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Phase 3a Medicine > Womens Health - Sexual Health > Flashcards

Womens Health - Sexual Health Flashcards

1
Q

What is bacterial vaginosis?

A

overgrowth of predominately anaerobic organisms eg Gardnerella Vaginalis.

leads to consequent fall in lactic acid = produces aerobic lactobacilli = raised vaginal ph

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2
Q

is Bacterial vaginosis (BV) STI?

A

NO but almost only seen in sexually active women.

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3
Q

features of bacterial vaginosis

A

vaginal discharge : “fishy” offensive
asymptomatic in 50%

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4
Q

What is amsels criteria?
used for?

A

used for bacterial vaginosis

diagnosis of BV - you need 3 of the following 4 :

  • thin white homogenous discharge
  • clue cells on microscopy- stippled vaignal epithelial cells
  • vaginal ph > 4.5
  • positive whiff test - addition of potassium hydroxide = fishy odour
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5
Q

how would you manage a BV patient?

A

asx: no tx. do swab. exception is if woman undergoing pregnancy termination

if symptomatic :
ORAL METRONIDAZOLE FOR 5-7 DAYS.
70-70% initial cure rate. relapse rate> 50% within 3 months.

if adherence issue: single oral dose metronidazole 2g.

topical metronidazole/clindamycin alternative

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6
Q

what pregnancy complications can BV have ?

A

results in increased risk of preterm labour, low birth weight and chorioamnionitis, late miscarriage

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7
Q

How to treat BV in pregnant pt?

A

previously they said no oral metronidazole in 1st trimester. NOW YOU CAN :)

TOPICAL CLINDAMYCIN TOO?

if asx: discuss with woman obstretrician

if sx: oral metronidazole 5-7 days or topical tx.

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8
Q

difference between BV and Trichomonasis?

A

BV: thin white discharge
TRI: frothy, yellow-green discharge

BV: microscopy :clue cells
TRI: wet mount: motile trophozoites

TRI: vulvovaginitis, strawberry cervix

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9
Q

similarities of BV and Trichomonasis?

A

offensive vaginal discharge

vaginal ph over 4.5

treat with metronidazole

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10
Q

what is trichomonas vaginalis?

A

highly motile flagellated protozoan parasite.

STI

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11
Q

features of trichomonas vaginalis

A

vaginal discharge: offensive, yellow/green, frothy

vulvovaginitis

strawberry cervix

ph> 4.5

in men: usually asx - could cause urethritis

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12
Q

investigations for trichomonas vaginalis

A

microscopy of wet mount: motile trophozoites

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13
Q

how would you manage trichomonas vaginalis?

A

oral metronidazole for 5-7 days.

could do one-off dose of 2g metronidazole

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14
Q

What is Vaginal Candidiasis ? (THRUSH)

A

common women condition.

80% cases of candida albicans - rest other candida species

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15
Q

predisposing factors for vaginal candidiasis ?

A

DM
drugs: abx , steroids
pregnancy
immunosuppresion: HIV

can just happen with no predisposing factors though.

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16
Q

features of vaginal candidiasis?

A

(white curdy vaginal discharge) cottage cheese - non offensive discharge - ph < 4.5

vulvitis: superficial dyspareunia, dysuria

itch

vulval erythema, fissuring, satellite lesions possible?

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17
Q

investigations of vaginal candidiais?

A

high vaginal swab not normally needed if clinical features are consistent.

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18
Q

how would you manage vaginal candidasis?

A

local/oral tx

oral flulconazole 150 mg - single dose - 1ST LINE

clotrimazole 500 mg intravaginal pessary - single dose - if oral therapy contraindicated

if vulval sx: consider adding topical imidazole in addition to an oral or intravaginal antifungal

if pregnant: only local tx : cream/pessaries - oral tx contraindicated

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19
Q

how would you define recurrent vaginal candidiasis?

A

BASHHH define - 4 or more episodes per yr

check compliance with previous tx
rule out differentials: lichen schlerosis
do bloods check DM

do high vaginal swab for microscopy and culture - confirm candidiasis

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20
Q

how would you treat recurrent vaginal candidiasis?

A

induction : oral fluconazole every 3 days for 3 doses

maintenance: oral fluconazole weekly for 6 months

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21
Q

What is Balanitis?

A

inflammation of glans penis

sometimes extending to underside of foreskin = balanoposthitis.

many causes: most common are infective ( bacterial and candidal). some autoimmune.

presentation can be acute or chronic. adults or children

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22
Q

what can make balanitis worse?

A

improper washing under the foreskin

tight foreskin

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23
Q

if balanitis is caused by candidiasis tell me about it?

frequency

acute/chronic?

features?

children/adults

A

very common

acute

usually after intercourse and associated with itching and white non-urethral discharge

children and adults

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24
Q

if balanitis is caused by dermatitis ( contact or allergic) , tell me abit about it?

frequency
acute/chronic
features
children/adults

A

very common

acute

itchy
somtimes painful
occasionally non-urethral discharge.
no other body area affected

children and adults

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25
Q

if balanitis caused by dermatitis (eczema or psoriasis ) , tell me about it?

frequency
acute/chronic
features
children/adults

A

very common

both acute and chronic

very itchy
no discharge
medical hx of inflammatory skin condition with active areas elsewhere

children and adults

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26
Q

if balanitis is caused by bacterial , tell me about it

frequency
acute/chronic
features
children/adults

A

common
acute

painful
itchy with yellow non-urethral discharge
due to STAPHYLOCOCCUS SPP.

children and adults

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27
Q

if balanitis caused by anaerobic , tell me about it?

frequency
acute/chronic
features
children/adults

A

common
acute
chidlren and adults

itchy possibly
most associated with : very offensive yellow non-urethral discharge

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28
Q

if balanitis caused by lichen planus, tell me abit about it

frequency
acute/chronic
children/adult
features

A

uncommon
acute and chronic
more commonly adults

may be itchy
diagnostic feature: WICKHAM’S STRIAE AND VIOLACEOUS PAPULES

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29
Q

if balanitis caused by lichen sclerosus (balanitis xerotica obliterans) , tell me about it

frequency
children/adults
acute/chronic
features

A

rare
chronic

itchy, white plaques, can cause scarring

children and adults

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30
Q

if balanitis caused by plasma cell balanitis of zoon , tell me about it

features
frequency
acute/chronic
children/adults

A

rare
chronic
children and adults

not itchy
clearly circumscribed areas of inflammation

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31
Q

if balanitis is caused by circinate balanitis, tell me about it

features
frequency
acute/chronic
children/adults

A

uncommon
acute/chronic
adults

not itchy no discharge

painless erosions
can be associated with reactive arthritis

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32
Q

how would you investigate balanitis

A

clinically diagnosed - use hx and physical appearance of glans penis

if infective cause suspected: swab for microscopy and culture - might show bacteria or Candida Albicans

if doubt about cause and extensive skin change: do biopsy

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33
Q

general treatment of balanitis

A

gentle saline washes
ensure wash foreskin properly

severe irritation and discomfort: 1% hydrocortisone for short period

if cause isnt clear these usually resolve condition

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34
Q

specific treatment of balanitis

A

candida: topical clotrimazole - 2 weeks to tx infection

bacterial : staphylococcus spp. or group b streptococcus spp. - oral flucloxacillin or clarithromysin if penicillin allergic

anaerobic balanitis: saline wash. topical/oral metronidazole if not settling

dermaitits/circinate: mild potency topic corticosteroid - hydrocortisone

lichen sclerosis/plasma cell balantis of zoon: high potency steroids - clobetasol

circumcision - helps lichen sclerosus

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35
Q

what is chancroid?

A

tropical disease

caused by haemophilus ducreyi.

painful genital ulcers : unilateral, painful inguinal lymph node enlargement.

ulcers:
sharply defined
ragged undermined border

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36
Q

What is chalmydia?

A

MC STI in UK

caused by chlamydia trachomatis. - obligate intracellular pathogen.

1/10 young women in uk.

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37
Q

what is the incubation period of chlamydia?

A

7-21 days

large percentage are asx

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38
Q

features of chlamydia?

A

asx for 70% women and 50% of men

women: cervicitis (discharge, bleeding), dysuria

men: urethral discharge, dysuria

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39
Q

potential complications of chlamydia

A

epididymitis

endometritis

pelvic inflammatory disease

infertility

reactive arthritis

perihepatitis (fitz-hugh-curtis syndrome)

increase incidence of ectopic pregnancy

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40
Q

how would you investigate chlamydia?

A

nuclear acid amplification tests (NAATs)

urine( 1st void sample), vulvovaginal swab or cervical swab - tested using NAAT technique

women: vulvovaginal swab - 1st line
men : urine test - 1st line

chlamydia testing: should be done 2 weeks after possible exposure

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41
Q

screening for chlamydia?

A

open to all men and women : 15-24

relies heavily on opportunistic testing

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42
Q

how would you manage chlamydia?

A

1st line : doxycycline 7 days .

if contrainidicated:

azithromycin (1g od for one day, then 500mg od for 2 days)

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43
Q

why is first line doxycycline rather than azithromycin?

A

concerns about mycoplasma genitalium.

this infection coexists with chlamydia - rising levels of macrolide resistance.

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44
Q

how would you treat chlamydia in pregnant women?

A

azithromycin, erythromycin or amoxicillin.

azithro 1g stat - drug of choice.

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45
Q

who would you let know if the pt has chlamydia

A

they should be offered choice of provider for initial partner notification: trained practise nurse or referral to GUM

men with urethral sx: all contacts since, and in the 4 weeks prior to sx onset

women and asx men : all partners from last 6 months or most recent sexual partner

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46
Q

what should you do for contacts of confirmed chlaymydia cases ?

A

offer tx prior to results of ix being known.

treat then test

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47
Q

What is lymphogranuloma venereum?

A

LGV

caused by chlamydia trachomatis serovars L1,L2,L3

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48
Q

risk factors of lymphogranuloma venereum

A

gay men
majority of pts who present in developed countries have HIV already

historically seen more in tropics

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49
Q

hiv + proctitis =

A

lymphogranuloma venereum

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50
Q

3 stages of infection for lymphogranuloma venereum

A

stage 1 : small painless pustule - later forms an ulcer

stage 2 : painful inguinal lymphadenopathy - may form fistulating buboes

stage 3 : proctocolitis

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51
Q

how would you treat lymphogranuloma venereum?

A

doxycycline

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52
Q

what bacterium causes normal chlamydia which leads to pelvic inflammatory disease and urethritis?

A

chlamydia trachomatis serovars d - k

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53
Q

Tell me a little about syphilis

A

STI

spirochaete treponema pallidum.

infection characterised by :
primary
secondary
tertiary

incubation period : 9-90 days

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54
Q

tell me primary stages of syphilis - features

A

chancre - painless ulcer at site of sexual contact

local non-tender lymphadenopathy

often not seen in women - lesion may be on cervix

55
Q

tell me secondary stags of syphilis - features

A

systemic symptoms: fever, lymphadenopathy

rash on trunk, palms and soles

buccal “snail track” ulcers (30%)

condylomata lata (painless, warty lesions on genitalia)

56
Q

tell me tertiary features of syphilis

A

gummas - granulomatous lesions of skin and bones

ascending aortic aneurysms

general paralysis of the insane (confusion,memory loss, paralysis)

tabes dorsalis (spinal cord damage - unsteady walking,sharp pain, coordination loss)

argyll-robertson pupil

57
Q

what isthe argyll-robertson pupil?

A

pupil dont respond to light

still constrict when focusing on nearby object.

late stage syphillis

58
Q

tell me some features of congenital syphillis

A

saber shins
saddle nose
deafness
keratitis
rhagades - linear scars at angle of mouth

blunted upper incisor teeth - hutchinsons teeth, “mulberry molars”

59
Q

How would you investigate syphilis?

A

treponema pallidum sensitive organism - cant be grown on artificial media.

clinical features
serology
microscopic examination of infected tissue.

60
Q

tell me about the serological tests for syphilis investigation?

A

non-treponemal tests:
-not specific for syphilis , might result in false positive
- based on reactivity of serum from infected patients to a cardiolipin-cholesterol-lecithin antigen
- assess the quantity of antibodies being produced.
- becomes negative after treatment
eg: rapid plasma reagin (RPR) and Venereal Disease Research Laboratory (VDRL)

treponemal-specific tests:
- generally more complex and expensive but specific for syphillis
- qualititive only - reported as “reactive” or “non-reactive”
- eg include: TP-EIA (t. pallidum enzyme immunoassay), TPHA (t. pallidum Hemagglutination test)

the TP-EIA is more popular

61
Q

tell me some causes of false positive non-treponemal (Cardiolipin) test)

A

pregnancy

SLE, anti-phospholipid syndrome

TB

leprosy

malaria

HIV

62
Q

Interpreting syphilis results

A

positive non-treponemal test + positiv treponemal test : active syphilis infection

positive non-treponemal test + negative treponemal test : false-positive syphilis result eg: due to pregnancy or SLE

negaive non-treponemal test + positive treponemal test : successfully treated syphilis

62
Q

how would you manage syphilis?

A

intramuscular benzathine penicillin - 1st line
alternative : doxycycline

monitor nontreponemal titres (RPR or VDRL) after tx to assess response: should be fourfold decline 1:16 - 1:4. - adequate response.

63
Q

what is the jarisch-herxheimer reaction?

A

seen following syphilis treatment

fever , rash, tachycardia after 1st dose of abx

in contrast to anaphylaxis - no wheeze or hypotension

due to release of endotoxins following bacterial death and typically occurs within few hrs of tx.

no tx needed other than antipyretic if required

64
Q

what is genital herpes?

A

2 strains of HSV in humans: HSV-1 AND 2.

first ppl used to think 1 is oral lesions (cold sores) and 2 is genital herpes - but now its known to have considerable overlap

65
Q

features of genital herpes

A

painful genital ulceration - dysuria and pruritis

primary infection often more severe than recurrent episodes :systemic features like:
- headache
-fever
- malaise

tender inguinal lymphadenopathy

urinary retention possible

66
Q

how would you investigate for genital herpes?

A

NAAT - nucleic acid amplification test

HSV serology - if recurrent genital ulceration of unknown cause

67
Q

how would you manage genital herpes?

A

saline bathing
analgesia
topic anaesthetic agent: lidocaine

oral aciclovir : if frequent exacerbations - longer term aciclovir

68
Q

what would you do in pregnancy with genital herpes?

A

elective caesarean section at term - if primary attack occurs during pregnancy at greater than 28 weeks gestation.

if recurrent herpes pregnant : treat with supressive therapy. - be advised that risk of transmission to baby is low.

69
Q

what are genital warts? (condylomata accuminata)

A

caused by many varieties of human papillomavirus HPV - especially types 6 and 11.

70
Q

what does hpv predispose you to?

A

hpv 16,18,33 predisposes to cervical cancer.

71
Q

features of genital warts

A

small (2-5mm) fleshy protuberances which are slightly pigmented.

may itch/bleed

72
Q

how would you manage genital warts?

A

topical podophyllum or cryotherapy : 1st line

if multiple non-keratinised warts : topical agents

if solitary keratinised warts : cryotherapy

second line: imiquimod - topical cream

genetal warts usually resistant to tx. recurrent common.
in most anogenital infections with HPV clear without intervention in 1-2 yrs.

73
Q

what is gonorrhoea caused by?

A

gram-negative diplococcus Neisseria gonorrhoeae.

74
Q

where does acute infection of gonorrhoea occur?

A

genitourinary

rectum
pharynx

75
Q

incubation period of gonorrhoea?

A

2-5 days

76
Q

features of gonorrhoea

A

male: urethral discharge, dysuria

female: cervicitis eg : leading to vaginal discharge

rectal and pharyngeal infection: usually asx

77
Q

Microbiology of gonorrhoea

A

cant immunise for gonorrhoea

reinfection common due to : - antigen variation of type 4 pili (proteins which adhere to surfaces)
- opa proteins (surface proteins which bind to receptors on immune cells)

78
Q

local complications of gonorrhoea

A

urethral strictures - scarring narrowing the tube that releases urine

epididymitis - tube at back of testicles swollen and painful

salpingitis (might lead to infertility) - inflammation of fallopian tubes

disseminated infection

79
Q

what is disseminated gonococcal infection?

what is gonococcal arthritis?

A

DGI: not fully understood.
due to haematogenous spread from mucosal infection (eg asx genital infection).

classic triad:
- tenosynovitis
- migratory polyarthritis
- dermatitis

later comps:
- septic arthritis
-endocarditis
-perihepatitis (fits-hugh-curtis syndrome)

80
Q

how would you manage gonorrhoea?

A

ciprofloxacin used to be - NOW CEPHALOSPORINS bc 36% resistance in uk to ciprofloxacin

previous 1st line : im ceftriaxone + oral azithromycin.
new 1st line : single dose IM ceftriaxone 1g.

IF SENSATIVES ARE KNOWN: oral ciprofloxacin 500mg

if ceftriaxone refused (needle phobic) - oral cefixime 400mg single dose + oral azithromycin 2g single dose.

81
Q

what is hiv?

A

RNA retrovirus.

HIV-1 MC.

HIV-2 in west africa.

virus enters and destroys the cd4 t-helper cells of immune system.

initial seroconversion flu-like illness occurs within a few weeks of infection.
the infection is then asx until it progresses to immunodeficiency. - could be years after initial infection.

82
Q

tranmission of HIV

A

unprotected anal vaginal oral sex

mother to child at any stage of pregnancy , birth or breastfeeding (vertical transmission)

mucous membrane, blood or open wound exposure to infected blood or bodily fluids (sharing needles,needle-stick injuries or blood splashed in eye)

83
Q

what is aids-defining illnesses?

A

happens with end-stage hiv infection.

when cd4 count dropped to level allowing for opportunitistic infections and malignancies to appear.

eg:
- kaposi sarcoma
- TB
-Lymphoma
- Candidiasis - oesophageal or bronchial)
- cytomegalovirus infection
- pneumocystic jirovecii pneumonia (PCP)

84
Q

features of hiv seroconversion

A

occurs 3-12 weeks after infection

sore throat
lymphadenopathy
diarrhoea
mouth ulcers
rarely meningoencephalitis
maculopapular rash
malaise,myalgia, arthralgia

85
Q

how would you diagnose HIV?

A

HIV antibodies -
might not present in early infection - 99% by 3 months.
- screening : ELISA (enzyme linked immunosorbent Assay) and confirmatory west blot assay
most ppl develop antibodies to hiv at4-6 weeks but all do by 3 months.

p24 antigen - viral core protein appears earluy in blood as viral rna levels rise.
positive from 1 week to 3-4 weeks after infection with hiv.

combition tests : hiv p24 antigen and hiv antibody - standard for diagnosis for screening of hiv

  • if combined positive - repeat to confirm diagnosis
86
Q

when should you test for hiv in asx patients

A

4 weeks after possible exposure

87
Q

if a suspected hiv patient is asx and inital negative result, what to do?

A

repeat in 12 weeks

88
Q

where might a hiv rna test be useful? (qualititive or quantitive)

A

non used much in screening/testing

use for diagnosis of neonatal hiv infection and screening blood donors.

89
Q

what are the possible causes for diarrhoea in HIV?

A

could be due to the virus itself (HIV enteritis) or opportunistic infections

possible causes:
- cryptosporidium + other protozoa (MC)
- cytomehgalovirus
- mycobacterium avium intracellulare
- giardia

90
Q

what is the most common infective cause of diarrhoea in hiv patients?

A

cryptospoidium

intracellular protozoa.

incubation period: 7 days.

variable presentation.

modified ziehl-neelsen stain (acid-fast) - red cysts of cryptosporidium.

tx: difficult

91
Q

Tell me about mycobacterium avium intracellulare?

A

atypical mycobacteria

cd4 - below 50.

typical features:
- fever
- sweats
- abdo pain
- diarrhoea
- hepatomegaly
- deranged lfts.

diagnosis: blood cultures. bone marrow exam.

management:
- rifabutin
-ethambuton
-clarithromycin

92
Q

what is the renal involvement in hiv patients?

A

due to tx or virus.

protease inhibitor eg indinavir prepitate intratubular crystal obstruction.

93
Q

tell me the 5 key features of hiv associated nephropathy?

A

massive proteinuria = nephrotic syndrome because it causes collapsing focal segmental grolerulosclerosis

normal or large kidneys

elevated urea and creatinine

normotension

focal segmental glomerulosclerosis with focal or global capillary collapse on renal biopsy.

94
Q

what is the treatment for hiv associated nephropathy?

A

antiretroviral therapy.

95
Q

what opportunistic infections can occur due to hiv if the cd4 count is 200-500?

A

oral thrush - secondary to candida albicans
shingles- secondary to herpes zoster
hairy leukoplakia - secondary to EBV
kaposi sarcoma - secondary to HHV-8

96
Q

what opportunistic infections can happen if cd4 count is 100-200? HIV

A

cryptosporidiosis - its self limiting

cerebral toxoplasmosis

progressive multifocal leukoencephalopathy - secondary to JC virus

pneumocystis jirovecii pneumonia

HIV dementia

97
Q

tell me what opportunistic infections you can get if the cd4 count is 50-100 : hiv?

A

aspergillosis - secondary to aspergillus fumigatus

oesophageal candidiasis - secondary to candidia albicans

cyrptococcal meningitis

primary CNS lymphoma - secondary to EBV

98
Q

tell me about cd4 count under 50 ? - hiv

A

cytomegalovirus retinitis - affects 30-40% of pts with cd4 under 50

mycobacterium avium - intracellulare infection

99
Q

tell me a little about kaposi sarcoma - hiv complications

A

caused by HHV-8 - human herpes

presentation:
- purple papules or plaques on skin or mucosa - eg gi and resp tract.

skin lesions may later ulcerate

respiratory involvement might cause massive haemoptysis and pleural effusion

radiotherapy + resection.

100
Q

tell me about pneumocystis jiroveci pneumonia - HIV

A

use pneumocystis carinii pneumonia (PCP)

unicellular eukaryote , classified as fungus

PCP - MC opportunistic infection in aids

101
Q

which patients should recieve pneumocystis jiroveci pneumonia prophylaxis?

A

all pts with cd4 count under 200

102
Q

features of pneumocystic jiroveci pneumonia: hiv

A

dyspnoea
dry cough
fever
very few chest signs

103
Q

common complication of pcp

A

pneumothorax

104
Q

what are the extrapulmonary manifestations for pcp: hiv?

A

rare

hepatosplenomegaly
lymphadenopathy
choroid lesions

105
Q

how would you investigate for pcp? hiv?

A

CXR - bilateral interstitial pulmonary infiltrates - present with other xray findings: lobar consolidation. - could be normal

exercise induced desaturation

sputum fails to show PCP - bronchoalveolar lavage ( BAL) needed to demonstrate PCP - silver stain shows characteristic cysts

106
Q

how would you manage pcp? hiv?

A

co-trimoxazole

iv pentamidine in severe

aerosolized pentamidine - alternative - less effective with pneumothorax

steroids if hypoxic - po2<9.3 kpa - reduced risk of rep failure by 50% and death by 1/3.

107
Q

what is the most common cause of oesophagitis in patients with hiv?

A

oesophageal candidiasis

cd4 count less than 100.

sx:
dysphagia
odynophagia

tx:
fluconazole +
itraconazole = 1st lne

108
Q

how would you manage hiv?

A

antiretroviral therapy - (ART)

combo of at least 3 drugs

2 nucleoside reverse transcriptase inhibitors (NRTI)

and
either:
- protease inhibitor (PI)
- non-nucleoside reverse transcriptase inhibitor (NNRTI).

this combo decreases viral replication and reduces risk of viral resistance emerging.

109
Q

when to start ART?

A

as soon as diagnosed with HIV

110
Q

entry inhibitors

A

maraviroc( binds to CCR5, prevents interaction with gp41) , enfuvirtide (binds to gp41, fusion inhibitor)

prevent HIV-1 from entering and infecting immune cells

111
Q

give examples of nucleoside analgoue reverse transcriptase inhibitors (NRTI)

A

zidovudine
abacavir
emtricitabine
didanosine
lamivudine
stavudine
zalcitabine
tenofovir

112
Q

give me some ntri side effects:

A

peripheral neuropathy

tenofovir: renal impairement , osteoporosis

zidovudine: anaemia, myopathy, black nails

didanosine : pancreatitis

113
Q

give me some exmaples and side effects of non-nucleoside reverse transcriptase inhibitors (NNRTI)

A

nevirapine
efavirenz

side effects: p450 enzyme interaction (nevirapine induces) , rashes

114
Q

give me some examples of protease inhibitors

A

indinavir
nelfinavir
ritonavir
saquinavir

115
Q

side effects of protease inhibitors

A

DM
hyperlipidaemia
buffalo hump
central obesity
p450 enzyme inhibition

indinavir: renal stones, asx hyperbilirubinaemia

ritonavir: potent inhibitor of p450 system

116
Q

examples of integrase inhibitors and pathophy

A

raltegravir
elvitegravir
dolutegravir

block action of integrase - viral enzyme inserts viral genome into dna of host cell

117
Q

untreated gonorrhoea in pregnancy can lead to what comps?

tx?

A

premature rupture of membranes

preterm labor

neonatal infections - conjunctivity.

tx: ceftriazone

118
Q

trichomonas vaginalis in pregnancy?

A

preterm birth
low birth weight
premature rupture of membrane.

tx: metronidazole - after 1st trimester.

119
Q

tell me about hiv in pregnancy?

A

increasing number of hiv positive women giving birth in uk.

120
Q

factors which reduce vertical tranmission (from25-30% to 2%)

A

maternal antiretroviral therpay

mode of delivery (caesarean section)

neonatal antiretroviral therapy

infant feeding (bottle feeding)

121
Q

screening for hiv in pregnancy

A

offered to all pregnant women

122
Q

what mode of delivery is recommended in hiv pregnant women?

A

vaginal delivery if viral load less than 50 copies/ml at 36 weeks. otherwise caesarean

zidovudine infusion - 4hrs before beginning the caesarean section

123
Q

how infant feed if women has hiv

A

not breast fed

124
Q

tell me about neonatal antiretroviral therapy

A

zidovudine - orally to neonate if maternal viral load is under 50 copies/ml.

otherwise triple ART.

therapy continued for 4-6 weeks.

125
Q

what is erectile dysfunction?

A

persistent inability to attain and maintain erection to permit satisfactory sex performance.

symptom.

causes:
organic
psychogenic
mixed

126
Q

factors causing organic cause of ED

A

gradual onset of symptoms

lack of tumescense

normal libido

127
Q

factors favouring a psychogenic cause of ED

A

sudden onset of sx

decreased libido

major life events

problems or changes in relationship

previous psychological problems

hx of premature ejaculation

good quality spontaneous or self-stimulated erections

128
Q

risk factors of ed

A

increasing age

cv disease rf: obesity, dm, dysplipidaemia, metabolic syndrome, htn, smoking

alcohol use

drugs: SSRIs, beta blockers

129
Q

how to investigate ed?

A

all men have 10yr cv risk calculated: measure lipid and fasting glucose serum levels.

measure free testosterone : between 9 and 11am.
if low/borderline: repeat with follicle stimulating hormone - luteinizing hormone and prolactin levels.

130
Q

how would you manage ed?

A

PDE-5 inhibitor: sildenafil, viagria
- prescribed to all pts
- can be otc.

vaccum erection devices - 1st line - if not take pde-5 inhibitor.

131
Q

what would you do for a young man that has always had difficulty achieving erection

A

refer to urology.

132
Q

what to do if ed pt cycles more than 3 hours per week?

A

STOP

Phase 3a Medicine (16 decks)

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