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Y4 - GOSH > sexual health > Flashcards

sexual health Flashcards

(55 cards)

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1
Q

what is the most common cause of vaginal discharge in women of child-bearing age

A

bacterial vaginitis

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2
Q

why is the normal pH of the vagina is 4.5?

A

presence of lactobacilli and so it makes it 4.5 to reduce the presence of other pathogens

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3
Q

what are the causes of vaginal discharge generally

A

non-infective

  • pyhsiological
  • cervical ectopion
  • foregin body

infective

  • Non-STI - Bacterial vaginitis, candida
  • STI - Trichomonas vaginitis
  • STI (endocervical) - chlamydia and gonorrhoea
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4
Q

what is the normal vaginal discharge

A

1-4 ml per 24 hours
usually watery or white
non-offensive odour
varies with the menstrual cycle

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5
Q

what is the pH of the vagina if BV present

A

4.5-6.0

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6
Q

RF for bacterial vaginosis

A 
douching 
Receptive cunnilingus (female receptive oral sex) 
a recent change of partner 
smoking 
present of STI 
black ethnicity
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7
Q

symptoms of bacterial vaginosis

A

inc discharge - white/watery, thin
fishy smelling vaginal discharge
not assoc with soreness, itching

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8
Q

signs of bacterial vaginosis

A

under speculum - white, thin, haemogenous discharge

no signs of inflammation

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9
Q

complications of bacterial vaginosis

A

PID inc BV chacnes

cellutlitis/abscess formation following TV hysterectomy

late miscarriage, preterm birth, PROM, postpartum endometritis

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10
Q

investigation for BV

A

outpatient/GP - low vaginal swab in transport medium to lab

GUM clinic - low vaginal swab (VVS), Gram stain veginal smear- shows purple if gram +ve

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11
Q

what does the gram staining of BV show?

A

purple

eggs with salt and pepper

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12
Q

management of BV

A

general advise - don’t douch, avoid antiseptic agents/bath products

Metronidazole (500mg BD for 7/7) /Clindamycin - oral or topical - can use in pregnancy/breast feeding but alter taste of the milk

only treat if symptomatic

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13
Q

what is the causative agent for candida

A

candida albicans 80-92%

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14
Q

RF for genital candida

A

immune suppression
antibiotic use
elevated oestrogen

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15
Q

symptoms of candida

A

vulval itch, soreness

thick white vaginal discharge

superficial dyspareunia

external dysuria - pain when urine touches skins

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16
Q

signs of candida

A 
erythema 
fissuring 
dicharge 
oedema 
satellite lesions 
excoriations - skin coming off
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17
Q

Ix for candida

A

often treated without investigation on typical symptoms

if not responsive to treatment then investigate

  • MC of gram stained vaginal slide in GUM
  • MC+S of low vaginal swab (VVS)
  • long purple bit - fungal hyphi
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18
Q

Mx of candida

A

general advise - routine use of soap substitute, regular emollient, avoid tight fitting synthetic clothing, local irritants

Clotriamzole perssary 500mg stat

fluconazole 150mg PO stat (not in pregnancy)

no need to treat asymptomatic male partners

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19
Q

What is the causative agent of trichomonas vaginalis

A

flagellated protozoon

almost exlcusively transmitted via sexual intercourse

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20
Q

what are the symptoms of TV

A 
10-50% asymptomatic 
inc vaginal discharge 
vulval itch 
dysuria
lower abdo pain
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21
Q

signs of TV

A

classical frothy yellow discharge in 10-30%

vulvitis

vaginitis

2% strawberry cervix

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22
Q

Ix for TV

A

high vaginal swab and wet mount - so the flagellated TV can swim

VVS NAAT

GP - test for pH which will be elevated

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23
Q

what will the pH of the vagina be if TV present

24
Q

Mx of TV

Study These Flashcards
A

general advise - sexual partners should be treated at the same time, avoid sex for 1/52 until partners treated

metronidazole - 200mg TDS for 7/7 or 400mg BD 7/7 or 2g for 1 dose
stat dose not suitable for pregnant ladies

25
what is the most commonly reported curable STI
chlamydia trachomatis
26
what age is the highest prevalence of chlamydia
< 25
27
RF for chlamydia
< 25 yrs new sexual partner > 1 partner per year lack of consistent condom use
28
symptoms of chlamydia
``` inc vag discharge dysuria PCB & IMB deep dyspareunia lower abdo pain ```
29
signs of chlamydia
mucopurulent cervicitis +/- contact bleeding
30
what is the window period of investigation for chlamydia
2 weeks
31
Ix for chlamydia
VVS NAAT in women | first pass urine in man
32
Mx of chlamydia
general advise - avoid sex for 1/52 until partners treated, test for cue if pregnancy, non-viable DNA can still be picked up after 3-5 wks following treatment uncomplicated - doxycycline 100mg BD for 1/7 or azithromycin 1g PO stat
33
complications of chlamydia
PID, endometritis, salpingitis tubal infertility ectopic pregnancy sexually acquired reactive arthritis (SARA) peri-hepatitis (Fitz-HughCurtis syndrome) - deranged LFT and dysuria
34
what is the causative agent for gonorrhoea
Nisseria gonorrheae
35
where does gonorrhoea usually infect?
mucous membrane ie urethra, endocervix, rectum, pharynx, conjunctiva
36
what are the symptoms of gonorrohea
altered vaginal discharge PCB or IMB or menorrhagia lower abdo pain in 25% urethral infection --> dysuria
37
what is a must have ddx if you have PCB
gonorrhoea --> poking the cervix so it bleeds
38
ix for gonorrhoea
gram stained slide for microscopy from infected site - dipococci VVS NAAT for gonorrhoea bacterial swab for gonorrhoea culture from infected site
39
mx for gonorrhoea
always culture for sensitivity avoid sex for 1/52 until treatment completed ceftriaxone 500mg IM 1g azithromycin PO as single dose
40
complication of gonorrhoea
PID
41
what is the general causes of urethral discharge in male
gonococcal --> gonococcal urethritis non-gonococcal --> chlamydia/ non-chlamydial eg mycoplasma genitalium/non-specific urethritis
42
what is the triad of urethritis
discharge discomfort dysuria
43
what must you do if there is urethral discharge in a man
always investigate
44
where are the primary sites of infection for gonorrhoea urethritis
urethra rectum pharynx so need 3 sites investigation in MSM
45
symptoms of gonorrhoea urethritis
80% will have urethritis +/- yellow discharge
46
ix for gonorrhoea urethritis
GUM setting --> gram stain microscopy or rectal smear --> dipolococci other setting --> NAAT from site of infection
47
mx for gonorrhoea urethritis
ceftriaxone 500mg IM & 1g azithromycin PO as single doses
48
complications of gonorrhoea urethritis as single doses in men
o Epididymo-orchitis, proctitis (inflammation of the lining of the gut), disseminated gonorrhoea
49
what can cause lymphogranuloma venereum
chlamydia in male
50
symptoms of chlamydia in man
o lymphogranuloma venereum (long term lymphatic system infection –lymphadenopathy) o Clear/white discharge o rectal symptoms investigate for lymphogranuloma venereum
51
ix for chlamydia urethritis
o GUM  gram stained urethral or rectal smear meeting | o Other siting  NAAT from sites of infection
52
mx of chlamydia in man
o Doxycycline 100mg BD for 7/7 (C/I in pregnancy) or azithromycin 1g PO stat o If Epididymo-orchitis  extended treatment
53
what are some of the causative organisms of chlamydia
``` C.trachomatis Mycoplasma genitalium ureaplasma Trachomons vaginalis adenovirus HSV ```
54
Ix for non-specific urethritis
Gum --> gram stain urethral smear other setting --> NAAT swab if -ve and symptom persist then refer to GUM leucocyte esterase test --> +ve leucocuyre on FPU indicative of urethritis
55
Mx of NSU
doxycycline 100mg BD 7/7 or azithromycin 1g stat

Y4 - GOSH (12 decks)

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