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4th Year > Sexual Health > Flashcards

Sexual Health Flashcards

(116 cards)

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1
Q

What are the 4 parts of a sexual history?

A
  1. With whom - male/female, regular/casual
  2. Type of sex - oral, vaginal, anal
  3. Condoms and contraception
  4. Risk assessment
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2
Q

What are the 5 parts of a risk assessment?

A
  • Known HIV +ve partner
  • MSM
  • IVDU
  • Sex with someone born outside UK
  • Paid or been paid for sex
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3
Q

What makes up an STI screen for an asymptomatic female?

A

Own VVS for chlamydia and gonorrhoea

Bloods for HIV, syphilis and hep B

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4
Q

What makes up an STI screen for a SYMPTOMATIC female?

A 
VVS for C+G - NAAT
2nd VVS for microscopy
Speculum - cervical smear if needed
HVS for BV, candida and Trichomonas - slide and plate
Endocervical swab for G culture
Bloods for HIV, S, Hep B
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5
Q

What colours are the NAAT and HVS/ECS tubes?

A 
NAAT = red
HVS/ECS = black
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6
Q

What makes up an STI screen for asymptomatic males?

A

1st void urine test for C+G

Bloods for HIV, S, Hep B

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7
Q

What makes up an STI screen for SYMPTOMATIC males?

A

Urine
Bloods
Urethral opening swab - slide and plate
Examine pelvis and penis

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8
Q

What makes up an STI screen for an asymptomatic MSM?

A

Throat, rectum, penis swab
Urine
Bloods

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9
Q

What makes up an STI screen for a SYMPTOMATIC MSM?

A

2x triple swab
Urine
Bloods
Examination

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10
Q

What type of test is a VVS?

A

NAAT test for C+G

2 week window

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11
Q

What type of test is first void urine?

A

NAAT test for C+G

2 week window

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12
Q

What type of test is a HVS?

A

Microscopy for BV, Candida and trichomonas

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13
Q

What type of test is an endocervical swab?

A

Culture for gonorrhoea sensitivities

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14
Q

What are the blood tests done in an STI screen?

A

HIV antibody and p-24 antigen - 3 month window
Syphilis treponemal antibody - 5 week window
Hep A IgM
Hep B surface antigen (HBsAh)
Anti-HCV

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15
Q

What type of test is a viral swab?

A

Viral PCR for herpes

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16
Q

What is chlamydia?

A

Intracellular bacteria

Affects columnar epithelium of GU tract

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17
Q

What are the symptoms of Chlamydia?

A

Vaginal discharge - mucopurulent
Lower abdominal pain
PCB, IMB

Dysuria and urethral discharge in men

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18
Q

How is Chlamydia diagnosed?

A

NAAT
VVS in women (red tube)
First void urine or urethral swab in men

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19
Q

What is the treatment of chlamydia?

A

1g Azithromycin STAT then 500mg next day, 250mg day after

OR 100mg Doxycycline BD 7 days

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20
Q

What advice should you give people with Chlamydia?

A

Abstain during treatment of both partners completed
Future condom use
Test for cure not necessary unless pregnant

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21
Q

What are some complications of chlamydia?

A 
PID
Reactive arthritis
Reiter's syndrome
Fitz-Hugh-Curtis syndrome
Conjunctivitis
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22
Q

What are the features of PID?

A

Abdo pain

Tubal infertility possibly

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23
Q

What is Reiter’s syndrome?

A

Triad of:

  • Urethritis
  • Arthritis
  • Conjunctivits

Associated with HLA-B27

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24
Q

What is Fitz-Hugh-Curtis syndrome?

A

Perihepatitis - characterised by pyrexia, RUQ pain, guarding, abnormal LFTs

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25
What are the complication of chlamydia in pregnancy?
IUGR Chorioamnionitis Preterm delivery/PROM Miscarriage
26
What is the treatment of chlamydia in pregnancy?
Erythromycin Doxycycline = contraindicated in pregnancy
27
What are two neonatal complications of chlamydia?
Ophthalmia neonatorum | Neonatal pneumonitis
28
What is ophthalmia neonatorum?
Presents 1-2 weeks Conjuctivitis, conjunctival oedema, purulent exudate Tx = erythromycin
29
What is neonatal pneumonitis?
Presents 1-3 months Staccato cough, tachypnoea Tx = erythromycin
30
What type of bacteria is gonorrhoea?
Gram-negative diplococcus
31
What are the symptoms of gonorrhoea?
``` Vaginal discharge - endocervical Lower abdominal pain Dysuria Proctitis with rectal bleeding Urethral discharge in men ```
32
How is gonorrhoea diagnosed?
Endocervical swab - culture VVS - NAAT Urethral, rectal, throat swabs
33
What is the treatment of gonorrhoea?
Ceftriaxome 500mg IM Azithromycin 1g PO etc TEST FOR CURE
34
What are some complications of gonorrhoea?
PID Subfertility Bartholin's abscess Similar to chlamydia
35
What is the treatment of gonococcal PID?
Ceftriaxone STAT plus doxycycline AND metronidazole for 14 days
36
What is Thrichomonas vaginalis?
Flagellate protozoan
37
How does TV present?
``` Vulval soreness and itching Foul smelling frothy green discharge Dysuria Dyspareunia Strawberry cervix ```
38
How is TV diagnosed?
Vaginal pH >5.0 | Seen on saline wet-mount (pathognomonic)
39
What is the treatment of TV?
Metronidazole 2g STAT or 400mg BD 7 days Both partners and contact tracing Test for cure
40
What is bacterial vaginosis?
Increased anaerobes and decreased lactobacilli -> alkaline pH Eg. Gardenella vaginalis, Mycoplasma hominis etc
41
What are the features of BV?
Fishy discharge Grey/white discharge adherent to vaginal walls More prominent during and following menstruation
42
What is the Amsel criteria for diagnosing BV?
1. Presence of clue cells on microscopy 2. Creamy grey/white discharge seen 3. Vaginal pH >4.5 4. Release of fishy odour upon alkali addition Need 3+ for diagnosis
43
What is the Hay criteria for BV?
Grade 1 = normal, lactobacillus predominates Grade 2 = intermediate, Gardenerella +/- Mobiluncus seen with lactobacillus Grade 3 = BV, lactobacillus absent, mostly Gardenerella
44
What is the treatment for BV?
Metronidazole 400mg BD 5 days or 2g STAT
45
Why is BV an issue in pregnancy?
If in 1st trimester, can cause late 2nd trimester miscarriages
46
What should women with a history of 2nd trimester miscarriages have?
Early pregnancy vaginal swab and treatment
47
What is vulvovaginal candidiasis?
90% = candida albicans
48
What are some risk factors for candidiasis? (5)
``` Pregnancy Immunocompromised High dose COCP Broad spectrum Abx HRT ```
49
What are the features of candidiasis?
``` Vulval itching and soreness Thick cottage cheese discharge Dyspareunia Dysuria Erythema ```
50
What is the vaginal pH of candidiasis?
Normal
51
How is candidiasis diagnosed?
HVS microscopy - see budding yeasts and pseudohyphae | Cultured on Sabutaud's medium
52
What is the treatment of candidiasis?
Only if symptomatic 500mg Clotrimazole pessary OR topical 10% clotrimazole cream OR oral fluconazole 150mg
53
What is the treatment of a complicated candida infection?
Same but for 2 weeks | Eg. severe, pregnancy, DM
54
What is recurrent candida infection?
4+ episodes per year with positive microscopy | Tx = Fluconazole 150mg PO 3 doses every 72hrs then 150mg weekly for 6 months
55
What is lichen simplex?
Chronic rubbing causes eczema and itching causes lichenification
56
What are the features of lichen simplex?
Poorly demarcated plaques with scaling, excoriations and lichenification
57
What is the management of lichen simplex?
Emollients mainly | Possibly mild topical steroids
58
What causes lichen planus?
Unknown
59
What are the features of lichen planus?
Itchy, papular eruption with a fine scale | Can also be oral - white stripes on tongue = Wickham's stricture
60
What is the treatment of lichen planus?
Conservative - usually self-limiting | Same as lichen simplex
61
What is lichen sclerosis?
Destructive inflammatory skin condition Affects anogenital area Often have another AUTOIMMUNE condition
62
What causes lichen sclerosis?
Autoimmune | Hyalinization of skin -> fragility and loss of anatomy
63
What are the features of lichen sclerosis?
Fragile skin Loss of anatomy Stricturing and narrowing of vaginal opening Vulval itching
64
What investigation may be useful for lichen simplex?
Biopsy - can confirm diagnosis
65
What is the treatment of leeching sclerosis?
Potent topical steroids
66
What is a complication of lichen sclerosis?
Squamous cell carcinoma
67
What is vulvodynia?
Vulval discomfort, often BURNING | In absence of skin disease
68
What are the features balanitis?
Sore, inflamed glans penis Can't retract foreskin Dysuria Possibly discharge
69
What can cause candida balanitis?
Diabetes - do BM and urine dip Oral Abx Poor hygiene Immunosuppression
70
What are some skin changes that may be present with candida balanitis?
Red papules with superficial erosions | White plaques
71
What is the treatment of balanitis?
Candida = Clotrimazole 1% cream Bacterial = Flucloxacillin Anaerobe = Metronidazole Hygiene measures
72
What are Pthyris pubis?
Pubic lice/crabs
73
What are the features of Pthyris pubis?
Genital itch Blue spots Perifolliculitis
74
What would indicate a diagnosis of Pthyris pubis?
Egg is pubic hair
75
What is the treatment of Pthyris pubis?
Permethrin 1% | Treat all sexual contacts
76
What are Hirsuties coronae glandis or coronal papules?
Pearly penile papules on ridge of glans penis | Normal
77
What are epidermoid cysts?
Small hard lumps which grow under the skin
78
What are Fordyce spots?
White/yellow bumps due to enlarged oils glands | Generally on face, can be on genitalia
79
What are the types of Herpes?
``` HSV1 = oral infection HSV2 = anogenital infection ```
80
What happens once infected with herpes?
Can remain latent in sensory ganglia | Lytic lesions at times of stress
81
What are the features of primary HSV infection?
Irritation or parasthesia at lesion site -> painful papule -> ulcer Whole episode completed within a week Some systemic flu-like symptoms also
82
What are the features of HSV reactivation?
Times of stress/menstruation Shorter and less severe than primary infection 50% patients
83
How is HSV diagnosed?
Clinical | Can do viral PCR swab (black tube)
84
What is the treatment of HSV infection?
Aciclovir 400mg TDS oral 5 days
85
What is the treatment of recurrent HSV?
None needing, self-limiting Saline baths and analgesia Frequent attacks = acyclovir in first 24hrs of attack
86
What are the complications of HSV infection?
Autonomic neuropathy -> urinary retention Aseptic meningitis Secondary bacterial infection
87
What do you do if a women gets primary herpes in the 1st or 2nd trimester?
Give Aciclovir 400mg TDS from 36 weeks | Reduces reactivation risk and need for LSCS
88
What do you do if a women gets primary herpes in the 3rd trimester?
Takes 6 weeks for antibody response to develop against HSV to protect neonate Greatest risk LSCS recommended Same as 1st/2nd trimester Mx otherwise
89
What is the management if a women has active HSV in labour?
LSCS | If vaginal delivery occurs = IV acyclovir for mother and neonate and avoid invasion procedures
90
What causes genital warts?
HPV 6 and 11
91
How are genital warts transmitted?
Gains entry via basal epithelial layer through microabrasions during sexual contact
92
How are genital warts prevented?
Gardasil vaccination at 12yrs includes 6 and 11 subtypes
93
What is the incubation period for genital warts?
3 months | Anywhere from 3wks to 2yrs
94
Can you contract genital warts from an asymptomatic partner?
Yes
95
What therapies are available for genital warts?
Ablation Immune modulation Surgery
96
What are the ablative therapies for genital warts?
Cryotherapy - if <6 warts | Podophyllotoxin cream - it >6 warts
97
What are the immune modulation therapies for genital warts?
Imiquimod 5% cream = keratinised, persistent or recurrent warts Lower recurrence rate (30%)
98
What organism causes syphilis?
Treponema pallidum
99
How is syphilis transmitted?
Abrasion in skin or intact mucous membrane | 3 week incubation
100
How does primary syphilis present?
9-90 days post-expose Painless ulcer = chancre Resolves in 2-6 weeks
101
How does secondary syphilis present?
6 weeks to 6 months post-exposure Generalised infection and lymphadenopathy Maculopapular rash on palms and soles Systemic symptoms
102
How does tertiary syphilis present?
10-40 years post-exposure | With severe organ effects
103
What is neurosyphilis?
Dorsal column loss, dementia, meningeal involvement
104
What is cardiovascular syphilis?
Aortic regurg, AAA, angioma
105
What are gumma?
Locally destructive fibrous nodules | Affect bones and skin generally
106
What is early latent syphilis?
Positive serology but no clinical evidence in first 2yrs of infection
107
What is late latent syphilis?
Positive serology after >2yrs of infection
108
What investigations should be performed for suspected syphilis?
Serology Dark group microscopy from ulcer PCR from ulcer
109
How accurate is serology?
Primary = 70-80% Secondary = 100% Repeat in 3 months if negative with genital ulcer
110
What is the advantage of microscopy and PCR?
Can give immediate treatment
111
What is the treatment for syphilis?
Benzathine Penicillin 2.4MU IM STAT
112
What is the 2nd line treatment for syphilis?
Oral azithromycin
113
What is the treatment of neurosyphilis?
Procaine benzylpenicillin 750mg IM for 10 days OR Doxycycline 100mg BD 14 days
114
What is Jarisch-Herxheimer reaction?
Reaction to syphilis treatment Acute febrile illness with headache, myalgia, chills Usually resolves within 24 hours
115
What is the major complication of syphilis infection in pregnancy?
1/4 have 2nd trimester miscarriage or stillbirth | 10% chance of neonatal death
116
What measures are taken to avoid syphilis in pregnancy?
All women screened at booking

4th Year (15 decks)

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