Sexual Health Flashcards by Belle Storey

Commonest bacterial STD in the UK

Chlamydia

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1st line for uncomplicated chlamydia infection

Doxycycline 100mg twice a day for 7 days

Azithromycin removed as alternative 1st line due to mycoplasma genitalium resistance

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2nd line for chlamydia infection (if doxycycline is contraindicated e.g. pregnancy, breastfeeding, intolerance)

Azithromycin 1g OD for one day, then 500mg for 2 days
Erythromycin
Amoxicillin

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Clinical features of chlamydia

Asymptomatic in 70% women and 50% men
Women: cervicitis (discharge, bleeding), dysuria
Men: urethral discharge, dysuria

Discharge = yellow, odourless

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Complications of chlamydia

PID
Epididymitis
Ectopic pregnancy
Infertility
Reactive arthritis
Perihepatitis (Fitz-Hugh-Curtis syndrome)

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Investigation of choice for chlamydia

Nuclear acid amplification tests (NAATs) (first void urine sample, vulvovaginal swab or cervical swab)
*1st line for women: vulvovaginal
*1st line for men: first void urine sample (site of chlamydia = urethra)

Should be carried out 2 weeks after a possible exposure

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Chlamydia incubation period

7-21 days

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Syphilis (Treponema pallidum) incubation period

9-90 days

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Primary features of syphilis

Usually 3 weeks from infection
Chancre (painful ulcer at the site of sexual contact) lasting 2-6 weeks
Local non-tender lymphadenopathy
Often not seen in women (the lesion may be on the cervix)

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Secondary features of syphilis

Occur 6-10 weeks after primary infection

Systemic symptoms: fevers, lymphadenopathy, glomerulonephritis
Rash on trunk, palms and soles
Buccal ‘snail track’ ulcers (30%)
Condylomata Lara (painless, warty lesions on the genitalia)

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Tertiary features of syphilis

Gummas (granulomatous lesions of the skin and bones)
Ascending aortic aneurysms
General paralysis of the insane
Tabes dorsalis
Argyll-Robertson pupil
Ejection systolic murmur

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Features of congenital syphilis

Blunted upper incisor teeth (Hutchinson’s teeth), ‘mulberry’ molars
Rhagades (linear scars at the angle of the mouth)
Keratitis
Saber shins
Saddle nose
Deafness

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Syphilis investigations

Screening test: Treponemal-specific test e.g. TPHA
- specific but remains positive even after treatment

Cardiolipin / Non-treponemal tests e.g. RPR and VDRL
- non-specific enzymes produced in active infection
- becomes negative after treatment so can measure treatment effectiveness

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Syphilis 1st line treatment

Intramuscular benzathine penicillin

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Pregnancy-related complications of chlamydia

Preterm delivery
Premature rupture of membranes from chorioamnionitis
Low birth weight
Postpartum endometritis
Neonatal infection (conjunctivitis and pneumonia)

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Associated conditions of hypospadias

Cryptorchidism (absence of testicle)
Inguinal hernia

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Management of Hypospadias

Usually identified on NIPE

Corrective surgery typically performed when the child is around 12 months of age

Essential that the child is NOT circumcised prior to surgery as the foreskin may be used in the corrective procedure

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Major organism responsible for BV

Gardnerella vaginalis + other anaerobic organisms

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Amsel’s criteria for diagnosis of BV

atleast 3 of:

thin, white homogenous discharge

clue cells on microscopy: stippled vaginal epithelial cells

vaginal pH > 4.5

positive whiff test (addition of potassium hydroxide results in fishy odour)

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Symptomatic BV management

oral metronidazole for 5-7 days

in all patients inc. pregnancy

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Risk of BV in pregnancy

increased risk of preterm labour
low birth weight
chorioamnionitis
late miscarriage

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80% of vaginal candidiasis causal organism

Candida albicans

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Risk factors for vaginal candidiasis

diabetes mellitus
drugs: antibiotics, steroids
pregnancy
immunosuppression: HIV

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Features of thrush

Discharge = ‘cottage cheese’, non-offensive
vulvitis: superficial dyspareunia, dysuria
itch
vulval erythema, fissuring, satellite lesions may be seen
pH < 4.5

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investigations of vaginal thrush

clinical diagnosis *high vaginal swab not routinely required*

1st line treatment for non-pregnant women with vaginal thrush 1st line for pregnant women

1st line: **oral fluconazole** as a single dose 1st line for pregnant women (oral treatments are C/I): **clotrimazole intravaginal pessary** as a single dose

key further test in recurrent vaginal candidiasis

blood glucose to exclude diabetes

management of recurrent vaginal candidiasis

induction-maintenance regime induction: **oral fluconazole** every **3 days** maintenance: **oral fluconazole** weekly for **6 months**

features of Trichomonas vaginalis

**Discharge = offensive, yellow/green, frothy** vulvovaginitis strawberry cervix pH > 4.5 in men is usually asymptomatic but may cause urethritis

investigation of trichomoniasis

microscopy of a wet mount shows motile trophozoites

management of trichomoniasis

oral metronidazole for 5-7 days

balanitis definition

inflammation of the glans penis *sometimes extends to the underside of the foreskin which is known as balanoposthitis*

3 common causes of balanitis

Candidiasis Dermatitis (contact or allergic) Dermatitis (eczema or psoriasis)

investigation of choice in genital herpes

nucleic acid amplification tests (NAAT)

management of genital herpes

oral aciclovir general measures include: saline bathing analgesia topical anaesthetic agents e.g. lidocaine

types human papillomavirus HPV that cause genital warts

6 & 11

management of genital warts: multiple, non-keratinised warts

topical podophyllum

management of genital warts: solitary, keratinised

cryotherapy

incubation period of gonorrhoea

2-5 days

features of gonorrhoea

males: urethral discharge, dysuria females: cervicitis e.g. leading to vaginal discharge rectal and pharyngeal infection is usually asymptomatic **Discharge = purulent (thick, milky white)** green or yellow

2 complications of gonorrhoea

epididymitis Disseminated gonococcal infection (DGI) and gonococcal arthritis

first line treatment for gonorrhoea

Sensitivities NOT known = single dose of **IM ceftriaxone 1g** Sensitivities known (and the organism is sensitive to ciprofloxacin) = single dose of **oral ciprofloxacin 500mg**

Disseminated gonococcal infection triad

tendosynovitis migratory polyarthritis dermatitis

Diagnosis gonorrhoea

NAAT (endocervical, vulvovaginal, urethral, first void urine sample) = **infection present** Charcoal endocervical swab for **microscopy, culture + antibiotic sensitivities** *Microscopy = gram negative diplococci*

Neonatal complication gonorrhoea

Gonococcal conjunctivitis *(ophthalmia neonatorum)*

Differentiation between hypoactive sexual arousal disorder and female sexual arousal disorder and sexual aversion disorder

HSAD: no desire to initiate sex (hypoactive) but can become physiologically aroused FSAD: no desire to have sex and experiences vaginal dryness when initiated (female) SAD: disgusted by the idea of sex

2 causes of neonatal meningoencephalitis

Group B Strep Herpes virus

4 causes of **superficial** dysparaeunia

genital herpes lichen sclerosus thrush vaginismus

Causative bacteria of syphilis and type of bacterium

Treponema pallidum *Spirochaete bacterium*

Which Abx can be used for the treatment of gonorrhoea and chlamydia

Azithromycin

chlamydia trachomatis under microscopy

gram negative rod shape

4 risk factors ED

1. Vascular problems (obesity, DM, smoking) 2. Alcohol use 3. Drugs (SSRIS, beta blockers) 4. Increasing age

2 ED investigations

1. Lipid and fasting glucose serum levels (CVD risk) 2. Free testosterone between 9am and 11am

How late can the depo provera (medroxyprogesterone acetate) injection be given after last dose without need for extra precautions

14 weeks

Adverse effects of depo injection (4)

1. Irregular bleeding 2. Weight gain 3. Osteoporosis increased risk 4. Fertility may not return for up to 12 months

Chancroid

*Tropical sexually transmitted disease caused by Haemophilus ducreyi* Causes **painful genital ulcers** associated with **unilateral, painful inguinal lymph node enlargement** The ulcers typically have a sharped defined, ragged, undermined border *Treated with antibiotics - azithromycin, ceftriaxone, ciprofloxacin, erythromycin*

Lymphogranuloma venereum

Caused by chlamydia trachomatis

Risk factors lymphogranuloma venereum

Men who have sex with men HIV

Treatment lymphogranuloma venereum

Doxycycline

Testosterone therapy and contraceptive advice in a person assigned female at birth and with a uterus

Does not provide protection against pregnancy and if the person gets pregnant testerone therapy is **teratogenic** Oestrogen contraceptive regimes are not recommended as they can antagonise the effect of testosterone therapy - progesterone contraceptives can be used

Contraceptive advice for patients assigned male at birth using oestradiol, gonadotropin-releasing hormone analogs, finasteride or cyproterone acetate

There may be a reduction or cessation of sperm production but this is not reliable and **condoms should be recommended** when engaging in vaginal sex

Treatment for pubic lice

Permethrin

Sexual Health Flashcards

(62 cards)