Sexual health Flashcards
What is the most common cause of vaginal discharge and what are the causative organisms?
Bacterial vaginosis caused by anaerobes: gardnerella. vaginalis or mycoplasma. hominis
What are the typical symptoms/signs of bacterial vaginosis?
Vaginal discharge
- white/grey creamy, foul “fish” smelling
- worse after sex or menstruation (due to release of amines from proteolysis)
What is the diagnostic criteria for BV?
Amsel criteria (3 out of 4)
- White/grey creamy disco
- Foul smelling fishy vag
- Clue cells grown in culture
- pH > 4.5
Treatment for bacterial vaginosis?
Cause is anaerobic therefore
- Metronidazole 400mg BD 5d or 2g single dose
- Clindamycin 2% topical cream 7d
- Discourage overfishing of vag - can destroy normal flora
What are the symptoms of candidiasis?
- Thick, curd like discharge
- Superficial dyspareunia
- Dysuria
- Vulval - itchy, sore, erythema
- Vaginal - erythema, typical white plaques
What are the investigative findings for BV?
- Microscopy - Clue cells
What are the treatments for Candidiasis (thrush)
- Fluconazole 150mg single dose
or - Clotrimazole pessary
In whom is fluconazole contraindicated?
Pregnancy
What are the investigations to diagnose chlamydia or gonorrhoea?
- Vulvovaginal or Endocervical swab with NAAT to detect n.gonorrhoea or c.trachomatis
- Must CS all gonorrhoea swabs before commencing Tx
What are the symptoms of trichomoniasis vaginalis?
- Vaginal discharge - yellow/green frothy, foul smelling
- Dysuria
- Strawberry cervix - punctate lesions
- Vulva itchy + sore
What are the similarities and differences in symptoms and signs of chlamydia and gonorrhoea?
Chlamydia
- Discharge - white, cloudy
- Deep dyspareunia
- Dysuria on voiding
- Vague lower abdo pain
- ± IMB and PCB
Gonorrhoea
- Discharge - green, watery, purulent
- Pus
- Dysuria on voiding
- Abdominal pain
- ± IMB and PCB
What is the treatment of gonorrhoea?
- IM Ceftriaxone 500mg STAT + Azithryomycin 1g PO
or
- Spectinomycin + Azithryomycin (if pen allergic)
What is the treatment of chlaymdia?
- Azithromycin 1g or
2. Doxycycline 100mg BD 7d
What is the treatment of cervical HSV infection?
- Saline wash
- Analgesia
- Topical anaesthetic
What are the symptoms of cervical HSV infection?
- Prodrome - tingly, itchy skin around affected area
- Flu-like symptoms
- Vulva sore + itchy (vulvitis)
- Rash: purulent vesicular ulcers
- Watery purulent discharge
What are the features of gonococcal conjunctivitis? What is the onset period?
- Purulent RED EYE (conjunctivitis) B/L or U/L
- Purulent watery discharge
- Keratitis –> photophobia and decreased acuity
- Lymphadenopathy
- Tender eye lid
- hyper-acute sudden onset within 12-24hrs
What are the features of chlamydial conjunctivitis? when does it occur?
- Mild prolonged conjunctivitis (3-12 months)
2. Green-stringy discharge (mornings)
What is the general treatment for bacterial conjunctivitis
Most cases are self-limiting and therefore do not require treatment
Abx must be given to those with chlamydial or gonococcal cause
What are the key features of ophthalmia neonatorum and what is the cause? when does it occur?
- Purulent exudative discharge
- Chemosis - oedema of conjunctiva
- Conjunctivitis
mainly caused by chlamydia but can also be gonorrhoea, s.aureus, s.penumoniae
First 28 days of life
What are the features of disseminated gonorrhoea?
- Polyarthritis
- Polyarthralgia
- Tenosynovitis
- Fever
- Pustular rash
What is the definition of ophthalmia neonatorum?
Any conjunctivitis within first 28 days of life
What subtypes of chlamydia cause chlamydial conjunctivitis?
Sero-types D-K of C.Trachomatis
What are the most common cervical and vaginal infections and how would you investigate them?
- Cervical
- Bacterial vaginosis
- Candidiasis
- Trichomonas. vaginalis
- ->investigate using high vaginal swab and MSC - Vaginal
- Chlamydia
- Gonorrhoea
- HSV1
- -> Investigate using endocervical and vulvovaginal swab with NAAT
What is Condylomata accuminata?
Ano-genital warts caused by HPV 6/11
Which HPV strains are a/w with cervical intraepithelial neoplasia (CIN)?
HPV 16/18
What is the presentation of condylomata accuminata?
Typically asymptomatic but:
- Vulval warts - flat pappilomatous lesions
- benign
- painless
- may become confluent
- can become caught on clothing - Superficial dyspareunia
- local skin irritation - burning or pruiritis
What is the treatment for condylomata accuminata?
Home
- Podophyllin pain - weekly
- Podophyllotoxin pain - BD, 3d cycles for 4wks
- Barrier contraception for new partners
Clinic:
- Cryotherapy
- Lazer, Scissor excision, electro-cautery
- Tri-chloro-acetic acid
What prophylaxis is their against HPV?
HPV 6/11/16/18 vaccine given to all 12-13 year olds
What is the caustive organism of syphilis?
Treponeumum Pallidum - spirochete
Tell me the time frame and features of primary syphilis?
occurs 2-3 wks post-infection (treponeum.p enters during sex)
- “Chancre” - single, painless, HARD ulcer (typically on genitals or mouth)
- Inguinal lymphadenopathy
How would you investigate and confirm primary syphilis?
- Dark field microscopy of ulcer fluid - visualise spirochete treponomes
Tell me the time frame and features of secondary syphilis?
6wks to 6 months post-infection (generalised infection)
- Rash: head, trunk, hands, soles (may be scaly)
- Alopecia
- Anterior uveitis
- Oral snail track ulcers
- Condylomata lata - flat grey/pink disc shape papule
- Hepatitis - RUQ pain + tender
How would you investigate and confirm secondary syphilis?
+ve Ab tests:
Cardiolipin Ab tests (VDRL, RPR, WR)
Treponeme specific Ab tests (TPHA, FTA, TPI)
Tell me the time frame and features of tertiary syphilis?
Occurs at ≥ 2 years
- Gumata
- granulomas develop in skin, bones, viscera (testis + lungs) - Neurosyphilis
- Dementia
- Tabes dorsalis (ataxia, lightning pain, decreased reflexes, Argyll-Robertson pupils, Charcot’s joints) - Cardiosyphilis
- syphillis aortis –> aortic aneurysm, regurgitation + angina
What is the treatment of syphilis?
- Benzathine Penicilin 1.8g - 2-3 doses at least 1 week apart
- Doxcycline as alternative
- Erythromycin if pregnant
What are the complications in pregnancy of syphilis?
- TORCH transmission
- Prematurity
- Early - Rash, sabre shin (anteriorly bent sting)
- Late - Hutchinson’s triad (blind, deaf (CNVIII injury), notched central incisors))
What are the common features between HSV and syphilis in early manifestation?
Both present with ulceration + lymphadenopathy
HSV is PAINFUL
Syphillis is PAINLESS
What is the causative organism of molluscum contagiosum?
DNA pox virus
What are the features of molluscum contagiosum?
- Pearly, pink rash over trunk, arms and genitals - painless, umbilicate (painful if disrupted)
What is the treatment for molluscum contagiosum?
- Watch and wait - self-limiting in 6-18 months
2. Cryotherapy, podophyllotxin paint
What type of organism causes HIV? what are the common subtypes in the UK?
DNA retrovirus which kills CD4+ cells
HIV1 type A & B common in the UK
What is the time scale and symptoms of seroconversion for HIV?
3 months
- Flu like symptoms - myalgia, pharyngitis, fever, coryza
- Maculopapular rash on trunk
- Exacerbation of chronic conditions like eczema
What are the symptoms of clinical latency HIV?
Often asymptomatic
may have persistent lymphadenopathy (>1cm for > 3months)
What is ARC and what are the symptoms?
AIDS related complex (ARC) is considered a prodrome to AIDS
- high HIV viral load and low CD4+ T-cells
Fever, Night seats, Weight loss, Diarrhoea
Opportunistic infections
- Oral - candida, hairy leukoplakia, EBV
- Skin - molloscum contagiosum, shingles, warts
- Serious - TB, pneumocystis, atypical pneumonia, cryptococcal meningitis, CMV, retinitis
When does AIDS occur and what is it defined as? What is the prognosis?
~ 8 years
CD4 level < 200 x10^6
Death in 2 years without HAART
What is the investigative ladder for suspected HIV?
- Point of care (POC) test
- rapid finger prick test
- results in 30 mins
- can be bought over the counter
- +ve results must be confirmed by ELISA
2a. Fourth generation test
- contains HIV serum Ab and HIV P24 Ag test combined
- must confirm -ve result with 2nd test 3 months later (to account for sero-conversion)
2b. Serum Ab
- test 2-4 weeks post-exposure
2c. HIV p24 Antigen screen
- test > 4 weeks post exposure
Must consider Pregnancy test and full STI screen (other infections are likely present)
What is the treatment for HIV?
HAART (highly active anti-retroviral therapy)
- OD tablet
- must have CD4 > 350 (or NHS will not fund tx)
- x2 NRTI = Tenofovir and Emtricitabine or Lamivudine and one of
a. Ritonovir (protease inhibitor)
b. Efavirenz (NNRTI)
c. Integrase inhibitor
What can be given as early intervention treatment for a patient with recent exposure?
PEP - given to a patient with exposure < 72 hours
- aims to prevent seroconversion
