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Obs and Gynae > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

Define dysuria and dyspareunia

A

Dysuria - painful/burning on peeing

Dyspareunia - difficult or painful sexual intercourse

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2
Q

What is erectile dysfunction

A

Persistent inability to attain and or maintain and erection

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3
Q

Causes of erectile dysfunction

A

Vasculogenjc (CVD, HTN, HYPERLIPIDAEMIA, DM, SMOKING)
Neurogenic (MS, Parkinson, stroke, cKD, polyneuropathy)
Hormonal (hypogonadism causing low testosterone, hyperprolactinaemia , hyper / hypothyroidism , Cushings

Drugs - anti hypertensives (beta blockers, verapamil, clonidine), diuretics (spironolactone, thiazides), antidepressants, corticosteroids, ranitidine, marijuana, alcohol

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4
Q

Erectile dysfunction diagnosis

A

History

Morning total testosterone (highest in morning, so even if borderline normal in morning, it’s a problem)

If total serum testosterone borderline normal, tests free testosterone with FSH, LH and prolactin then refer to endocrinology for more tests

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5
Q

Erectile dysfunction management

A

Refer to urology if abnormality found on physical exam or if young patient

Refer to endocrinology if abnormal hormone levels

PDE 5 inhibitor (phosphodiesterase inhibitor) - sidenafil, tadalafil, vardenafil, avanafil - regardless of suspected cause unless they have a high cardiovascular risk

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6
Q

Possible causes of premature ejaculation

A

Prostatic is, thyroid disease or psychological distress

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7
Q

Premature ejaculation management

A

Psychosexual counselling
Topical anaesthetic
Dapoxetine (SSRI) as this causes delayed orgasms as a side effect - take 1-3 hrs before sexual activity

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8
Q

Causes of decreased libido

A

Low testosterone
Hypothyroidism
Anxiety/depression
SSRIs and SNRIs
Recreational drug use

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9
Q

What is anorgasmia

A

Persistent or recurrent delayed, infrequent or absent orgasms

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10
Q

Causes of anorgasmia

A

Neurological disorders, previous gynae surgery’s, medications (SSRIs or diuretics), alcohol or smoking, psychological problems

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11
Q

Management of anorgasmia

A

Treat underlying cause
Psychosexual counselling

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12
Q

Define Vaginismus

A

Involuntary contraction of vaginal musculature - can cause pain during vaginal penetration (gynae exam, tampon insertion or sexual intercourse)

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13
Q

Vaginismus causes

A

Psychological - prev sexual trauma

Vestibulodynia (tender at entrance of vagina) e.g. in post menopausal women due to oestrogen deficiency or due to previous genital surgery or skin disorders

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14
Q

Vaginismus presentation

A

Dyspareunia
Vagina, dryness
Inability to use tampons
Anorgasmia
History of previous trauma examination or sexual experience

May physically have signs of scarring or inflammation or entrance

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15
Q

Vaginismus management

A

Vaginal trainers
Psychosexual therapy
Topical lidocaine
Hormone replacement therapy for post hysterectomy, peri or post menopausal women
Pelvic floor exercises

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16
Q

Define atrophic vaginitis

A

Volvo vaginal atrophy, drying, inflammation secondary to declining oestrogen in peri or post menopausal women

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17
Q

Atrophic vaginitis presentation

A

Dyspareunia
Light bleeding following intercourse
Vaginal dryness/burning
Vaginal discharge
Pruritus vulvae - itchy vulva
Dysuria
Urinary urgency and incontinence
Polyuria
Recurrent UTIs

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18
Q

Atrophic vaginitis diagnosis and management

A

Pelvic examination
urinalysis to rule out UTI

Vaginal moisturisers
water based lubricants to use prior to sexual activity
Topical oestrogen - for menopausal atrophic vaginitis - used short term

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19
Q

Define oligozoospermia, asthenozoospermia and teratozoospermia

A

Oligozoospermia - low sperm count
Asthenozoospermia - reduced sperm motility
Teratozoospermia - high amount of abnormal shaped sperm

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20
Q

Define infertility

A

Failure to conceive after frequent unprotected sexual intercourse for at least one year

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21
Q

Causes of infertility

A

Sperm abnormalities
Ovulating disorders e.g. PCOS, premature menopause
Tubal damage from PID
Uterine or peritoneal disorders e,g, fibroids

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22
Q

Female infertility assessment

A

Serum mid-luteal phase progesterone - to confirm ovulation
Chlamydia testing for PID
Serum FSH and LH
Thyroid function tests
Serum prolactin

Hysterosalpinography (x ray that looks inside uterus and fallopian tubes to see if there is partial or full blockage) or ultrasonography

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23
Q

What to ask in history to check for female infertility

A

Length of time trying to conceive and sexual intercourse frequency
Menstrual cycle details
Galactorrhoea or hirsuitms
Thyroid dysfunction or diabetes

Symptoms for PID or endometriosis
History of STIs
Smoking and alcohol consumption

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24
Q

Male fertility assessment

A

Semen analysis - repeat if abnormal
Chlamydia testing

Imagining of urogenital tract
Testicular biopsy
Endocrine tests

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25
Q

Things to ask in history to test for male infertility

A

Length of trying to conceive and frequency of sexual intercourse
History of mumps (causes orchitis (inflammation of testes) is resulting in permanent damage for sperm production)
STIs
Testicular trauma or torsion
Prev abnormality or surgeries e.g. undescended testes
Erectile dysfunction

26
Q

What clinical findings on physical examination may you find in male infertility

A

Penile structure Abnormalities (hypospadias - opening of urethra on underside)
Scrotal examination - varicocle, hernia or undescended testes
Signs of hypogonadism (small tests, gynaecomastia, decreased body hair)

27
Q

Infertility management

A

Advice - regular intercourse every 2-3 days, take folic acid, smoking cessation and healthy body weight

Refer - medicine (clomifene for women who don’t ovulate), surgery, assisted conception (IVF or intrauterine insemination - IUI)

28
Q

What is chlamydia and how is it transmitted

A

Genital infection caused by BACTERIUM CHLAMYDIA TRACHOMATIS

Transmitted via contact with infection secretions / fluids

29
Q

Symptoms depending on where infection is and clinical signs of chlamydia and PID

A

urethral / cervical infection - Purulent vaginal discharge, dysuria, post coital / inter menstrual bleeding

Deep dyspareunia and pelvic pain if PID

Anorectal infection - Anorectal discomfort and discharge

Penile urethral - dysuria, urethral discharge and painful ejaculation

Clinical signs - inflamed friable cervix and discharge , testicular pain, swelling and tenderness

30
Q

Chlamydia management

A

Refer to GUM clinic
Begin treatment if symptoms strong without waiting for results

Doxycycline 100mg BD 7days
Avoid sexual intercourse until pt and their sexual partner have completed treatment
Screen for other STIs

31
Q

What is gonorrhoea, how is it transmitted

A

STI caused by bacterium NEISSERIA GONORRHOEAE

32
Q

Complications of gonorrhoea

A

Epidemic-orchitis
Prostatic is
Penile urethral structure
Male infertility
PID
Perihepatic abscess
Reactive arthritis

33
Q

Gonorrhoea symptoms and clinical signs - depending on where infection is - penile, anorectal, pharyngeal, cervical

A

Penil - discharge, dysuria and testicular pain or swelling
Anorectal - discharge, anal pain, rectal bleeding, tenesmus, pain on DRE
Pharyngeal - sore throat, asymptomatic - may have tonsillar exudate, erythema

Cervical - symptoms within first 10 days - abnormal vaginal discharge, inter menstrual bleeding, friable cervix, may have dyspareunia or lower abdominal pain (PID)

34
Q

Gonorrhoea diagnosis

A

Refer to GUM clinic
NAAT tests on swabs or for penile first catch urine , culture and density and screen for other STIs

35
Q

Gonorrhoea management

A

Refer to GUM clinic
Obtain culture then start antibiotics - ceftriaxone if culture pending or ciprofloxacin if sensitive on culture result)

Abstain from sex for 7 days until them and partner treated
Test if cured 1 week after treating

36
Q

Define HPV and how is it transmitted

A

Human papillomavirus- viral aetiology of warts
Transmitted via skin to skin contact or with genital secretions

37
Q

HPV symptoms

A

Skin growth of anogenital or oral regions (verruca (cauliflower like growth under 10mm) - may be irritation, itchy if bleeding

Wart is mostly raised, attached to skin and pigmented or skin coloured

38
Q

HPV diagnosis

A

Clinical diagnosis
Biopsy if atypical and screen for other STIs

39
Q

HPV management

A

Refer to sexual health
Use condoms and smoking cessation advice
Screen partner - they may not have transmitted it to pt as latency period is 3wks to 8 months

Cryotherapy, excision, electrocautery of warts
Podophyllotoxin solution, imiquimod cream, sinecatechins ointment - may taken 1-6 months for efficacy but if no response after 4-5 weeks change treatment

40
Q

What is HSV genital and how is it transmitted

A

Herpes simplex virus Genital infection caused by HSV1 or HSV2 through direct contact of mucosal surfaces or break in skin with infection secretions (HSV1 spreads orally or genitally but HSV2 only spreads via genital contact)

41
Q

Primary HSV infection presentation

A

Clustered painful erythematous vesicles
Fever
Malaise
Headache
Dysuria if breakout is in penile area
Tender inguinal lymphadenopathy
Vaginal /urethral discharge
Tingling in genital area

Lasts up to 3 weeks

42
Q

Recurrent HSV infection presentation

A

Clustered painful erythematous vesicle within same dermatology as primary outbreak
Burning up to 48 prior to vesicles appearing
Not as many systemic symptoms as primary infections (fever etc…)

Lasts 6-12 days

43
Q

Genital HSV diagnosis and advice and management

A

Swab lesions for HSV viral PCR
Avoid sex if lesions present and transmission possible with infected lesions e.g. on bed sheets and linen
After lesions gone, must use condoms as transmission can occur when asymptomatic

Refer to sexual health service
Oral antiviral (aciclovir or valciclovir) within 5 days of start of episode

If more than 6 recurring episodes in a year give daily aciclovir, valaciclovir or famciclovir to suppress for a year then increase dosage if symptoms come back

44
Q

What is trichomoniasis and how is it transmitted

A

STI caused by flagellated protozoan Trichomonas vaginalis
Transmitted only through sexual intercourse

45
Q

Trichomoniasis diagnosis

A

Vaginal swab pH testing - if higher than 4.5 suggestive
Gram staining via high vaginal swab

If urethral infection - first catch urine and culture / microscopy

46
Q

Trichomoniasis management

A

Oral metronidazole
Treat sexual partners of within 4 weeks before presentation
Screen for other STIs
Avoid sex until treatment of pt and partner completed

47
Q

What is syphilis and how is it transmitted

A

Infection caused by sporophyte bacterium TREPONEMA PALLIDUM

Transmitted via direct contact with infectious lesion, mother to child during pregnancy or by needle sharing

48
Q

Primary syphilis presentation

A

Chancre- painless ulcer develops at site of inoculation within 90 days of infection and resolves by itself after 3-10 weeks
Localised lymphadenopathy

49
Q

Secondary syphilis presentation

A

4-12 weeks after chancre symptoms appear

Non pruritic rash on palms and soles of feet
Condyloma Lara (moist grey white wart like lesions in areas of friction like vulva, breast or axillae)
Snail tract lesions - patchy oral mucosa lesions
Alopecia

50
Q

How does latent syphilis present

A

Asymptomatic in early and late latent syphilis

Tertiary syphilis - presents 10-30 yrs after initial infection - gummatous syphilis, cardiovascular syphilis or neuro syphilis

Gummatous syphilis- granulomatous lesi9ms with necrotic centre
Cardiovascular syphilis- aortic regurgitation, aortic aneurysm or heart failure
Neuro syphilis - paresthesia, absent reflex

51
Q

Syphilis diagnosis

A

Refer to GUM specialist
Treponemal tests (detects IgG and IgM for bacteria that causes syphilis)
Dark field microscopy or PCR swab of chancre

Lumbar puncture for CSF testing (for bacteria) if suspecting neuro syphilis

52
Q

Syphilis management

A

Screen other STIs and contact trace

Intramuscular benzathine benzylpenicillin

IV aqueous benzylpenicillin if neuro syphilis

53
Q

What is HIV and how is it transmitted

A

Human immunodeficiency virus - RNA retrovirus - infects and destroys CD4 T helper cells

Contact with bodily fluids - blood, semen, vaginal secretions, breast milk or amniotic fluid

54
Q

How is AIDs defined

A

CD4 count less than 200 cells / uL

55
Q

Acute HIV infection presentation (symptoms and clinical signs)

A

Fever, malaise, myalgias, sore throat, headache, night sweats, lymphadenopathy, rash, diarrhoea, mouth sores

Lymphadenopathy
Maculopapular rash
Aphthous ulcerations

56
Q

Chronic HIV presentation

A

Fever, weight loss, night sweats, lymphadenopathy, chronic diarrhoea
Recurrent treatment resistant infections - shingles, candidiasis, seborrheic dermatitis, skin infections

Opportunistic infections and malignancies (Kaposi’s sarcoma)

57
Q

AIDs defining illnesses

A

Candidiasis of lungs or oesophagus
TB
Kaposi’s sarcoma
HIV related lymphoma

58
Q

When to test for HIV

A

Consider testing if sever, recurrent symptoms and infections
Persistent lymphadenopathy
Conditions related to immunosuppression (candidiasis and shingles)
Glandular fever like illness
Unintended weight loss of over 10 kg
Risk factors for HIV

Diagnosed with STI
Pregnant

59
Q

HIV diagnosis

A

Depends on window period

Serum HIV RNA PCR - viral load - early detection but may show false negative if too early - for suspected acute HIV infection

HIV antibody and p24 antigen test - accurate after 4 weeks of infection

Rapid tests - finger prick or mouth swab - accurate 3 months after infection so may show false positives earlier as it’s looking for HIV antibodies - quick results in 5-10 mins

60
Q

HIV management and its side effects

A

Refer to GUM clinic if new diagnosis
Antiretroviral (ART) medications
Monitor serum CD4 count and HIV RNA PCR (viral load).- aim for undetectable viral load (less than 20 / uL)

Side effects if ART
- diarrhoea , fatigue, renal dysfunction, liver toxicity, glucose intolerance, hyperlipidaemia

Obs and Gynae (5 decks)

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