STI week Flashcards
take a sexual history
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outline an approach to HIV pre-test counselling, including informed consent and confidentiality
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describe the clinical presentation of acute and chronic pelvic inflammatory disease and sexually transmissible infections
acute infection of the upper genital tract structures in women, involving any or all of the uterus, oviducts or ovaries - usually accompanised by involvement of the neighbouring pelvic organs
clinical features:
- lower abdominal pain is the cardinal presenting symptoms in women with PID
- associated features: recent onset of pain that worsens during coitus/jarring movement, onset of pain during shortly after menses; bilateral pain; abnormal uterine bleeding; non specific (new vaginal discharge, urethritis, proctitis, fever and chills)
RF: age under 25, multiple partners, no contraception
physical examination: abdominal exam, pelvic exam
diagnosis
- cervical motion tenderness in the presence of lower abdomina;/pelvic pain
- uterine or adnexal tenderness in the presence of lower adbominal/pelvic pain
- additional criteria: oral temp, abnormal cervical/vaginal discharge, abdundant WBC, increased ESR, CRP
- definitive diagnosis: histologic evidence on biopsy, imaging technique, laparoscopic
Investigations
- lab tests: pregnancy test, microscopic exam, complete blood count, Urinalysis, CRP, HIV, serologies, cultures
what are the symptoms of the chronic PID
- long term sequelae of acute/subacute infection and may folow post abortion or puerperal infection
pyosalpinx = chronic pus tube that forms as a result of blockage of the oviduct lumen - distension, adhesions,
hydrosalpinx = end result of burnt out pyogenic salpingitis which was of low virulence but highly irritating producing large quantities of clear excude eithin the closed protion of the oviduct
chronic pelvic cellulitis = usually occurs due to a sequelae of acute pelvic cellulitis and results in thickening and fibrosis of the CT of the parmetrium resulting in disotortion of uterus position
pain - side, back
develop skills in clinically assessing someone with acute abdominal pain
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what are the socio-cultural-behavioural that influences sexual health
sociocultural: paedophilia, peer pressure, increased risk taking behaviour, family influence, religion, sexual health edu, finances, access to contraception, confidential services
Behavioural: EtOH/other drugs, being organised, teenagers and younger adults
list some barriers to sexual health
education
access
financial
other
how to overcome some barriers to sexual health
- improve method characteristics and the distribution systems
- consumers must be convinced that these methods are convenient and easy
- train consumers to use methods correctly and over come some perceived negative characteristics of the methods
- change values about the perceived importance of method characteristics
- public health campaigns
what is contact tracing
identifying contact of the index case so that they can also be iven appropriate testing, counselling or treatment
confidential
objectives
- to interrupt the transmission of infection
- to identify people with an infection who may benefit from treatment and minimise the complications of infection
- to provide individual counselling to affect sustained behaviour change among infected people or people at high risk of infection, and
- more generally to identify and reach populations at particular risk of infection in order to influence community norms
describe the concept of boundary violations with the doctor patient relationship
any behaviour on the part of a physician or patient that transgresses that limits of the professional relationship. boundary violations have the potential to exploit or harm either the doctor or the patient
outline the range of violations and identify connections between some of these types of physician impairment
violations
- physical contact
- sexual relationships with patients
- treating family members
- self-prescribing and self-administering
- time and length of appoirtments
- allowing other economic transactions (bantering)
- language (eg over familiar)
- low or no fee
- accepting gifts/engaging in social contact
- self disclosure
describe the ethical legal, personal and professional issues associated specifically with sexual boundary violations and abuse within the doctor-patient relationship
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describe the basic pathophysiology underlying conditions causing acute lower abdominal pain, giving examples of a clinical condition for each category
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list differential diagnosis of acute lower abdominal pain (Consider differences which may occur with age and gender)
upper abdominal pain syndromes
–> biliary disease, acute pancreatitis, dyspepsia, hiatus hernia, pneumonia, MI, splenic abscess or infarction
Lower abdominal pain syndromes
–> appendicitis, diverticular disease, kidney stones, bladder distensions
Diffuse abdominal pain
–> mesenteric ischaemia and infarction, ruptured aneurysm, peritonitis, intestinal obstruction
Women
–> PID, adenexal pathology, endometriosis, ectopic pregnancy, endometriosis, leiomyomas
the acute abdominal
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what is the normal vaginal flora
normal vaginal flora contains a rich network of organisms, predominated by hydrogen peroxide producing lactobacillia
bacteria maintain a slightly acidic pH, making it inhispitable for pathogenic organisms - disruption of this flora by anaerobic bacterial leading to increased vaginal pH, leading to adverse health outcomes in both pregnant and non-pregnant women
absence of normal lactobacilli is a strong indicator of te pregence of sexually transmitted disease
Epithelial cells = barrier
antimicrobial peptides
immune cells
cytokines/chemokines
list and describe the characeristic of the flora of the female genital tract in health and disease
commensal
pathogenic viruses, bacteria, fungi/protozoan
bacterial vaginosis
- imbalance of normal flora of the female genital tract
pathophysiology: mixed flora replaced normal lactobacilli of vagina
clinical features
- predisposing factors = post menstrual post coital or IUD
- homogenous, thin, grayish which discharge that coat vaginal walls, vaginal pH >4.5, positive white amine test, clue cells
outline the principles of pharmacological and clinical aspects of treatment
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what is the pathogenesis of acquired immunodeficiency syndrome?
- immunosuppression results from severe loss of CD4+ T cells - 1-2 billion cells lost per day
Mechanisms of loss of T cells
- mainly through the direct cytopathic effects of the replicating virus, colonisation of lymphoid organs and may destroy them, chronic activation of uninfected T cells (–> apoptosis), loss of immature procursors of T cells, fusion of infected and uninfected cells
also other cells infected - macrophages and DC
