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Obs & Gynae > Sexual Health > Flashcards

Sexual Health Flashcards

(67 cards)

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1
Q

Who is most at risk of contracting STIs?

A

Yougn adults, multiple partners, pregnancy before age 20, previous STI, abnormal cervical cytology, sex workers

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2
Q

What is used for asymptomatic STI screening in people with vaginas?

A
  • Vulvo-vaginal swab + NAAT-> chlamydia + gonorrhoea

- Bloods-> syphilis + HIV

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3
Q

What is used for asymptomatic STI screening in people with penises (inc het males)?

A
  • 1st void urine sample-> chlamydia + gonorrhoea

- Bloods-> syphilis + HIV

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4
Q

What is used for asymptomatic STI screening in people with penises (inc MSM)?

A
  • 1st void urine + pharyngeal swab + rectal swab (chlamydia + gonorrhoea)
  • Bloods-> syphilis, HIV + Hep B
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5
Q

What is used for symptomatic STI screening in people with vaginas?

A
  • High vaginal swab (wet and dry slides)-> BV, TV and candida
  • Cervical swab + slide-> gonorrhoea
  • Urine dip
  • Bloods-> syphilis + HIV
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6
Q

What is used for symptomatic STI screening in people with penises (inc het males)?

A
  • Urethral swab + slide-> pus cells + gonorrhoea culture
  • 1st void urine
  • Urine dip
  • Bloods-> syphilis + HIV
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7
Q

What is used for symptomatic STI screening in people with penises (inc MSM)?

A
  • Urethral, pharynx and rectal swabs-> slides + culture plates
  • 1st pass urine sample
  • Blood test-> syphilis, HIV + Hep B
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8
Q

What organism causes chlamydia?

A

Chlamydia trachomatis (gram negative cocci)

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9
Q

How can chlamydia present in people with vaginas?

A

Asymptomatic (70%), increased discharge, cervicitis, period problems

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10
Q

How can chlamydia present in people with penises?

A

Asymptomatic (50%), dysuria, discharge, tingling, pain/swelling in testicles

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11
Q

Investigations for chlamydia?

A
  • Asymptomatic screens, urine PCR

- Endocervical or urethral swabs

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12
Q

Treatment options for chlamydia?

A
  • Azithromycin-> 1g single dose PO

- Doxycycline-> 100mg BD 7 days

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13
Q

Potential complications of chlamydia?

A
  • PID, infertility, ectopic risk
  • In pregnancy-> PROM, premature, low birth weight, neonatal conjunctivitis + pneumonia
  • Reiter’s syndrome-> more in men
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14
Q

What is Reiter’s syndrome?

A
  • Complication of chlamydia
  • Arthritis + urethritis + conjunctivitis
  • More common in men
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15
Q

What organism causes gonorrhoea?

A

Neisseria gonorrhoeae (gram-negative diplococcus)

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16
Q

How can gonorrhoea present in people with vaginas?

A

Asymptomatic (50%), green discharge, intermenstrual bleeding, symptoms often few days after intercourse

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17
Q

How can gonorrhoea present in people with penises?

A

Painful urination, asymptomatic (10%)

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18
Q

Investigations for gonorrhoea?

A
  • Endocervical +/- urethral swabs

- Rectal + pharyngeal swabs if symptoms

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19
Q

Treatment options for gonorrhoea?

A
  • Ceftriaxone-> 250mg IM single dose
  • Ciprofloxacin-> 500mg orally single dose
  • Cefixime-> 400mg oral single dose
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20
Q

Complications of gonorrhoea?

A
  • PID, Bartholin’s abscess, tubal infertility
  • Disseminated-> fever, rash, septic arthritis
  • Pregnancy-> PROM, prematurity, chorioamnionitis, opthalmia neonatorum etc
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21
Q

What organism causes syphilis?

A

Treponema pallidum (spirochete)

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22
Q

How might primary syphilis present?

A

Painless genital/cervical chancre + inguinal lymphademopathy-> 10-90 days after infection

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23
Q

How might secondary syphilis present?

A
  • Generalised polymorphic rash-> on palms + soles
  • Generalised lymphadenopathy
  • Genical condyloma lata
  • Anterior uveitis
  • Present within 2 years of infection
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24
Q

How might tertiary syphilis present?

A
  • Neuro-> dementia, tabes dorsalis
  • CV-> aortic root
  • Gummata-> inflammatory plaques/nodules throughout body
  • When infected for 2+ years
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25
Investigations for syphilis?
- VDRL cargon antigen test - Rapid plasma regain test - Smear from rpimary lesion - Fluorescent treponemal antibody absorption test (FTA-abs)
26
How is syphilis treated?
- Benzathine penicillin-> IM single dose) - Procaine penicillin G-> IM 10 days - Oral doxycycline or erythromycin
27
What are the complications of syphilis?
Tertiary, prematurity, stillbirths, congenital syphilis
28
What is the pathophysiology behind herpes simplex?
- HSV1 (oral) and HSV2 (genital) | - Reactivate in sacral ganglia when latent
29
How can genital herpes simplex present?
- Small vesicles then red open sores - Primary-> flu like, inguinal lymphadenopathy, vulvitis, pain, urinary retention - Recurrent-> usually less severe + triggered by stress, sex or menstruaton
30
Investigation of herpes simplex?
- Viral culture of vesicle fluid | - Antibody testing
31
Treatment of herpes simplex?
- Usually none + analgesia | - Aciclovir-> if within 5 days of symptom onset in primary
32
Complications of herpes simplex?
- Meningitis, disseminated infection, sacral radiculopathy | - Pregnancy-> vertical transmission
33
How might congenital herpes simplex infection present?
Disseminated disease in most, sometimes just mouth + eyes, during 1st 2 weeks of life
34
What is bacterial vaginosis?
Not an STI-> overgrowth of anaerobes that replace normal vaginal lactobacilli
35
What are the risk factors for developing bacterial vaginosis?
TOP, IUD, PID
36
How does bacterial vaginosis present?
Asymptomatic or profuse white/grey fishy discharge
37
Investigations for bacterial vaginosis?
- Whiff test-> add 10% potassium hydroxide and +ve if fishy smell - Microscopy-> clue cells - Vaginal pH-> <5.5
38
Treatment for bacterial vaginosis?
- Metronidazole for 5 days or single dose - Clindamycin cream for 7 days - May not need any if spontaneously resolves
39
Complications of bacterial vaginosis?
Increased risk of infection after surgery, miscarriage, PROM, prematurity
40
What is trichomonas vaginalis?
A flagellated protozoan causing infection via STI
41
How does trichomonas vaginalis present?
Asymptomatic (50%), frothy/green/smelly discharge, 'strawberry cervix' due to haemorrhages, itchy, sore, dysuria
42
Investigations for trichomonas vaginalis?
Wet smear + culture
43
Treatment for trichomonas vaginalis?
Metronidazole single dose or 5-7 days
44
Complications of trichomonas vaginalis?
Increased HIV transmission, prematurity, low birth weight
45
What causes genital warts?
Human papillomavirus (HPV) types 6 + 11
46
How do genital warts present?
Asymptomatic, warts on labia or clitoris, can be irritating, change to urine flow, often alongside other STIs
47
Investigations for genital warts?
Clinical but may do biopsy to exclude neoplasia
48
Treatment for genital warts?
- Podophyllin pain, podophyllotoxin solution, trichloroacetic acid - Liquid nitrogen cryotherapy - Excision or diathermy
49
How can genital warts be prevented?
HPV vaccine in all children aged 12-13
50
What types of HPV can be present on the cervix?
HPV types 16 + 18
51
Investigations for HPV?
- Often incidental finding - Cervical cytology (smears) - Colposcopy-> whitening when topical acetic acid applied
52
Complications of HPV infection?
- High grade CIN | - Cervical neoplasia-> especially when immunosuppressed or smoker (reduce viral clearance)
53
What is thrush?
Candidiasis from fungus (usually candida albicans)-> not an STI
54
What are the risk factors for thrush?
Antibiotic use, pregnancy, high dose COCP, diabetes, anaemia
55
Presentation of thrush?
- Thick curd-like white discharge - Itchy + sore, dysuria, superficial dyspareunia - Erythema + white plaques on vaginal wall
56
Investigations for thrush?
- High and/or low vaginal culture | - Wet slides-> spores + pseudohyphae on microscopy
57
Treatment for thrush?
- Only when symptoms - Clotrimazole pessary +/- topical cream - Fluconazole oral single dose
58
Who is at risk from complications due to thrush?
Immunocompromised patients
59
Who is at risk of contracting Hepatitis B and how is it prevented?
Sex workers, IVDUs, MSM, high risk areas-> get screening + vaccines if non-immune
60
How can HIV initially present (ie in acute HIV syndrome)?
Flu like illness, ulcers, swollen lymph nodes, diffuse rash-> for 1-2 weeks + 2-6 weeks after infection
61
How might early symptomatic HIV present?
- May be months/years after infection - Shingles - Recurrent oral/vaginal thrush - Oral hairky leukoplakia-> like thrush but can't scrape off - Molloscum contagiosum - Aseptic meningitis - Swollen lymph nodes
62
What are some of the late symptoms/complications of HIV?
Kaposi's sarcoma, pneumocystis pneumonia, AIDS
63
What complications can HIV cause in pregnancy?
Stillbirth, pre-eclampsia, IUGR, gestational diabetes
64
What does treatment of HIV before delivery depend on?
- Viral load - <50 doesn't need - <400-> should consider - >400-> should give - >1000-> give anti-retrovirals
65
What is given to babies at low risk of vertical HIV transmission?
Zidovudine (anti-retroviral)
66
What is given to babies at high risk of vertical HIV transmission?
Combination post-exposure prophylaxis
67
Do babies need HIV prevention treatment when mum is breastfeeding?
No-> formula feeds + support is fine

Obs & Gynae (5 decks)

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