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3a Women's health > Sexual health > Flashcards

Sexual health Flashcards

(67 cards)

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1
Q

Describe the microbiology of chlamydia trachomatis

A

intracellular gram-negative bacteria

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2
Q

How is chlamydia transmitted

A

vertical transmission`
sexual contact

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3
Q

Give 3 RFs for chlamydia

A
  • under 25
  • new/multiple sexual partners
  • not using condoms
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4
Q

Give 4 ways chlamydia may present in women

A

asymptomatic (70%)
* abnormal vaginal discharge - cloudy/ yellow
* pelvic pain
* dysuria
* post coital/intermenstrual bleeding

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5
Q

Give 4 ways chlamydia may present in men

A

asymptomatic (50%)
* urethral discharge
* dysuria
* testicular pain

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6
Q

How is chlamydia diagnosed

A
  • nucelic acid amplification test (NAAT) - first catch urine (men) and vulvovaginal swab (women)
  • test for lymphogranuloma venereum in MSM with rectal chlamydia
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7
Q

How is chlamydia managed in men and non pregnant women

A
  • doxycycline 100mg orally BD for 7d
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8
Q

How is chlamydia managed in a pregnant woman

A

Any of:
* azithromycin 1g stat then 500mg oral OD for 2 days
* erythromycin
* amoxicillin 500mg oral TDS for 7d

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9
Q

What advice should be given to patients with chlamydia

A
  • no sex for 1 week
  • refer to GUM for contact tracing
  • leaflet on condition
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10
Q

Give 5 complications of chlamydia

A
  • epididymo-orchitis
  • ectopic pregnancy
  • reactive arthritis
  • pelvic inflammatory disease
  • infertility
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11
Q

When should a test of cure be done for chlamydia

A

after 6 weeks if pregnant or rectal infection

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12
Q

What type of bacteria is neisseria gonorrhoea

A

gram negative diplococcus

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13
Q

3 ways gonorrhoea may present in females

A
  • odourless mucopurulent discharge (50%)
  • pelvic pain
  • dysuria
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14
Q

2 ways gonorrhoea may present in males

A
  • mucopurulent discharge (80%)
  • dysuria
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15
Q

2 investigations done for gonorrhoea

A
  • NAAT
  • charcoal swab for culture, microscopy and antibiotic sensitivities
  • swabs in women should be taken from the vulvo-vaginal area
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16
Q

How is gonorrhoea managed

A

depends on whether antibiotic sensitivities are known
* first line: Single dose IM ceftriaxone 1g
* sensitive: single dose oral ciprofloxacin 500mg
Alternative: single dose oral cefixime + azithromycin

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17
Q

When is test of cure done for gonorrhoea

A

after a week for all people who have been treated

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18
Q

What is the most common cause of vaginal discharge in women of reproductive age

A

bacterial vaginosis

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19
Q

What is bacterial vaginosis

A

overgrowth of predominately anaerobic bacteria in the vagina

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20
Q

Describe the pathophysiology of bacterial vaginosis

A
  • lactobacilli are the main component of the healthy vaginal flora
  • lactobacilli produce lactic acid that keep the vag ph low (<4.5)
  • loss of lactobacilli results in a raised vaginal pH which enables anaerobic bacteria to multiply
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21
Q

Give an example of an anaerobic bacteria associated with bacterial vaginosis

A

Gardnerella vaginalis

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22
Q

Give 4 RFs for bacterial vaginosis

A
  • multiple sexual partners
  • excessive vaginal cleaning - douching, cleaning products
  • recent antibiotics
  • smoking
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23
Q

Describe the presentation of bacterial vaginosis

A
  • half of women are asymptomatic
  • grey-white discharge with characteristic fishy odour
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24
Q

How is bacterial vaginosis diagnosed

A
  • vaginal pH >4.5
  • positive whiff test(addition of KOH = fishy odour)
  • thin,white homogenous discharge
  • clue cells on microscopy
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25
How is bacterial vaginosis managed
* asymptomatic: don't usually require treatment unless undergoing termination * symptomatic: oral metronidazole for 5-7 days or topical clindamycin
26
What advice should be given to patients when prescribing metronidazole and why
avoid alcohol for duration of treatment as together they can cause a disulfiram-like reaction * N+V,flushing and in severe cases shock
27
What are 4 complications of bacterial vaginosis
* preterm labour * chorioamnionitis * late miscarriage * STIs
28
What is vaginal candidiasis
aka thrush * vaginal infection with a yeast of the candida family
29
Which species of candida is the most common in vaginal candidiasis
candida albicans
30
Give 4 RFs for vaginal candidiasis
* pregnancy * Poorly controlled diabetes * Immunosuppression (e.g. using corticosteroids) * Broad-spectrum antibiotics
31
Give 4 ways vaginal candidiasis may present
* thick, white, non-offensive discharge ('cottage cheese') * itching * superficial dyspareunia and dysuria * vulval erythema
32
How is vaginal candidiasis investigated
* pH < 4.5 (normal) * high vaginal swab for culture and microscopy * Investigations are not routinely indicated if clinical features are consistent with candidiasis
33
How is vaginal candidiasis managed
* oral antifungal - fluconazole 150mg as single dose * antifungal pessary - clotrimazole as single dose * topical antifungal - clotrimazole * if pregnant only manage with creams/ pessaries.
34
How are recurrent vaginal candidiasis defined and managed
* 4 or more episodes in a year * consider blood glucose test to exclude diabetes * confirm diagnosis with HVS * induction-maintenance regime of oral fluconazole for 6 months
35
What is the most common cause of genital warts
human papillomavirus 6 and 11
36
Give 3 clinical features of genital warts
* most asymptomatic * painless non-ulcerative lesion * may itch
37
How are genital warts managed
first-line treatments depend on the location and type of lesion * multiple, non-keratinised warts are generally best treated with topical podophyllum/ podophyllotoxin * solitary, keratinised warts respond better to cryotherapy * topical imiquimod is 2nd line
38
What causes genital herpes
herpes simplex virus 1 and/or 2
39
How may genital herpes present
* asymptomatic * multiple painful genital ulcers * dysuria and itching * primary infections may have systemic features e.g. fever and headache * the primary episode is often more severe than recurrent episodes
40
What occurs after an initial infection with herpes simplex virus
following primary infection, virus becomes latent in sensory ganglia, periodically reactivating to cause symptomatic lesions or asymptomatic viral shedding
41
How is genital herpes investigated
NAAT: HSV DNA detection by PCR * sample base of ulcer
42
How is genital herpes managed
* primary herpes: oral aciclovir 400mg TDS for 5d * Recurrences of herpes – Aciclovir 800mg TDS for 2 days * If >6 outbreaks a year consider suppressive therapy with Aciclovir 400mg BD for 12 months * advice: saline bathing, analgesia
43
What is syphilis
STI caused by treponema pallidum (gram -ve spirochete)
44
How is syphilis transmitted
* sexual contact * vertically * IVDU
45
Give 2 features of primary syphilis
* painless genital ulcer (chancre) at site of invasion * local non-tender lymphadenopathy
46
Give 5 features of secondary syphilis
* non-itchy maculopapular rash on trunk, palms and soles * systemic: lymphadenopathy, fever, headache * condylomata lata - painless, grey warty lesions on genitalia * buccal 'snail track' ulcers
47
Give 2 features of tertiary syphilis
* gummatous in skin and bones - Chronic painless nodules that break down into ulcers which heal slowly * aortic aneurysms
48
At what stages can neurosyphilis occur, and how does it develop?
Neurosyphilis can occur at any stage of syphilis if the infection reaches the central nervous system
49
Give 5 symptoms of neurosyphilis
* meningitis * optic neuritis * sensorineural hearing loss * Tabes dorsalis (demyelination affecting the spinal cord posterior columns) * Argyll-Robertson pupil - constricted pupil that accommodates when focusing on a near object but does not react to light
50
How is syphilis investigated
* Dark ground microscopy from the primary chancre Serology: * Treponemal-specific test: e.g. T.pallidum enzyme immunoassay (TP-EIA) * Non-specific tests: rapid plasma reagin (RPR) and venereal disease research laboratory (VDRL) tests. used to measure response to treatment
51
How is syphilis managed
* IM benzathine penicillin stat * late syphilis (>2y) - IM benzathine penicillin weekly for 3 doses * follow up 3,6 and 12m * A sustained four-fold or greater increase in the VDRL titre suggests re-infection or treatment failure
52
What is Trichomonas vaginalis
highly motile flagellated protozoan parasite
53
How is Trichomonas vaginalis transmitted
sexual contact
54
Give 5 clinical features of Trichomonas vaginalis
50% asymptomatic * vaginal discharge: offensive, yellow/green, frothy * dysuria * itching * strawberry cervix * pH > 4.5 * may cause urethritis in men
55
How is Trichomonas vaginalis investigated
* microscopy of wet slide from posterior fornix of vagina * urethral swab/ first catch urine in men
56
How is trichomonas vaginalis treated
oral metronidazole for 5-7 day
57
What advice should be given to people with trichomonas vaginalis
* no sexual contact for 1 week after patient and partner treated * patient information leaflet * See health advisor for contact tracing
58
What type of virus is the human immunodeficiency virus and what is the most common type
RNA retrovirus HIV-1
59
How is HIV transmitted
* sexual contact * needle sharing * vertical * needle stick injury * blood transfusion
60
Describe the stages of HIV
1. Acute infection: often asymptomatic 2. seroconversion (3-12 weeks after exposure): myalgia, fever, rash, severe sore throat 3. Asymptomatic phase: loss of CD4 cells, persistent generalised lymphadenopathy (30%) 4. AIDS: CD4 count <200 x 106/L, fatal if untreated
61
How is HIV investigated
* HIV antibody: ELISA (enzyme linked immune-sorbent assay) and confirmatory western blot assay * combined tests: HIV antibody and HIV p24 antigen * if a combined HIV test is +ve, repeat to confirm diagnosis * Serum HIV rapid test - point of care test
62
How should HIV be tested for in asymptomatic patients
* testing should be done at 4 weeks after possible exposure * after an initial negative result, offer a repeat test at 12 weeks
63
How is HIV monitored
* CD4 count (normal= 500-1200 cells/mm3) * testing for HIV RNA per ml of blood indicates viral load - aim for undetectable
64
How is HIV managed
highly active anti-retroviral therapy (HAART) at diagnosis * Nucleoside reverse transcriptase inhibitors (NRTI) * Non-nucleoside reverse transcriptase inhibitors (NNRTI) * Protease inhibitors (ritonavir) * Integrase inhibitors (raltegravir) * entry inhibitors (e.g. fuzeon)
65
Give 3 examples of Nucleoside analogue reverse transcriptase inhibitors (NRTI)
* zidovudine * tenofovir * emtricitabine * didanosine
66
Give 4 AIDS defining illnesses
* Kaposi’s sarcoma * Pneumocystis jirovecii pneumonia (PCP) * Cytomegalovirus infection * Candidiasis (oesophageal or bronchial) * Hodgkin's Lymphomas * Tuberculosis
67
What is the prophylaxis for HIV
* post exposure prophylaxis (PEP): used within 72hrs of exposure to reduce risk of transmission - emtricitabine/tenofovir (Truvada) and raltegravir for 28 days * Pre-exposure prophylaxis (PrEP): ART for those at high risk of transmission - co-formulation of emtricitabine/tenofovir

3a Women's health (12 decks)

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