Sexual health Flashcards
(159 cards)
1
Q
Name 3 STIs
A
Chlamydia
Genital warts
Gonorrhoea
Genital herpes
PID
Trichomonas vaginalis
Non-specific urethritis
Syphilis
HIV
Epididymorchitis
Hep B and C
2
Q
Name 3 non-STIs that are dealt with in sexual health
A
Candidiasis
Bacterial vaginosis
Genital dermatoses - lichen sclerosis, balanitis
Vulval condition - vulvodynia, vestibulitis
Psychosexual problems
Sexually acquired reactive arthritis
Sexual assault victims
3
Q
What should you ask about in a general sexual history?
A
HPC
Past GU history
Past general Medical/surgical history
Drugs (any antibiotics in last month)
Sexual history - last 3-12 months
- Last sexual intercourse
- Regular/casual partner
- Male/female
- Condom use
- Type of SI
4
Q
What should you ask in a sexual history specific to women?
A
Menstrual history
Pregnancy history
Contraception
Cervical cytology history
5
Q
What should you ask in a sexual history specific to men?
A
When last voided urine
6
Q
What is important in a sexual health examination?
A
Privacy
Dignity
Chaperone
Explanation
7
Q
What should you examine in both sexes in a sexual health examination?
A
Genital skin
Inguinal nodes
Pubic hair
8
Q
What should you examine in women in a sexual health examination?
A
Vulva
Perineum
Vagina
Cervix
Bimanual pelvic examination
Possibly anus and oropharynx
9
Q
What should you examine in men in a sexual health examination?
A
Penis
Scrotum
Urethral meatus
Anus and oropharynx in MSMs
10
Q
What asymptomatic screening is done for women?
A
Self-taken vulvo-vaginal swab for gonorrhoea/chlamydia NAAT
Bld for STS + HIV
11
Q
What asymptomatic screening is done for heterosexual men?
A
First void urine for chlamydia/gonorrhoea NAAT
Bld test for STS + HIV
12
Q
What asymptomatic screening is done for MSM?
A
First void urine for chlamydia/gonorrhoea NAAT
Pharyngeal swab for chlamydia/gonorrhoea NAAT
Rectal swab for chlamydia/gonorrhoea NAAT
Bld for STS, HIV, hep B (+ hep C if indicated)
13
Q
How might women present symptomatically with an STI?
A
Vaginal discharge
Vulval discomfort/soreness, itching or pain
Superficial dyspaerunia
Pelvic pain/deep dyspaerunia
Vulval lumps/ulcers
Intermenstrual bleeding
Post-coital bleeding
14
Q
How might men present symptomatically with an STI?
A
Pain/burning during micturition
Pain/discomfort in the urethra
Urethral discharge
Genital ulcers, sores, or blisters
Genital lumps
Rash on penis or genital area
Testicular pain/swelling
15
Q
What symptomatic screening is done for women?
A
Vulvo-vaginal swab for gonorrhoea + chlamydia NAAT
High vaginal swab (wet + dry slides) for
- Bacterial vaginosis
- Trichomonas vaginalis
- Candida
Cervical swab for slide + gonorrhoea culture
Dipstick urinalysis (if dysuria)
Bld for STS + HIV
16
Q
What symptomatic screening is done for heterosexual men?
A
Urethral swab for slide + gonorrhoea culture
First void urine for gonorrhoea + chlamydia NAAT
Dipstick urinalysis (if dysuria)
Bld for STS + HIV
17
Q
What symptomatic screening is done for MSM?
A
Test as for asymptomatic MSM
+ urethral and rectal slides
+ urethral, rectal, pharyngeal culture plates
18
Q
Who should be screened for hep B?
A
MSM
Commercial sex workers (CSW) and their sexual partners
IVDUs current/past and their sexual partners
People from high risk areas and their sexual partners - Africa, Asia, Eastern Europe
Aim to vaccinate if non-immune
19
Q
Why are partners treated?
A
Central activity in GUM
Necessary to prevent re-infection of index patient
To identify and treat asymptomatic infected individuals as a public health measure
Role of health advisers
Importance of confidentiality in maintaining patient trust
20
Q
How common are STIs?
A
Predominantly affect adolescent and young adult population, however anyone who is sexually active is at risk
STIs commonly occur in multiples - if you find one look for others
Asymptomatic infections common
Balance of individual patient treatment and public health function
21
Q
What is chronic pelvic pain?
A
Non-cyclical pain that persists for 6 or more months
Localised to pelvis or lower abdomen
Not occurring exclusively with sexual intercourse or periods
Not associated with pregnancy
May affect as much as 1 in 6 women
22
Q
What can cause chronic pelvic pain?
A
Not well understood
Often more than one cause of the pain is identified
Social, psychological and physical factors play a role
Sometimes no cause found
Endometriosis
Adenomyosis
Leiomyoma (fibroids)
Pelvic congestion syndrome
Pelvic inflammatory infection (PID)
Pelvic organ prolapse
IBS
Diverticular disease
Interstitial cystitis
Degenerative joint disease
Somatisation
Nerve entrapment
23
Q
What do you need to ask in a history about chronic pelvic pain?
A
Pain - SOCRATES
Urinary, bowel symptoms, MSK
Sexual history - deep dyspareunia, contraception, STIs
Menstruation history - frequency and character of periods, intermenstrual bleeding, pain
Vaginal discharge
Cervical smear history
Psychological and social issues (especially sexual abuse)
DH, SH, FH
24
Q
What examination should you do in a chronic pelvic pain examination?
A
General demeanour
Vital signs
Abdominal examination - distension, masses, tenderness, guarding, rebound
Vaginal speculum + bimanual examination
25
What does tenderness or pain on bimanual examination suggest?
Infective cause - PID or non-infective inflammatory cause - endometriosis
26
What does cervical motion tenderness suggest?
Ectopic pregnancy
Or PID
27
What does pain within anterior vaginal wall suggest?
Interstitial cystitis
28
What does a large uterus suggest?
Fibroids
29
What does a fixed mobile uterus suggest?
Adhesions
30
What investigations should you do for chronic pelvic pain?
Urinalysis + MSU
Pregnancy test
FBC, CRP, TFT, LFTs
High vaginal swab and endocervical swab
Transvaginal USS for adnexal masses
MRI useful for adenomyosis
Diagnostic laparoscopy
31
What is endometriosis?
Presence of endometrial-like tissue outside of the uterus
Induces a chronic inflammatory reaction
Usually found within pelvis, especially within pouch of Douglas and uterosacral ligaments behind to uterus
Rarely found in distant sits such as the umbilicus, abdominal scars, perineal scars, pleural cavity, and nasal mucosa
Responds to cyclical hormonal changes and bleeds during menstruation just like true endometrium
Associated with infertility
32
Who does endometriosis affect most?
Women between 25 and 35
Oestrogen-dependent, so rarely diagnosed after menopause
33
What are the symptoms of endometriosis?
Severe dysmenorrhoea
CPP
Deep dyspareunia
Pain during ovulation
Cyclical symptoms
Pain of defecation (dyschezia)
Infertility
34
What investigations can you do to diagnosed endometriosis?
TVS could identify gross endometriosis in ovaries
Diagnostic laparoscopy (gold standard)
35
What is the management of endometriosis?
Medical
- Simple analgesia - NSAIDs + tranexamic acid
- Ovulation suppression - tricyclic COCP, mirena coil, GnRH analogues
Surgical
- Conservative with laser or diathermy ablation of lesions
- Radical with hysterectomy and oophorectomy
36
What is adenomyosis?
Presence of endometrial tissue within the myometrium
Oestrogen-dependent so regresses after menopause
In it's most severe form, pools of blood can form within myometrium
37
Who does adenomyosis affect most?
Tends to affect older women who have had children
38
What are the symptoms of adenomyosis?
Painful and heavy menstruation
Cyclical pain
Uterus enlarged and mildly tender
39
What are the investigations of adenomyosis?
TSH and MRI
40
What is the management of adenomyosis?
Medical
- Simple analgesia - NSAIDs + tranexamic acid
- Ovulation suppression - tricyclic COCP, mirena coil, GnRH analogues
Surgical
- Conservative with laser or diathermy ablation of lesions
- Radical with hysterectomy and oophorectomy
41
What is a leiomyoma?
Fibroids
Benign smooth muscle tumours of myometrium
Oestrogen-dependent
Pedunculated, submucosal, intramural, subserosal
42
How common are leiomyomas?
Occurs in 30% women > 30
43
What are the symptoms of leiomyomas?
Asymptomatic
Menorrhagia
Urgency, frequency, retention
Pelvic pain
44
What investigations can you do for leiomyomas?
TVS
Hysteroscopy
Diagnostic laparoscopy
45
What is the management for leiomyomas?
NSAIDs +/- tranexamic acid
COCP/minerna coil
Myomectomy
Hysterectomy
46
What are the complications of leiomyomas?
Fibroid torsion
Subfertility
Miscarriage
Red degeneration during 1st and 2nd trimester (fever, pain, vomiting)
0.1% transform into leiomyosarcoma
47
What is pelvic congestion syndrome?
Incompetence of pelvic vein valves
Typically occurs after pregnancy
48
Who does pelvic congestion syndrome affect most?
Occurs in 1 in 5 women with varicose veins
49
What are the symptoms of pelvic congestion syndrome?
Constant dull ache in lower abdomen
Worse after standing/prolonged activities/prior to periods or during or after intercourse
Pressure from veins could irritate the bladder and cause interstitial cystits
50
What investigations are there for pelvic congestion syndrome?
Transvaginal duplex USS
MRI venogram
51
What is the management for pelvic congestion syndrome?
Analgesia
Non-invasive transcatheter vein embolization
52
What is PID?
Infection of upper genital tract (cervix, uterus, fallopian tubes)
Most commonly due to STI (chlamydia, gonorrhoea)
Rarely due to descending infection eg appendicitis
53
What can increase your risk of PID?
Young age
Multiple sexual partners
Not using barrier contraception
Surgical TOP
ICUD (especially inserted within last 20 days)
Previous STIs
54
What are the symptoms of PID?
Bilateral lower abdominal pain, could be chronic
Deep dyspareunia
Abnormal vaginal bleeding - postcoital, intermenstrual, menorrhagia
Vaginal/cervical discharge that is purulent
55
What are the signs of PID?
Lower abdominal tenderness
Mucopurulent cervical discharge
Cervical motion tenderness and adnexal tenderness on bimanual vaginal examination
Fever > 38
56
What investigations should you do in PID?
Bloods - FBC, CRP, ESR
HSV and endocervical swabs
Diagnostic laparoscopy - PID could lead to subfertility and ectopic pregnancy due to inflammation, scarring, and adhesion in the fallopian tubes
57
How can you manage PID?
Ceftriaxone 500mg as single IM dose, followed by doxycycline 100mg orally twice daily and metronidazole 400mg BD for 14 days
Could require admission for IV antibiotics if infection severe enough
IUCD removed
Contact tracing
58
What is a pelvic organ prolapse?
Vaginal wall/uterus protrude beyond the normal anatomical confines
59
What is a cystocele?
Anterior wall involvement prolapse
60
What is a rectocele?
Posterior wall involvement prolapse
61
What are the stages of prolapse?
0 - no prolapse
1 - more than 1cm above hymen
2 - within 1cm proximal or distal to plane of hymen
3 - more than 1cm below plane of hymen but protrudes no further than 2cm less than total length of vagina
4 - complete eversion of vagina
62
What can increase your risk of prolapse?
Menopause
Multiparity
Vaginal delivery (especially forceps/ventouse)
Obesity
Chronic cough
Pelvic surgery
63
What are the symptoms of prolapse?
Dragging sensation
Something coming down
Dyspareunia
Urgency, frequency, dysuria
Constipation
64
What investigations might you do in prolapse?
Speculum examination
65
What is the management of prolapse?
Pelvic floor exercises
Weight loss
Vaginal pessaries
Surgery - hysterectomy, repair of cystocele/rectocele, vaginal/bladder sarcospinous fixation
66
How do you manage chronic pelvic pain?
Identify pathology
Treatment directed towards dominant symptoms if pathology not identified
Analgesia +/- pain team referral
If history suggest non-gynaecological component of pain, referral to gastro/urology/genitourinary/physio/psychologist/psychosexual counsellor considered
67
Why is contraception important?
Control fertility and prevent unplanned pregnancy
Family spacing
Maintain continued reduction in teenage pregnancy
Reduce abortion rates
68
When does fertility return post-partum?
Fertility likely to return in 3 weeks after birth even when breast feeding and before menstruation resumes
69
When should contraception post-partum be started?
Provide timely access to contraceptive counselling and for method of contraception to be started before leaves birthing facility
70
Why is post-partum contraception important?
Short interpregnancy interval - less than 12 months increases risk of complications
- Preterm birth
- Low birth weight
- Stillbirth
- Neonatal death
Current WHO recommendation 24 month interpregnancy interval after childbirth
71
What contraceptive methods can be started any time after birth?
Implant
Injection
Mini pill
Male condoms
Female condoms
Natural family planning and lactational amenorrhoea
72
What contraceptive methods can be started 3 weeks after birth if not breast feeding or 6 weeks after birth if breast feeding or VTE risk?
Combined contraceptive
Patch
Ring
73
What contraceptive methods can be started 4 weeks after birth if not fitted in first 48 hours post delivery?
IUD
IUS
Diaphragm/cap from 6 weeks
74
When can female sterilisation be carried out?
Female 99% effective, either during elective c-section or 6 weeks after birth
75
What is the implant?
Nexplanon
68mg etonogestrel
Progesterone only
Single rod inserted into upper arm
76
How long does the implant last for?
3 years
77
How does the implant work?
Primary mode of action to suppress ovulation
Thickens cervical mucus to prevent sperm penetration and suppresses endometrium
78
What are the potential side effects of the implant?
Altered bleeding patterns - irregular, prolonged, infrequent, absent
Headaches
Breast tenderness
Mood swings
Weight changes
Loss of libido
Worsening or new onset acne
79
What is the injection?
Depo provera
Medoxyprogesterone acetate
Progesterone only
80
How often do you give the injection?
Administer at 12 week intervals
IM
S/C self administration at 13 weeks
81
How does the injection work?
Primary mode of action to suppress ovulation and thickens cervical mucus to prevent sperm penetration and suppresses endometrium
82
What are the potential S/E of the injection?
Altered bleeding (amenorrhoea, infrequent bleeding, spotting, prolonged bleeding)
Loss of bone density < 18 only use after consideration of other methods, review 2 yearly
Weight gain
Headache
Hair loss
Mood swings
Decreased libido
Possible small increased risk of breast cancer
Possible local raction
83
How does the mini pill work?
Thickens cervical mucus to prevent sperm penetration, suppression of endometrium, suppression of ovulation
84
What are the S/E of the mini pill?
Altered bleeding patterns (amenorrhoea, infrequent bleeding, spotting, prolonged bleeding)
Loss of libido
Slight increased risk of ovarian cysts
Possible small increased risk of breast cancer
85
How do male condoms fail?
Condom put on after genital contact
Condom not completely rolled onto penis
Condom slipped off when withdrawing penis or during sexual intercourse
Use of fat soluble lubricants
Leakage of sperm when penis withdrawn
Condom rupture
86
What is natural family planning?
Fertility awareness
Can be used to plan pregnancy as well as prevent
Need 3-12 months of cycles to predict fertile time
Commitment from both partners
Periods of abstinence
Predictor kits
87
What is LAM?
Based on postpartum infertility when woman amenorrhoeic if fully breast feeding on demand day and night and baby < 6/12
If hand/pump expressing increased failure rate to 5-6%
Once menses return (2 sequential days of bleeding/spotting) then no longer amenorrhoeic and LAM becomes less effective
Always have back up contraceptive plan
88
What is combined hormonal contraception?
Combination of ethinylestradiol and progesterone in 3 forms
- Oral pill (varying doses and hormones)
- Transdermal patch
- Vaginal ring
89
How do combined oral contraceptives work?
Primary action prevention of ovulation, also suppresses LH and FSH, changes cervical mucus, endometrium and tubal motility
90
What are the potential S/E of combined oral contraceptives?
Mood swings
Decreased libido
Headache/migraine
Small increased risk of breast and cervical cancers
Break through bleeding first 3-6 months
Increased in BP
Increased risk of VTE (dependent on progesterone type and dose)
Increased risk of MI and ischaemic stroke
91
What is the IUD?
Intrauterine device (copper coil)
92
How does the IUD work?
Causes foreign body reaction within uterus preventing implantation and sperm transport
93
How long does the IUD last for?
Long term (5-10 years), reliable and reversible
Effective immediately
Effective as emergency contraception
94
What are the potential S/E of the IUD?
May cause menstrual irregularities, spotting, IMB
Menorrhagia and dysmenorrhoea
Increased risk of PID first 20 days of insertion (screen for STIs)
Risk of ectopic pregnancy
Perforation at insertion
95
What is the IUS?
Intrauterine system (hormonal coil x3 - mirena, jaydess, kyleena)
Similar to IUD but contains progesterone levenorgesterel
96
What are the different types of IUS?
Mirena 52mgs (5 years), jaydess 13.5mg (3 years), kyleena 19.5mgs (5 years)
Mirena only also used for menorrhagia and progesterone HRT
97
How does the IUS work?
Causes endometrial atrophy, thickens cervical mucus and may suppress ovulation
98
What are the S/E of the IUS?
Acne
Breast tenderness/pain
Headache
Slight increased risk of ovarian cysts
Risk of ectopic pregnancy
Changes to menstruation, irregular, prolonged, or infrequent bleeding for 3-6 months after insertion
99
What is the diaphragm or cap?
Small dome that covers the cervix to prevent sperm penetration (barrier method)
Spermicide required with device
Requires correct fitting by medical staff
Must remain in position for 6 hours after intercourse (no longer than 30 hours
100
What is female sterilisation?
Clips on fallopian tubes to prevent fertilisation
Highly effective
Immediately effective (will need to continue to use effective contraception until after 1st period following sterilisation)
Permanent
No hormonal effects
Surgical procedure
General anaesthetic
Not easily reversible (not available on the NHS)
Associated complications
101
What drugs might the hormonal contraceptives interact with?
Enzyme inducers generally cannot be given with hormonal contraception
- Antiepileptics - carbamazepine, phenobarital, phenytoin, primidone and others
- Antibiotics - rifampicin
- Antiretrovirals
- St John's wort
102
What is FGM?
All procedures involving partial or total removal of female external genitalia or other injury to the female organs for non-medical reasons
Involves damaging and removing normal, healthy female genital tissue and hence interferes with the natural function of girls' and women's bodies
103
What is class I of FGM?
Clitoridectimy - partial or total removal of clitoris
104
What is class II of FGM?
Excision - partial or total removal of clitoris and labia minor with or without excision of labia majora
105
What is class III of FGM?
Infibulation - narrowing of vaginal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or majora with or without excision of the clitoris
106
What is class IV of FGM?
All other harmful procedures to female genitalia for non-medical purposes, including pricking, piercing, incising, scraping and cauterisation
107
Why is FGM carried out?
Status and respect
Preserves a girl's chastity/virginity
Part of being a woman
Rite of passage
Upholds family honour
Cleanses and purifies girl
Fulfils perceived religious requirement
Gives girl and family sense of belonging to community
Gives girl social acceptance, especially for marriage
108
How common is FGM globally?
Most prevalent in African and South East Asian countries
Estimated 100-140 million girls and women worldwide
3 million girls per year in Africa
109
How common is FGM in the UK?
Approx 60,000 girls aged 0-14 born in England to mothers who have undergone FGM
Approx 103,000 women aged 15-49 who have emigrated to England and Wales are living with FGM
FMG hotspots - London, Cardiff, Manchester, Sheffield, Northampton, Crawley, Birmingham, Oxford, Reading, Slough, Milton Keynes
110
What is the law around FGM in the UK?
Offence to perform FGM in England, Wales and Northern Ireland
Offence to assist in carrying out of FGM
Offence to assist a non-UK person to carry out FGM outside the UK on a UK national or permanent UK resident
Under children act 1989 local authorities can apply to the courts for various orders to prevent a child being taken abroad for mutilation
111
When must you report FGM and where?
Mandatory to record in patients health records if they have a FGM
Mandatory to report any type of FGM in under 18s
- Discovered during professional work/disclosed by patient
- Police force in area girl resides
- Close of next working day
112
What are the potential gynaecological complications of FGM?
Dyspareunia
Sexual dysfunction with anorgasmia
Chronic pain
Keloid scar formation
Dysmenorrhoea
Urinary outflow obstruction/recurrent UTI
PTSD
Difficulty conceiving
113
What are the potential obstetric complications of FGM?
Fear of childbirth
Increased likelihood of c-section
Increased likelihood of PPH
Increased likelihood of episiotomy
Increased likelihood of severe vaginal lacerations (including fistula formation)
Extended hospital stay
Difficulty performing vaginal examinations in labour
Difficulty in applying foetal scalp electrodes
Difficulty in performing foetal blood sampling
Difficulty catheterising of the bladder
114
When should you reverse infibulation?
Ideally preconception
Antenatal period around 16-21 weeks
- 16 weeks unlikely to cause miscarriage or problems with baby
- 21 weeks anaesthetic may cause labour
If after 21 weeks during labour
115
Name 3 common paediatric gynaecological problems
Amenorrhoea
Precocious puberty
Delayed puberty
Menstrual disorders
116
When does normal menarche occur?
Age 12-13 (11-14.5 in 95%)
117
What is menarche preceded by?
Preceded by development secondary characteristics and peak height velocity
118
What might happen after menarche?
Initial cycles usually anovulatory - pain free and often long gaps between
119
What is the definition of primary amenorrhoea?
No menses by age 16 in presence of secondary sexual characteristics (hypothalamic, pituitary, ovarian - Turners, POF, Swyer syndrome, anatomical, enzyme/receptor-CAH, CAI)
120
What is the definition of secondary amenorrhoea?
Cessation after onset of menses (weight loss, excessive exercise, PCOS)
121
What is oligomenorrhoea?
Menses more than 35 days apart
122
What is precocious puberty?
Appearance of physical and hormonal signs of pubertal development earlier than is considered normal
Puberty before 8 in girls, 9 in boys
123
What can cause precocious puberty?
Central
- Gonadotropin-dependent maturation of entire HPG axis
- CNS abnormalities - trauma, tumours, hydrocephalus
Pseudopuberty
- Gonadotropin independent
- CAH, tumours of adrenals, ovaries, Mc-Cune Albright syndrome
124
What is common with delayed puberty?
Runs in families
125
What investigations should you do for delayed puberty?
Baseline (FBC, CRP, U&Es, LFT to exclude anaemia, IBD, renal and liver disease), bone profile, alk phosp, coeliac, TSH, free T4
126
What antibiotics can you give before NAAT?
1g azithromycin PO STAT
127
How is chlamydia treated?
D before A and 71 dicks
1st line doxycycline 7/7 CI pregnancy
Azithromycin 1g PO single dose
128
What complications of chlamydia in pregnancy can there be?
Chorioamnionitis -> prelabour ROM
Vaginal delivery - neonatal conjuntivitis/pneumonia
129
What does chlamydia look like on microscopy?
Gram negative rod
130
How is gonorrhoea treated?
In the group Chat
Ceftriaxone/cefixime - single dose
131
What does gonorrhoea look like on microscopy?
Gram negative diplococci
132
What organism causes syphilis?
Treponema Pallidum
133
How is syphilis treated?
On the Penis Dome
Procain penicillin 10/7
If penicillin allergic - doxycycline 2/52 or 4/52 if allergy
134
How is BV treated?
Smells like Mega Cod
Metronidzole/Clindamycin
135
How is trichomoniasis treated?
Metronidazole BD 5-7/7
136
What are the symptoms of trichomoniasis?
Frothy, green discharge, pruritis, vaginitis, PCB
Small punctuate haemorrhages on speculum - strawberry cervix
137
How is thrush treated?
Fluconazole/canestan
138
What is thrush?
Candidiasis
139
What are the symptoms of thrush?
Itching
Dyspareunia
Cottage-cheese discharge
140
What is lichen sclerosis?
Chronic inflammatory skin condition
Usually in post-menopausal women
141
What are the symptoms of lichen sclerosis?
White lesions affecting vulva and perianal areas
Perineum sparing - hour glass/figure of 8
Itching worse at night
Time -> atrophy -> dysuria and dyspareunia
Skin may crack/bleed
142
What is the risk of lichen sclerosis?
Vulval cancer
143
What are the 6P's of lichen planus?
Planar - flat topped
Purple
Polygonal
Pruritic
Papules
Plaques
144
What are the symptoms of lichen sclerosis?
Itching
Change in discharge
Pain
Vulval erosions
Other areas of body affected eg skin/mouth
145
Name 2 organisms that can cause BV
Gardnerella vaginalis
Prevotella spp
Mycoplasma hominis
Mobiluncus spp
146
What can increase your risk of getting BV?
Sexual activity (but not always)
Smoking
Douching
Bubble baths
New sexual partner
Other STI
147
What can protect you from getting BV?
COCP
Condoms
Circumcised partner
148
How does BV present?
50% ASx
Offensive fishy discharge
No soreness/irritation -> thrush
O/E thin white discharge covering vaginal wall
149
What is the diagnosis for BV?
Amsel's criteria
Homogenous discharge
Microscopy - vaginal epithelial cells coated with many bacilli
pH > 4.5
Fishy odour on adding 10% KHO to fluid
150
What is the management of BV?
Advice on RF
ASx - none unless pregnanct
Sx or pregnant - Abx
151
What can BV increase your risk of?
Acquiring and transmitting HIV and/or other STIs
152
What are the risks of BV in pregnancy?
Pre-term delivery
PROM
PP endometritis
153
How long needs to have elapsed for syphilis to be diagnosed accurately?
3/12
154
What are the symptoms of primary syphilis?
Chancre
3/52 after infection
Lasts for 2-6/52
155
What are the symptoms of secondary syphilis?
Widespread rash - classically including palms and soles
Neural Sx - headaches
Glomerulonephritis
Lymphadenopathy
Flu-like
6-8/52
156
What systems are affected in tertiary syphilis?
Cardiovascular
Neuro
Visual
157
What is the cardiac symptom of tertiary syphilis?
Ejection systolic murmur
158
What are the neuro symptoms of tertiary syphilis?
Meningitis
Ataxia
Dementia
Strokes
159
What are the symptoms of congenital syphilis?
LOTS
-Lymphadenopathy
-Hepatosplenomegaly
-Rash
-Skeletal malformations
