Sexual and reproductive health

Question 1

What are the investigations and management for herpes?

Answer 1

PCR testing - swab of liquid, also test for syphilis.
Management - Explanation of diagnosis and Aciclovir and saline bathes

Question 2

What are the features of genital herpes?

Answer 2

Painful genital ulcers which may be associated with dysuria and pruritis.
Primary infection may present with systemic features eg, headaches, fever, malaise.
Tender inguinal lymphadenopathy,
Urinary retention may occur due to severe dysuria.

Question 3

Describe features of PEP

Answer 3

28 day course of Truvada and Raltegravir.
Final HIV testing 45 days after completing PEP.

Question 4

Describe features of PrEP

Answer 4

Taken before sex or every day - Truvada.
May get a bit of nausea, headaches and affect renal function but generally well tolerated.

Question 5

What is the diagnosis and management of genital warts?

Answer 5

Diagnosis is clinical.
Podophyllotoxin (caution in pregnancy),
Imiquimod - better for carpet warts.
Cryotherapy -solitary, keratinised warts
Multiple, non keratinised warts respond better to topical treatments.

Question 6

What are the common wart causing viruses?

Answer 6

HPV 6 and 11 are the most common

Question 7

Describe features of BV

Answer 7

Most common cause of abnormal discharge. Often described as fishy. Generally no other symptoms.
Occurs due to reduction of healthy lactobacilli,

Question 8

What is the diagnostic criteria for BV?

Answer 8

Amsel’s criteria. Patient needs 3 of the following:
Thin, white homogenous discharge.
Clue cells on microscopy.
Vaginal pH > 4.5.
Positive whiff test

Question 9

What is the management of BV

Answer 9

Asymptomatic is usually untreated.
If symptomatic then give oral metronidazole for 5-7 days.

If pregnant and asymptomatic then discuss with obstetrician as it is associated with preterm labour, low birth weight. If symptomatic then give Metronidazole for 5-7 days.

Question 10

Chlamydia

Answer 10

Women:cervicitis (bleeding & discharge), dysuria.
Men: Urethral discharge and dysuria.
Ix: NAAT from first catch urine (men) or vulvovagial swab (women). 2 week indow period.
Treatment: Doxycycline 100mg BD for 7 days. If pregnant then use azithromycin or erythromycin.

Question 11

Gonorrhoea

Answer 11

Presentation - Men: Urethral discharge, dysuria. Women: cervicitis (discharge).
Ix: NAAT from urine/swab.
Rx: 1mg IM ceftriaxone. If refued then oral cefixime and oral azithromycin

Question 12

Trichomonas

Answer 12

Presentation: profuse, malodorous, frothy discharge, superficial dyspareunia, vulval irritation. Strawberry cervix. pH > 4.5.
Increased risk of preterm labour
Ix: Microscopy shows motile trophozoites.
Rx: Oral metronidazole for 5-7 days

Question 13

Symptoms and signs of candida

Answer 13

Symptoms - Itch, pain, discharge, dyspareunia
Signs - Swellings, fissues, discharge, vulvovaginitis

Question 14

Explain the diagnosis and management of thrush

Answer 14

Diagnosis - History and clinical exam, pH < 5 and microscopy.
Management:
Uncomplicated: clotrimazole 500mg pessary or fluconazole 150mg (avoid in pregnancy/breast feeding).
Complicated is if its severe, immunocompromised or diabetic.

Question 15

Features of primary syphilis

Answer 15

Chancre - painless lesion at site of sexual contact.
Local non-tender lymphadenopathy.

Question 16

What are the contraceptive needs?

Answer 16

21 days after childbirth,
5 days after an abortion/miscarriage/ectopic.
Until 45-50 and amenorrhoea for 2 years of 50+ and amenorrhoea for 1 year or until 55+.

Question 17

Describe features of secondary syphilis

Answer 17

Occurs 6-10 weeks after primary infection.
Systemic symptoms: Fever and lymphadenopathy.
Rash on trunk, palms and soles,
Buccal snail track ulcers.
Condylomata lata (warty lesion on genitalia)

Question 18

Describe features of tertiary syphilis

Answer 18

Gummas (granulomatous lesions of skin and bones).
Ascending aortic aneurysms,
General paralysis of the insane,
Tabes dorsalis

Question 19

What are the investigations for syphilis?

Answer 19

Serology (blood sample) - Non-treponemal tests(risk of false positive) and treponemal specific tests.
Dark field microscopy

Question 20

What can cause a false positive non-treponemal test?

Answer 20

Pregnancy,
SLE,
Antiphospholipid syndrome,
TB,
Leprosy,
Malaria,
HIV

Question 21

What is the management of syphilis?

Answer 21

IM Benzathine penicillin.
Monitor response by measuring nontreponemal tests (RPR or VDRL), 4 fold decline is considered adequate response.
Complication: Jarish-Herzheimer reaction - fever, rash and tachycardia after first dose of abx.