Sexual health Flashcards

Question

Discuss scabies -Pathogen -Mode of infection -Presentation -Management (7)

Answer 1

1. Mite Sarcoptes scabiei 2. Close body contact 3. Presentation -Itch - worse at night -silver lines 5-15mm long indicating mite burrows -Excoritation -Skin scraping at burrows may reveal mites 4. Management -Avoid contact till both parties treated -Offer STI screen -Permethrin 5% to whole body for 12hrs -Antihistamines -Hot wash clothes, bedding, towels -No role for contact tracing -No need to FU

Answer 2

1. Pathogens -Staphlococcus aurus -Steptococcus pyogenes 2. Toxins -TSST-1 -Enterotoxins A-E 3. Risk factors -Menstration -Tampons -Postparum -Post surgery -Post miscarriage -Burns patients 4. Investigations -Bloods: Raised WCC Thrombocyctopenia Derranged LFTs AKI Prolonged PR -Cultures: confirms diagnosis of toxin producing organism but is often negative 5. Presentation -Fever -Rash - macular erythrodermal -Desquamation -Hypotension -Multisystem involvement 6. Management -Antibiotics (Clindamycin suppresses txin production) -IgG -IVF - Hypotension may not respond -Vassopressors 7. Prognosis -2.5% mortality for menstrual cases

Answer 3

1. Incidence - commonest cause of abnormal discharge 5-50% 2. Risk factors -Sexual activity, smokers, IUD users, douching, harsh soaps, feminine hygiene products 3. Pathogens -Caused by an over growth of anaerobic organisms -Gardnerella vaginalis -Atopobium species -Mobiluncus species -Prevotella species 4. Presentation -Fishy odour -Worse after sex or menstruation -Thin white or grey discharge -Not usually itchy or irritated 5. Diagnosis -Vaginal pH >4.5 (Replace lactobacilli and increase pH) -Characteristic discharge -Clue cells on wet microscopy -Positive whiff test - fishy odour when alkali added to slide 6. Management -Treat if symptomatic, undergoing surgery, pregnant -Avoid or change modifiable risk factors -Metronidazole 400mg PO BD 7/7 or 2g stat -Clindamycin 300mg BD 7/7 -If recurrent consider -metronidazole pre and post period. -pH regulators - boric acid pessaries, AciJel -No contact tracing or test of cure required

Answer 4

1. Incidence -Affects 75% of women during their lifetime -Associated with oestrogenised environments (COC, young women, pregnancy) -Not in children or PM (Unless HRT) 2. Causative pathogens -Candida albicans 80-90% -C. glabrata - most common, C. Tropicalis, C. Krussei (10-15%) - needs longer course of treatment. Only treat if Sx 3. Risk factors -Diabetes, immunocompromised, antibiotic use, synthetic underwear, COC, oestrogenised women 4. Presentation -Discomfort, superficial dysparenunia, pruritis, erythema, fissures, thick white discharge, vuvla oedema -Asx in 10-20% 5. Management -Avoid irritants -Topical clotrimazole, nystatin -Fluconazole 150mg stat -Itraconazole 200mg BD 1 day -Probiotics don't impact long term clinical cure -If pregnant use 7 days of clotrimazole. (Longer course and avoid PO meds - can cause spont mc, cardiac abnormalities) -Can consider short course topical hydrocortisone to manage associated inflammation

Answer 5

1. 4 or more episodes in 12 months 2. <5% of women with candidiasis 3. Presentation -Predominantly burning and itch not discharge -Cyclical with onset of periods -Co-exists with dermatitis which may be from overuse of antifungal creams 4. Treatment -Fluconazole 150mg every 72hrs for 3 doses then weekly for 6 months (regimens vary) -Itraconazole 100mg daily for 1 month then weekly for 6 months -Clotirmazole topical cream for 10-14 days then 500mg clotrimazole pessaries weekly for 6 months -Hydrocortisone in short term for inflammation

Answer 6

1. Pathogens -Gonorrhoea -Chlamydia -Gardenella -Trichomonas -Mycoplasma, GBS, Bacteroides -TB and actinomyces = chronic PID 2. Pathophysiology -Acending infection causing inflammation of endometrium, fallopian tubes, parametrium, ovaries, pelvic peritoneum 3. Risk factors -Most important is previous chlamydia, gonorrhoea or PID -Age <30 -Lack of barrier contraception -Change in sexual partners, or multiple sexual partners -Vaginl douching -Sex just after or during menstruation -IUD insertion within 4 weeks -TOP/ERPOC -Upper genital trct instrumentation -Postpartum

Answer 7

1. Investigations: -Bloods, swabs LVS and HVS (NAAT and Culture) -USS for salpingitis or TOA >90% sens and spec -Diagnostic lap (gold standard but 15-30% of PID missed because mild or endometritis only 2. Management Medical -Outpatient - Ceftriaxone 500mg IM stat, Doxy 100mg PO BD 14/7, Metronidazole 400mg PO BD 14/7. -Inpatient - Ceftriaxone 2g IV Q24H Metronidazole 500mg IV BD, Doxy 100mg PO BD. Step down to PO Metronidazole and doxy for 14/7 -If breastfeeding or pregnant switch doxy for 2 x stat doses azythromycin 1 wek apart Surgical -If no response to therapy or severe disease or TOA -Drain abscess, Salpinectomy -IR drainage Other -Consider removing IUD if no improvement after 48-72hrs of abx or if actinomyces -Encourage sexual contact tracing for previous 3 months

Answer 8

1. Infertility -12% after first episode -20% after second episode -50% after third episode 2. Ectopic pregnancy 10% 3. Chronic pelvic pain 20% 4. Fitz hugh curtis 15% -Liver capsule inflammation and viloin string adhesions -Presents with RUQ pain and shoulder tip radiaiton -Normal transaminases -No role for adhesiolysis

Answer 9

1. Pathogenesis -Inflammatory mass involving the tube +/- ovary +/- pelvic side wall -Results from upper genital tract infection - usally PID -May arise from local spread of infection - appendix, IBD, adnexal surgery, haematological spread -Tubal infection results in oedema and necrosis of tissue. Results in anerobic cavities which form abscesses 2. Pathogens -Polymicrobial -Ecoli, aerobic strep, bacteroides fragilis, prevotella, TB, actinomyces -Gono and Chlamydia thought to facillitate in invasion of upper genital tract by other microbes

Answer 10

1. Imaging -USS - complex multilocular mass that obliterates adnexa -CT - thick walled rim enhancing adnexal mass with adjacent bowel thickening and mesenteric stranding 2. Management Medical -Abx same as for PID - minimum of 2 weeks. Some recommend until abscess resolved on imaging -Abx alone effective in 70% of cases -Consider Abx alone if: -Haemodynamically stable, no signs of rupture -TOA <9cm (30-40% require surgery too) -Not good surgical candidate -Premenopausal Surgical -Do immediately if signs of rupture or haemodynamically unstable -Do if TOA >9cm (60% require surgery) -Do if failed Abx therapy after 48-72hrs -Remove as much of cavity and pus as possible with irrigation ++ -May require USO or TH + BSO -Allows for culture of microbes, confirmation of TOA, biopsy if malignancy suspected Interventional drainage -Good option if medically co-morbid -Difficult if poor location or multiloculated

Answer 11

1. Rupture 15% 2. Sepsis 10-20% 3. Malignancy - esp in post menopausal women

Answer 12

1. Pathogen -Treponema pallidum -Gram negative spirochette -Spread by close contact, vertical transmission, sexual contact 2. Stages Primary syphillis -Presents 9-90 days (average 3 weeks) post exposure -Solitary painless paupule - ulcerates to a chancre -Assoicated with painless lymphandenopathy -Resolves in 3-8 weeks Secondary syphillis - 1-6 months after primary syphillis (average 6 weeks) - Lethargy, malaise, myalgias, anorexia, fever, headache -Rash - generalised macular of skin and mucous membranes -Mucous patch - snail track ulcer - Condylomata lata -Alopcia Latent syphillis -Lasts 3-30 yrs -Asymptomatic -All untreated infected people become asymptomatic in 12-24 months. -No longer infectious after 24 months but can still have vertical transmission Tertiary syphillis -Gummatous syphillis -Neuro syphillis -Meningovascula and cardiovascular syphillis

Answer 13

1. Microscopy -Dark ground microscopy from chancre in primary syphillis or mucous patch in secondary syphillis to look for microbe 2. Serology Specific tests -TP EIA - enzyme immunoassay. Detects IgM and IgG. Will always remain positive after infection. Becomes positive after 3-4 weeks post infection -TPPA - partial agglutination assay. Confirmation test if EIA is positive -TPHA - also used to confirm EIA positivity Non-Specific tests RPR - rapid plasma reagin. Perform if EIA positive to confirm. Can be non-reactive after treatment VDRL - Titre used to confirm treatment success or reinfection. 3. STI screen as usual

Answer 14

1. Management -Notifiable disease -Contact trace for partners and children. How far back depends on stage syphillis diagnosed. -Refer to sexual health physician -Full STI screen -Avoid sex until assessment, treatment and all lesions healed -Get baseline VDRL Medical regimen -Primary or secondary syphillis - Benzathine Penicillin G 2.4MU IM one off dose -Latent syphillis or > 1yr since infection or unknown duration of infection - 3 doses (once a week) of Benzathine Penicillin G 2.4 MU IM 2. Follow-up for confirmation of treatment success -Repeat serology at 3,6,12 months -4 fold drop in RPR titre shows serological cure -<4 fold drop in titre shows inadequate treatment -4 fold rise in RPR titre suggests reinfection

Answer 15

1. Desire / Libido 2. Arousal/Excitment -vasocongestion of clitoris and labia minora, secretion of vaginal lubricant from Batholins, expansion of vagina inlength and circumference 3. Plateau -Florid discolouration of labia minora, retraction of clittoris behind prepubce, generalised myotonic spastic contractions of hands and feet 4. Orgasm -Rythmic contractions and release of vasocongestive adn myotonic tension 5. Resolution -Decongestion of labia, detumescence of clitoris, relaxation of vagina

Answer 16

1. Incidence - 40% of women world wide - 12% with distressing symptoms 2. Criteria -Minimum duration 6 months -Occurs 75-100% of sexual encounters -Causes significant distress -Non explained y organic causes -Not explainedby nonsexual mental disorder or relationship distress 3. Causes Physical Gynae related: Endometriosis, prolapse, atrophy, Physical non Gynae: MS, Arthritis, spinabifidam stoma, chronic illness Drugs: SSRI, EtOH, Beno's, Antipyschotics Psychological: Anxiety/depression, fatigue, stress, shame Context: Relationship conflict, prior abuse, lack of privacy

Answer 17

-Management depends on cause which is often multifactorial -Identify all issues and prioritise/co-ordinate treatments -Address goals for woman -Address partner issues -Treatment should be multidisciplinary and multifactorial -Counselling -psychotherapy -Life style changes -Pharmacology (Testosterone) -Physiotherapy -Treat physical gynae issue

Answer 18

1. Diagnosed if 3 of the following present -Little interest in sex -Few thoughts related to sex -Decreased start and rejection of sex -Little pleasure during sex most of the time -Decreased interest in sex even with exposure to erotic stimuli -Little genital sensation during sex most of the time 2. Management -Reassurance of normalisation of normal sexual activity -Suggest ways of invigorating long term relationship -Hormone therapy: Estrogen cream, testosterone - Andofeme 1% - Androgenic side effects -Psychotropic agents -Buproprion -Flibanserin

Answer 19

1. Diagnosis -Marked delayed , infrequent or absent orgasm -Present in 75-100% of sexual activity -Present for > 6 months -Distressing -Must be alone as well as with partner 2. Causes -Medical conditions: MS, Pelvic nerve damage, Spinal cord injury -Medication or illicit drug use -Partner issue 3. Management -Can use PDE% inhibitor to reverse efects of SSRI

Sexual health Flashcards

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