Week 1 Lectures Flashcards
What does the symptom review involve in a sexual history?
Female- unusual vaginal discharge, vulval skin problems, lower abdo pain, deep dyspareunia, dysuria, unusual vaginal bleeding, post coital bleeding, intermenstrual bleeding
Male: urethral discharge, dysuria, genital skin problems, testicular discomfort or swelling, peri anal/anal symptoms
What should you ask about their last sexual contact?
Gender
Type of sexual contact
Condom/barrier use
Relationship with the partner, duration of relationship and whether partner can be contacted
Time interval since LSC
Symptoms or risk factors for blood borne viruses in partner including known or suspected STIs, injecting drug use, previous homosexual sex,
What does the female genital examination involve?
Inguinal and femoral lymph nodes
Inspection of the vulva and perianal area
Speculum examination of vagina and cervix
Bimanual examination if clinically indicated
What does the Male genital examination?
Inguinal and femoral lymph nodes
Scrotum- skin, testes, epididymi, penile shaft, glans and prepuce, meatus
What investigations would you carry out for asymptomatic woman suspected of having an STI?
Self taken vulvovaginal swab- GC and CT dual NAATS
Bloods- HIV and syphilis +/- Hep B and C
Urinalysis/ pregnancy test as appropriate
What investigations would you carry out in an asymptomatic Male suspected of having an STI?
First pass urine- GC and CT dual NAATS test
Rectal and pharyngeal swabs in MSM
Bloods HIV and syphilis +/- Hep B and C
What investigations would you do in symptomatic woman you suspect of having an STI?
Do the same as asymptomatic +
High vaginal swab for microscopy and pH testing for trichomomas vaginalis, bacterial vaginosis and candid ICA
Depending on history and examination, may also do…
. Pharyngeal and rectal swabs for GC and CT NAATS, culture
. Dark ground microscopy (primary syphilis)
. Herpes simplex virus PCR
. Urinalysis
. Pregnancy test
How do you investigate asymptomatic Male you suspect of having a STI?
Same as asymptomatic + Urethral smear- GC/NGU (microscopy) . Rectal and pharyngeal swabs in MSM . Dark ground microscopy (primary syphilis) . Herpes simplex virus PCR . Urinalysis
What is meant by puerperium?
Time from delivery until the anatomical and physiologic changes of pregnancy have resolved
It approximately resolves within 6 weeks
What are the physiologic changes in puerperium.
1) lochia and uterine involution
2- lactation
3- menstruation and resumption of ovulation
The first physiological change is lochia is and uterine involution, what does this involve?
Lochia…
This is the normal discharge after delivery
Discharge will be bloody for the 1st day
Sero sanguinous for up to 7-10 days
Clear for 6 weeks
Uterine involution
At umbilicus after delivery
Becomes a pelvic organ by 10 days
Os is closed by 3 weeks
The second physiological change in puerperium is lactation, what does this involve?
Oestrogen stimulates duct growth while progesterone stimulates alveolar growth.
Placental lactose affects growth of epithelium in the alveoli
Initiation of lactation is dependent on fall in oestrogen which stimulates release of prolactin from hypothalamus
Milk ejection needs oxytocin from posterior pituitary
What is initially produced post pregnancy?
Colostrum is produced for the first 3 days
