Sexual Health Flashcards
(219 cards)
1
Q
Neisseria gonorrhoea
A
GN coffee bean shaped diplococci
2
Q
GN coffee bean shaped diplococci
A
Neisseria gonorrhoea
3
Q
PID symptoms in females
A
lower abdo pain, dyspareunia, fevers, vaginal discharge, IMB, PCB
4
Q
lower abdo pain, dyspareunia, fevers, vaginal discharge, IMB, PCB are symptoms of
A
PID in females
5
Q
PID causative organisms
A
Chlamydia trachomatis, Neisseria gonorrhoea (most common two), Gardnerella vaginalis, Haemophilus influenzae
6
Q
Chlamydia trachomatis, Neisseria gonorrhoea (most common two), Gardnerella vaginalis, Haemophilus influenzae causes of
A
PID
7
Q
Fitz-Hugh-Curtis S
A
complication of PID where infection tracks up to the liver from the pelvis, RUQ pain + perihepatitis, adhesions between liver capsule and abdo wall
8
Q
complication of PID where infection tracks up to the liver from the pelvis, RUQ pain + perihepatitis, adhesions between liver capsule and abdo wall
A
Fitz-Hugh-Curtis S
9
Q
Chlamydia trachomatis
A
GN intracellular coccoid/rod shaped pathogen
10
Q
GN intracellular coccoid/rod shaped pathogen
A
Chlamydia trachomatis
11
Q
condyloma acuminatum
A
benign genital warts
12
Q
primary syphilis
A
2-3/52 post infection, painless, solitary, genital/perianal ulcer, may resolve spontaneously (can be multiple + painful)
13
Q
painless genital ulcer, may resolve spontaneously
A
primary syphilis
14
Q
secondary syphilis
A
4-8/52 post 1’ lesion, generalised illness, lymphadenopathy, diffuse macular papular rash (trunk + extremities, w/o sparing palms/soles, symmetrical, not itchy)
15
Q
generalised illness, lymphadenopathy, diffuse macular papular rash (trunk + extremities, w/o sparing palms/soles)
A
secondary syphilis
16
Q
tertiary syphilis
A
v rare, years post initial infection, granulomatous DZ, CVS DZ, neurological DZ
17
Q
years post initial infection, granulomatous DZ, CVS DZ, neurological DZ
A
tertiary syphilis
18
Q
trichomoniasis
A
Trichomonas vaginalis, frothy green discharge, pruitit, vaginitis, PCB, punctate haemorrhages (strawberry cervix)
19
Q
frothy green discharge, pruitit, vaginitis, PCB, punctate haemorrhages (strawberry cervix)
A
trichomoniasis
20
Q
candidiasis risk factors
A
DM, immunosuppression, recent ABx
21
Q
DM, immunosuppression, recent ABx are risk factors of
A
candidiasis
22
Q
vaginal discharge differentials
A
BV, gonorrhoea, chlamydia, candida, tricomonas
23
Q
male urethral discharge differentials
A
gonorrhoea (2-5/7 incubation), chlamydia (1-3/52 incubation)
24
Q
genital ulceration differentials
A
syphilis, herpes, Bechet’s S, LGV, chancroid
25
genital rash differentials
psoriasis, eczema, scabies
26
genital lesions differentials
lichen planus, lichen sclerosis, VIN, SCC, basal cell carcinoma, Paget's DZ, malignant melanoma, Bartholin cyst/abscess, 2' syphilis (condylomata lata), warts, molluscum contagiosum
27
dysuria differentials
chlamydia, gonorrhoea, UTI, non-specific urethritis
28
epididymitis
infection of the upper GU tract from an STI
29
infection of the upper GU tract from an STI
epidymitis
30
LGV
lymphogranuloma venereum = long term chronic infection of the lymphatic system, cause by Chlamydia trachomatis
31
Chlamydia strains
L1, L2, L3 = LGV
| A-K = oculogenital chlamydia
32
contraception options
COCP, POP, IUD, IUS, implant, injection, withdrawal method, ovulation method, cap, diaphragm, condom, femadom, patch, ring
33
PID complications
chronic pain, infertility
34
chronic pain, infertility are complications of
PID
35
PID O/E
lower abdo pain, adenexal tenderness, cervical excitation, fever, dyspareunia, discharge
36
lower abdo pain, adenexal tenderness, cervical excitation, fever, dyspareunia, discharge O/E are indicative of
PID
37
PID DD
apendicitis, ectopic pregnancy, UTI, ovarical cyst torsion/rupture, endometriosis, IBS
38
PID investigations
pregnancy test, gonorrhoea + chlamydia NAATS, WCC, ESR, CRP, laproscopy, TVUS
39
PID management
analgesia, protected sex, ABx, partner notification
40
IUD
spermicidal + prevents implantation, effective immediately, periods heavier, longer, more painful, 2/1000 perforation, ectopic, infection, expulsion
41
spermicidal + prevents implantation, effective immediately, periods heavier, longer, more painful, 2/1000 perforation, ectopic, infection, expulsion
IUD
42
IUS
prevents endometrial thickening, effective after 7/7, periods lighter, 2/1000 perforation, ectopic, infection, expulsion
43
prevents endometrial thickening, effective after 7/7, periods lighter, 2/1000 perforation, ectopic, infection, expulsion
IUS
44
chlamydia investigations
urine/swab NAATS (nucleic acid amplification test)
45
chlamydia management
1. azithromycin single dose
2. doxycycline 7/7
pregnancy use: azithromycin, erythromycin, amoxicillin
partner notification (1/52 partners if symptomatic male, 6/12 of partners if asymptomatic or female)
46
chlamydia presentation
often asymptomatic, discharge, bleeding, dysuria, epididymoorchitis
47
chlamydia complications
epididymitis, PID, endometriosis, ectopic pregnancies, infertility, reactive arthritis, perihepatitis (Fitz-Hugh-Curtis S)
48
chlamydia screening
opportunistic e.g. freshers' week, registering with a GP
49
urine/swab NAATS (nucleic acid amplification test)
chlamydia/gonorrhoea
50
1. azithromycin single dose
2. doxycycline 7/7
pregnancy use: azithromycin, erythromycin, amoxicillin
partner notification (1/52 partners if symptomat ic male, 6/12 of partners if asymptomatic or female)
chlamydia management
51
epididymitis, PID, endometriosis, ectopic pregnancies, infertility, reactive arthritis, perihepatitis (Fitz-Hugh-Curtis S)
chlamydia complications
52
opportunistic e.g. freshers' week, registering with a GP
chlamydia screening
53
gonorrhoea presentation
discharge, dysuria
54
gonorrhoea complications
urethral strictures, epididymitis, salpingitis, PID, infertility, disseminated gonococcal infection, gonococcal arthritis, perihepatitis
55
DIG disseminated gonococcal infection
tenosynovitis, migratory polyarthritis, dermatitis, later complications: septic arthritis, endocarditis, perihepatitis
56
tenosynovitis
inflammation of the fluid filled sheath surrounding tendons
57
inflammation of the fluid filled sheath surrounding tendons
tenosynovitis
58
tenosynovitis, migratory polyarthritis, dermatitis, later complications: septic arthritis, endocarditis, perihepatitis
disseminated gonococcal infection
59
gonorrhoea management
ceftriaxone 500 mg IM single dose + azithromycin 1g PO single dose
60
ceftriaxone 500 mg IM single dose + azithromycin 1g PO single dose
gonorrhoea management
61
urethral strictures, epididymitis, salpingitis, PID, infertility, disseminated gonococcal infection, gonococcal arthritis, perihepatitis
gonorrhoea complications
62
causatie agent of syphilis
Treponema pallidum
63
transmission of Trepomena pallidum
sexually, ertically during pregnancy
64
description of ulcer in syphilis
macule to papule to ulcer, round, clean, indurated base, defined edges, heals w/i 3-10/52
65
in warm oppsed areas e.g. anus, labia the maculopapular rash of 2' syphilis can
coalesce to form large fleshy masses - condyloma lata
66
if 2' syphilis is left untreated
will resolve, may have recurrent episodes of 2' syphilis
67
latent syphilis
when s/o has untreated syphilis w/o signs/symptoms
68
early stage latent syphilis
DZ present for <2 years
69
late stage latent syphilis
DZ present for >2 years
70
latent syphilis aka
3' syphilis
71
neurosyphilis definition
10-20 years post-infection, asymptomatic, meningovascular/parenchymatous (general paresis + tabes dorsalis)
72
tabes dorsalis process
slow degeneration of dorsal column neural tracts, leading to loss of proprioception, vibration + discriminative touch
73
meningovascular syphilis presentation
early (part of 2')/late (2-20 years post-infection) stages of syphilis, acute meningeal involvement (during 2' syphilis), headache, papilloedema, Argyll Robertson pupils
74
Argyll Robertson pupil
sm, unequal pupils, react to accommodation, not to light (ARP = accommodation reflex present)
75
parenchymatous syphilis describes
general paresis, tabes dorsalis
76
early symptoms of general paresis
irritability, fatiguability, personality change, headaches, impaired memory, tremor
77
late symptoms of general paresis
lack of insight, depression/euphoria, confusion, disorientation, delusions, seizures, transient paralysis, aphasia
78
signs of general paresis
expressionless facies, tremor of lips/tongue/hands, dysarthria, impairment of handwriting, hyperreflexia, pupillary abnormalities, optic atrophy, convulsions, extensor plantar responses
79
tabes dorsalis symptoms
increasing ataxia, failing vision, sphincter disturbances, attacks of severe pain (lightening), paraesthesiae, deafness, ED
80
asymptomatic neurosyphilis
no neuro signs/symptoms, diagnosis based on serum/SCF
81
paraesthesiae
abnormal sensation, tingling/pricking, caused by P + damage of n
82
tabes dorsalis signs
Argyll Robertson pupil, absent refleces, Romberg's sign, impaired vibration/proprioception/touch/pain sensation, optic atrophy, ocular palsies, Charcot's joints
83
Romberg's sign
close eyes, stand still, tests proprioception
84
Charcot's joint
neuropathic arthropathy
85
CVS syphilis most commonly affects
large vessels, aorta
86
symptoms of CVS syphilis
are that of an aneurysm affecting the arch of the aorta putting P on mediastinal structures
87
gummata
3-12 years post infection, granulomatous lesions, painless, 3' syphilis
88
diagnosing syphilis
NAATs, PCR, dark ground microscopy (1' + 2'), serology (RPR, EIA), CSF, radiology
89
syphilis Hx
previous syphilis screening/diagnosis/treatment
90
serum RPR for syphilis
non-specific, becomes +ve 3-5/52 post-infection, quantitative assessment of stage + DZ activity (i.e. response to treatment), false +ves in acute infecion (HSV, measles, mumps, AI DZ, RA)
91
serum EIA for syphilis
specific, become +ve early in DZ course (2-4/52 post infection), false +ve in yaws
92
suspected neurosyphilis investigations
LP, neuro examination
93
treatment of syphilis
penicillin (benzylpenicillin), doxycycline in PenA
94
syphilis management
early: contact tracing (previous 3-6/12)
95
T. pallidum is a
spirochaete bacterium
96
CVS syphilis causes
aortic regurgitation, angina, aortic aneurysm, 10-40 years post-infection
97
1' syphilis presentation in HIV
larger, painful, multiple ulcers
98
2' syphilis presentation in HIV
genital ulcers (slow healing of 1' ulcers), higher titres of RPR
99
Treponema pallidum causes
syphilis
100
macule to papule to ulcer, round, clean, indurated base, defined edges, heals w/i 3-10/52 describes
ulcer in syphilis
101
when s/o has untreated syphilis w/o signs/symptoms
latent syphilis
102
3' syphilis aka
latent syphilis
103
10-20 years post-infection, asymptomatic, meningovascular/parenchymatous (general paresis + tabes dorsalis) describes
neurosyphilis
104
slow degeneration of dorsal column neural tracts, leading to loss of proprioception, vibration + discriminative touch
tabes dorsalis
105
early (part of 2')/late (2-20 years post-infection) stages of syphilis, acute meningeal involvement (during 2' syphilis), headache, papilloedema, Argyll Robertson pupils
meningovascular syphilis
106
sm, unequal pupils, react to accommodation, not to light
Argyll Robertson pupil
107
no neuro signs/symptoms, diagnosis based on serum/SCF
asymptomatic neurosyphilis
108
close eyes, stand still, tests proprioception
Romberg's test
109
neuropathic arthropathy
Charcot's
110
3-12 years post infection, granulomatous lesions, painless
gummata, 3' syphilis
111
HSV-1 vs HSV-2 in genital herpes
HSV-1 is the most common causative agent of 1st episode herpes, HSV-2 is more likely to manifest as recurernt DZ
112
HSV incubation period
5-14/7, although 1st episode of visible ulcer may be aftert this (not symptomatic at every flare)
113
progression of a herpes ulcer
vesicular to ulcer
114
herpes presentation
painful genital ulcer(s), local tender lymphadenopathy, m aches, headache, malaise, photophobia
115
duration of a herpes episode
3/52
116
local complications of herpes
superinfection of lesions (strep/staph), adhesion formation, vaginal candida, dysuria, urinary retention
117
distant complications of herpes
myalgia, dissemination (to neonate in pregnancy), autoinnoculation to distant sites, erythema multiforme
118
neuro complications of herpes
headache, encephalitis, radiculitis, transverse myelitis, AI neuropathy
119
psychological complications of herpes
anxiety, depression
120
risk factors for f recurrence of herpes
HSV-2 infection, no previous infection with ither HSV type, male > female, 1st year following infection, symptomatic acquisition episode, prolonged acquisition episode, immunocompromised
121
herpes diagnosis
PCR, culture, Ag detection
122
management of first episode herpes
PO antiviral: aciclovir, famciclovir, valaciclovir 5-10/7, PO analgesia
123
management of herpes recurrences
may not require treatment, short course antiviral during prodrome, continuous antivirals (valaciclovir), counselling
124
counselling in HSV infection
source of infection, duration of illness, natural course of illness (risk of asymptomatic shedding), future treatment options, reducing transmission, pregnancy (inform + prevent new acquisition), partner notification
125
genital herpes in pregnancy first episode
PO/IV aciclovir, planned vaginal delivery, daily suppressive aciclovir from 36/40, greatest risk if episode occurs in 3rd trimester (offer c/s)
126
genital herpes in pregnancy recurrent episodes
no threat to foetus, avoid foetal scalp monitoring, consider c/s if active at EDD
127
neonatal herpes acquisition
contact with infected maternal genital tract, noscomisal, community acquired
128
neonatal herpes types
local, encephalitis, disseminated (potentially fatal)
129
painful genital ulcer(s), local tender lymphadenopathy, m aches, headache, malaise, photophobia describes the presentation of
genital herpes
130
superinfection of lesions (strep/staph), adhesion formation, vaginal candida, dysuria, urinary retention are
local complications of herpes
131
HSV-2 infection, no previous infection with ither HSV type, male > female, 1st year following infection, symptomatic acquisition episode, prolonged acquisition episode, immunocompromised are risk factors for
recurent herpes
132
PO antiviral: aciclovir, famciclovir, valaciclovir 5-10/7, PO analgesia is the managment for
first episode genital herpes
133
may not require treatment, short course antiviral during prodrome, continuous antivirals, counselling is the management for
recurrent episode genital herpes
134
active outbreak of herpes in pregnancy increases transmission of
HIV
135
HPV is a risk factor for
cervical ca, vulval ca, vaginal ca, penile ca, anal ca
136
low risk HPV strains
6, 11 associated with genital warts
137
high risk HPV strains
16, 18 (cervical ca)
138
genital warts presentation
asymptomatic, pruitis, irritation, single vs multiple
139
genital warts diagnosis
clinical examination, biopsy in uncertain situations
140
when to biopsy a genital wart
pigmented, indurated, fixed, unresponsive to treatment, persistent ulceration, persistent bleeding
141
types of genital wart
condylomata acuminata, smooth papules, flat papules, keratotic warts
142
condylomata acuminata
cauliflower-like appearance, skin coloured, pink, hyperpigmented, non-keratinised on mucosal surfaces, may be keratotic on skin
143
smooth papules
usually dome shaped, skin coloured
144
flat papules
macular/slightly raised, flesh coloured, smooth surface, > common on internal structures e.g. cervix, but also on external genitalia
145
keratotic warts
thick, horny layer, resembles common warts/seborrheic keratosis
146
genital wart DD
molluscum contagiosum, condylomata lata (syphilis), seborrheic keratosis, lichen planus, fibroepithelial polyp, adenoma, melanocytic naevus, neoplastic lesion, pearly penile papules/coronal papilae, fordyce spots, vestibular papillae (micropapillomatosis labialis), skin tags (acrochordons)
147
genital wart management
education on transmission, stop smoking (may help HPV clearance), treatment is aesthetic > viral clearance/infectivity, chemical applications, cryotherapy, excision, electrosurgery, laser, counselling
148
genital wart investigations
STI screen, contact tracing
149
two types of HPV vaccine available
Gardasil (HPV-6, 11, 16 + 18), Cervarix (HPV-16 + 18)
150
HPV-6 + 11
are low risk strains causing benign genital warts
151
HPV-16 +18
are high risk strains contributing to cervical + other genital cancers
152
cauliflower-like appearance, skin coloured, pink, hyperpigmented, non-keratinised on mucosal surfaces, may be keratotic on skin
condylomata acuminata
153
usually dome shaped, skin coloured
smooth papules
154
macular/slightly raised, flesh coloured, smooth surface, > common on internal structures e.g. cervix, but also on external genitalia
flat papules
155
thick, horny layer, resembles common warts/seborrheic keratosis
keratotic warts
156
factors contributing to increased risk of HIV transmission
viral load, coexisting STIs, type of sexual activity, f of sexual activity, breach in mucosal barrier, genital HSV (increases HIV shedding + susceptibility to infection)
157
protective factors of HIV transmission
condons, male circumcision
158
mother to child transmission rates
1/3 w/o intervention, 10% in utero, 50% delivery related, 40% breastfeeding
159
prevention + control of HIV
surveillance, provision of testing, counselling, education, screening blood donors, heat treatment of blood products, antiretroviral treatment, infant feeding counselling, needle exchanges, STI detection/treatment, male circumcision, family planning/contraception
160
HIV in pregnancy at delivery c/s vs vaginal delivery
vaginal delivery (w/o instrumentation) is safe in women who have an undetectable viral load, c/s is recommended in those with a detectable VL
161
breastfeeding for mothers with HIV
not recommended, unless it is unsafe (risk vs benifit) for the baby to be by an alternative method
162
primary HIV infection presentation
subclinical, fever, malaise, myalgia, lymphadenopathy, pharyngitis, rash, ?transient aseptic meningoencephalitis
163
ELIZA detects Abs which are produced
2-6/52 post infection, some people undergo delayed seroconversion + require repeat testing at 3/12
164
VL post HIV infection
initially v high, rapidy decline w/i days/weeks, then a plateau
165
high VL is associated with a low
CD4 count + quicker progression to symptomatic DZ
166
most common physical feature of chronic HIV
persistent lymphadenopathy (cervical/axillary)
167
non-specific features of declining CD-4 count
fevers, night sweats, diarrhoea, weight loss
168
skin conditions associated with immunosuppression
seborrhoeic dermatitis, folliculitis, impetigo, tinea infections
169
oral mucosa conditions associated with immunosuppression
oral candidiasis, oral hairy leucoplakia, HZV, recurrent oral/anogenital HSV
170
AIDS
1 or more indicator conditions, in absence of other immunodeficiency, CD4 <200 cells/mm2
171
AIDS defining DZs
TB, pneumocustis, cerebral toxoplasmosis, 1' cerebral lymphoma, cryptococcal meningitis, progressive multifocal leucoencephalopathy, Kaposi's sarcoma, persistent cryptosporidiosis, NHL, cervical ca, CMV retinitis
172
pneumocystis jiroveci presentation
malaise, fatigue, weight loss, dry cough, SOB, fever, retrosternal chest pain, desaturate on exertion
173
pneumocystis jiroveci CXR
?N, bx fine infiltrates (perihilar)
174
pneumocystis jiroveci diagnosis
cytology of induced sputum, fibre optic bronchoscopy + bronchioalveolar lavage
175
management of pneumocystis jiroveci
high dose co-trimoxazole, steroids in severe DZ
176
complication of pneumocystis jiroveci
pneumothorax (exclude in PTs with clincal deterioration)
177
lymphadenopathy, night sweats, fevers, weight loss think
TB
178
oropharyngeal candidiasis presentation
dysphagia, retrosternal discomfort
179
oropharyngeal candidiasis diagnosis
biopsy/culture at endoscopy
180
oropharyngeal candidiasis treatment
fluconazole + itraconazole
181
oral hairy leukoplakia is caused by
EBV
182
oral hairy leukoplakia presentation
white lesions on the lateral border of the tongue
183
cerebral toxoplasmosis DD
1' cerebral lymphoma, cerebral abscess
184
AIDS-related dementia
memory loss, apathy, impaired concentration, hyperreflexia, hypertonia, frontal signs
185
HIV retinopathy
benign, cotton wool spots w/o haemorrhages
186
CMV retinitis
destructive, potentially blinding
187
CMV retinitis presentation
floaters, blurring, loss of central vision, flashing lights, scotomas, ux (maybe bx)
188
CMV retinitis fundoscopy
retinal pallor, multiple granular white dots, haemorrhages, starts in the periphery and spread to macula
189
complications of CMV retinitis
retinal detachment, branch retinal a occlusion, cataract, persistent iritis
190
management of CMV retinitis
IV ganciclovir
191
Kaposi's sarcoma causative agent
HHV-8 aka KSHV
192
Kaposi's sarcoma presentation
violaceous plaques, macules, papules, nodules, non-pigmented lesions may occur
193
KS diagnosis
histology
194
NHL in HIV+ PTs compared with HIV-
more advnaced, less responsive to cytotoxic treatment, extranodal DZ (CNS, BM, GIT)
195
> 50% of AIDS related lymphomas are associated with
EBV/HHV-8/both
196
cervical smear f in HIV+ women
annually
197
HIV+ve PTs have an increased risk of which non-HIV related conditions
CVS, renal, liver DZ, neurocognitive impairment, non-AIDS ca
198
HIV management
antiretrovirals
199
types of antiretrovirals
NRTIs (nucleoside/nucleotide analogue reverse transcriptor inhibitors), NNRTIs (non-NRTIs), PI (protease inhibitors), entry inhibitors, fusion inhibitors, CCR5 antagonists, integrase inhibitors
200
choice of antiretrovirals dependent on
PT choice, toxicity profile, pill burded, dosing schedule, likelihood of adherence, comorbidities, drug interactions
201
objective of antiretroviral therapy
is to keep VL <5O copies/mL (undetectable)
202
when to initiate antiretroviral therapy decision based upon
at diagnosis, clinical status, VL, benifit vs drug toxicity, PT choice
203
problems with current antiretroviral therapies
drug resistance, long term drug toxicity
204
immune reconstitutional S describes
restoration of immune function with subsequent worsening of opportunistic infections
205
immune reconstitutional S occurs after
the initiation of antiretroviral therapy in PTs with low CD4
206
immune reconstitutional S presentation
fever, worsening of opportunistic infections
207
subclinical, fever, malaise, myalgia, lymphadenopathy, pharyngitis, rash, ?transient aseptic meningoencephalitis
1' HIV infection presentation
208
low CD4 count is associated with high
VL + quicker progression to symptomatic DZ
209
malaise, fatigue, weight loss, dry cough, SOB, fever, retrosternal chest pain, desaturate on exertion
pneumocystis jiroveci
210
high dose co-trimoxazole, steroids in severe DZ
pneumocystis jireoveci
211
white lesions on the lateral border of the tongue
oral hairy leukoplakia
212
benign, cotton wool spots w/o haemorrhages
HIV retinopathy
213
floaters, blurring, loss of central vision, flashing lights, scotomas, ux (maybe bx)
CMV retinitis
214
retinal pallor, multiple granular white dots, haemorrhages, starts in the periphery and spread to macula
CMV retinitis
215
restoration of immune function with subsequent worsening of opportunistic infections
immune reconstitutional S
216
progressive multifocal leukoencephalopathy is caused by
JC virus
217
cerebral toxoplasmosis on CT
single/multiple, ring enhanced lesions, mass effect
218
diarrhoea in HIV+ PTs most common causative agent
cryptosporidium
219
other cause of diarrhoea in HIV
CMV, mycobacterium avium intracellulare, giardia
