Trichomonal vaginalis?

A
  • miscarriage,
  • early labour,
  • low-birth weight
31
Q

What are the complications of Syphilis?

A
  • Dementia
  • Cardiac abnormalities

when they progress to tertiary infection

32
Q

What are the complications of Hepatitis B & C

A
  • Cirrohosis
  • Liver cancer

due to chronic inflammation

33
Q

What are the complications of HIV?

A
  • opportunistic infections,
  • lymphoma,
  • non-AIDS malignancies
34
Q

What is Sexual Health?

A

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

35
Q

frequency

What sexual difficulties do both men and women face when it comes to sex?

A
  • 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
36
Q

What sexual difficulties do women report about their experience of sex?

A
  • 55% lacked interest in sex
  • 29% unable to orgasm
  • 27% experienced pain during intercourse
  • 24% vaginal dryness
37
Q

What sexual difficulties do men report about their sexual experience?

A
  • 25% lacked interest in sex
  • 24% orgasmed too quickly
38
Q

What can low sexual function be related to?

A
  • greater age
  • depression
  • poor physical health
  • cardiovascular health
  • lower relationship satisfaction
  • inability to talk about sex with partners
39
Q

What is sexual coercion and what are the effects of on an individual?

  • occurrence
A
  • 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
40
Q

What are the sexual health concerns among young people?

A
  • avoiding unintended pregnancy
  • avoiding STIs
  • treating STIs to protect reproductive health
41
Q

What are the sexual health concerns in adulthood?

A
  • optimising reproductive health
  • optimising sexual satisfaction
42
Q

What are the sexual health concerns in older age?

A
  • optimising sexual function
  • limiting imapact of physical health on sexual health
    • CVD
43
Q

Give an overview of the epidemiology of sexual activity and the effect this has

A
  • 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
44
Q

What are two key sexual problems among men, how do they are with age?

A
  • anxiety
  • erectile problems
  • not only physical problems it is related to relationship satisfaction, and ability to talk about sex with partners
45
Q

What are two key sexual problems amongst women and how does this vary with age?

A
  • 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
46
Q

How are condoms used, how do people engage with condom use?

A
  • 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
47
Q

What is PEP and PrEP?

A
  • 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
48
Q

What is the purpose of sexual health screening?

A
  • collect data
  • raise awareness
  • treat people
  • notify partners

203: Theme 3 (6 decks)

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