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Module 203, Theme 3- Gynaecological pathology, common gynaecological disorders and sexual health > T2 L8 Sexually Transmitted Diseases > Flashcards

T2 L8 Sexually Transmitted Diseases Flashcards

1
Q

What group of people get STIs?

A

Young age (<20 years) - low age at 1st intercourse - coitarche

Frequent partner change, high no. lifetime partners, concurrency (simultaneous partners)

Sexual orientation (e.g. MSM)

Specific ethnic for some STIs

Use of non barrier contraception

Residence in inner city/ deprivation

History of previous STI

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2
Q

Why are younger people at an increased risk of getting STIs?

A

They are 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 contraception awareness
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3
Q

Why are young women more vulnerable to a HPV infection?

A

There is a larger SA of columnar epithelium in younger female which is what viruses like HPV likes to infect.

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4
Q

What is happening to the age of first intercourse in the UK?

A

The age of first intercourse is declining

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5
Q

Which sex has a higher % of STIs between the ages of 16-24?

A

Females

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6
Q

What % of men and women expressed regret regret for not waiting longer to have sexual intercourse?

A 
Men = 20%
Women = 42%
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7
Q

What vulnerabilities are associated with early intercourse?

A
  • Leaving home / not living with parents before 16 years
  • Leaving school early
  • Family disruption & disadvantage
  • Lack of nurturing relationships
  • Those whose main source of information on sex was not school / parents
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8
Q

Where do young people get their information on sex from?

A

School

Peers

Internet

Parents

Books

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9
Q

What % of teenagers view porn regularly?

A

58%

NOTE: 1:10 watch it every day

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10
Q

What is the average age of first seeing porn in boys and girls?

A

Boys: 10 years
Girls: 14 years

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11
Q

What the main reasons boys start to watch porn?

A

Learn about sex / how to give pleasure

Gain status in peer group

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12
Q

What are the effects of consuming a lot of porn on males?

A

More likely to have earlier sex

Certain sexual activities,

Less condom use

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13
Q

How many times are men more likely than women to access porn?

A

6 times more likely

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14
Q

What are female attitudes towards porn?

A

More likely to see as degrading

Many afraid to show concerns

Have mixed feelings about their partners using it

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15
Q

What are the negative aspects of porn usage?

A

-Unrealistic nature & expectations
-Self-image / performance anxiety
-Lack of censorship / boundaries – hardcore material becomes addictive / normalised
-Ethical issues e.g. exploitation of women
-Sexual consent blurred
-Lack of condom use = reduced risk perception /
perceived need to practice safe sex

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16
Q

What are the main messages that should be gotten across to young people about sex?

A
  • Don’t rush into it – avoid peer pressure
  • Use a condom with all new partners - continue until both screened
  • Sort out contraception
  • Avoid overlapping sexual relationships
  • Get screened for chlamydia/gonorrhoea when you have a new partner
  • MSM should have regular sexual health screens, including HIV, get vaccinated for hepatitis A/B and HPV & consider PrEP for HIV prevention
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17
Q

What % of men and women had concurrent partnerships within the last 5 years?

A 
Men = 14.6 %
Women = 9%

NOTE: Higher rates concurrence in the younger age range

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18
Q

What % of gonorrhoea diagnoses in men were among MSM?

A

Over 70%

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19
Q

What % of syphillis diagnoses were among MSM?

A

84%

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20
Q

How did the rate of syphillis compare to other STIs? How does its rate differ between men and women?

A

Rates of syphilis diagnoses were much lower than for other STI infections

Rates were ten times higher among men compared to women

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21
Q

Which ethnic group had the highest rate of STIs and which had the lowest rate?

A

The highest rates of STI diagnoses were reported in ‘Black or Black British’ & ‘Mixed’ ethnic groups.

The lowest rates were among those of ‘Asian or Asian British’ ethnic group.

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22
Q

Define “core group”

A
  • sub-group of the population – high turnover
  • not a static entity
  • highly sexually active individuals
  • high prevalence of infection
  • reservoirs of infection
  • high frequency of transmission
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23
Q

What is the effective control at the population level based on?

A

Targeting core groups

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24
Q

In terms of area, where was the rate of STIs the highest?

A

Highest among those living in the most deprived areas of England

NOTE: STI rates increased with increasing IMD (Index of Multiple Deprivation) quintile

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25
Q

What group of people have the highest rate of repeat gonorrhoea infections?

A

MSM

26
Q

What is the GMC guidance on carrying out a genital examination?

A

Offer a chaperone (this does not mean that you have to have a chaperone with you at all times)

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

27
Q

In what % of examinations are chaperones used?

A

> 5%

28
Q

What should be done when carrying out a female genital examination?

A
  • Inspect pubic area, labia majora & minora & perianal area
  • Inspect & palpate inguinal region
  • Leg rests - allow better visualisation
  • Speculum examination (use water as lubricant - gels can interfere with tests)
  • Bimanual examination (if indicated
29
Q

What should be done when carrying out a male genital examination?

A
  • Inspect pubic area, inguinal region
  • Inspect scrotum & perianal area
  • Palpate scrotal contents – note presence of testes, any lumps/ tenderness
  • Inspect penis - record whether circumcised - if not inspect under foreskin
  • Particular attention to coronal sulcus, frenulum & meatus
  • Note presence of urethral discharge
30
Q

If you see this on the male/female genitalia is it normal or abnormal?

  • Pearly penile papules/ vulva papules (a.k.a papillomatosis)
  • Fordyce spots
  • Genital enlarged sebaceous glands
  • Malignant melanoma
  • Tinea cruris
  • Pruritic papules
A
  • Pearly penile papules/ vulva papules (a.k.a papillomatosis) = NORMAL
  • Fordyce spots = NORMAL
  • Genital enlarged sebaceous glands = NORMAL
  • Malignant melanoma = ABNORMAL
  • Tinea cruris = ABNORMAL - indicates a dermatophyte (fungal) infection
  • Pruritic papules = ABNORMAL - indicates scabies
31
Q

Is scabies always sexually transmitted?

A

NO

32
Q

What are the characteristics of bacterial/protozoa STIs?

A

Chlamydia, gonorrhoea, syphilis, trichomonas

  • more often florid symptoms
  • early presentation
  • rapid diagnosis
  • effective treatment available
  • curative
  • reservoirs can be controlled
33
Q

What are the characteristics of viral STIs?

A

Herpes, warts, HIV, hepatitis

  • many unaware of infection
  • delayed presentation
  • diagnostic tests may be unreliable
  • symptomatic treatment only
  • often life-long
  • expanding reservoirs
34
Q

What symptoms does gonorrhoea & chlamydia commonly cause?

A
  • dysuria

- discharge

35
Q

What is the incubation period for gonorrhoea/chlamydia? When do most symptoms occur?

A

The incubation period = 2 to 30 days

Symptoms occur between 4–6 days (after being infected)

36
Q

When does primary syphilis occur?

A

1-3 weeks after contact (9-90 days)

37
Q

What are the physical characteristics of syphilis?

A

red mark => raised spot => ulcer at the site of contact

Enlarged lymph nodes in the groin/neck

Heals within 1-3 weeks (with or without treatment)

38
Q

TRUE OR FALSE

Lesions of primary syphilis lesions are very painful

A

FALSE

39
Q

When does secondary syphilis occur? How long does it last for?

A

2-6 weeks after 10 stage

Lasts for 2-4 weeks

40
Q

What are the signs/symptoms of secondary syphilis?

A

Systemic dissemination - millions spirochaetes spread through-out the body

Flu-like illness, headache, lymphadenopathy

Mouth ulcers - “snail track” painless

Condylomata lata - white/grey lumps in moist areas

Arthritis

NOTE: Particularly suspect if rash involves palms & soles

41
Q

How is syphilis treated?

A

Penicillin

Rapid resolution with effective treatment

42
Q

What is Trichomonas vaginalis?

A

Single cell protozoan parasite

Infects vagina & urethra

Causes trichomonas vaginalis

43
Q

What are the symptoms caused by Trichomonas vaginalis?

A

Dysuria

Discharge (causes frothy discharge, “strawberry cervix”)

44
Q

How is Trichomonas vaginalis diagnosed?

A

Diagnosed by seeing motile organisms on microscopy

45
Q

How is Trichomonas vaginalis treated?

A

Responds well to metronidazole

46
Q

What is the common cause of genital warts?

A

Extremely common, human papilloma virus (HPV)

Type 6 & 11 in 90%

Vs types 16 & 18, 31, 33 etc. (cervical cancer)

47
Q

TRUE OR FALSE

Increased cervical smears are recommended in patients with genital warts

A

FALSE

48
Q

What has happened to the number of diagnoses of anogenital warts since 2009? What could be the reason behind this?

A

It has declined

The decline can partly be attributed to the moderately protective effect of HPV 16/18 vaccination against anogenital warts in young women.

49
Q

What is Molluscum contagiosum?

A

A viral infection that affects the skin

50
Q

How can Molluscum contagiosum be treated?

A
  • Liquids, gels or creams that are applied directly to the skin
  • Minor procedures such as cryotherapy (where the spots are removed by freezing them)
51
Q

What are the symptoms for Herpes simplex?

A

painful ulceration, dysuria, vaginal discharge

systemic symptoms e.g. fever and myalgia (more common in primary stage)

52
Q

What are the signs for Herpes simplex?

A

blistering & ulceration (+/- cervix/rectum)

inguinal lymphadenopathy

53
Q

What proportion of people are aware they have genital herpes?

A

20%

54
Q

TRUE OR FALSE

Genital herpes is always type 2, cold sores are always type 1

A

FALSE

55
Q

Name the non-sexually transmitted infections and their characteristics

A

Candida / thrush

  • fungal
  • itching, discharge, swelling
  • papular rash in males
  • topical antifungals

Bacterial vaginosis

  • discharge / “fishy” odour
  • imbalance of vaginal flora
  • overgrowth of anaerobes
  • often result of over-washing / bubble baths etc.
  • responds to metronidazole
56
Q

What are the complications of chlamydia / gonorrhoea?

A
  • PID
  • Epididymitis
  • Infertility
  • Chronic pain
  • Reiter’s syndrome (urethritis, arthritis, conjunctivitis)
57
Q

What are the complications of HPV / warts?

A
  • Cervical cancer
  • AIN (acute interstitial nephritis)
  • VIN (vulvar intraepithelial neoplasia)
  • PIN (prostatic intraepithelial neoplasia)
58
Q

What are the complications of bacterial vaginosis?

A
  • Miscarriage
  • Early labour
  • Low-birth weight
59
Q

What are the complications of Trichomonas vaginalis?

A
  • Miscarriage
  • Early labour
  • Low-birth weight
60
Q

What are the complications of syphilis?

A

Dementia

Cardiac abnormalities

61
Q

What are the complications of hepatitis B, hepatitis C?

A

Cirrhosis

Liver cancer

62
Q

What are the complications of HIV?

A
  • Long term morbidity & mortality opportunistic infections
  • Tumours
  • Non-AIDS malignancies

Module 203, Theme 3- Gynaecological pathology, common gynaecological disorders and sexual health (8 decks)

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