Sexual Health Flashcards
(130 cards)
What do the Fraser Guidelines relate to?
Giving contraception and sexual health advice to those under 16 without parental consent
Pneumonic to remember Fraser competence
UPSIS = unprotected sex is silly
young person Understands the advice given
Parental involvement encouraged by clinician
young person likely to continue having Sexual intercourse
it is in the young persons best Interest to supply them with contraception
Young persons physical and mental health is likely to Suffer without contraception
What is the Sexual Offences Act 2003?
Sexual intercourse and all forms of sexual touching of minors (under 16yrs) are illegal in England and Wales
Children under 13 years are deemed incapable of consent. It is therefore classified as rape or sexual assault and must be reported.
There is no legal obligation to report sex between 13-16 yr olds unless exploitation is suspected
What is the commonest STI and which age group is it most common in?
Chlamydia Trachomatis
Commonest in 15-25 age group (approx 5% infected)
Why is chlamydia trachomatis difficult to culture?
It is an obligate intracellular bacteria (cannot replicate outside of host cell)
What is the incubation period of chlamydia trachomatis?
1-3 weeks
What % of people with chlamydia are asymptomatic?
50% men and 75% women
Thus often found on screening, contact tracing or when complications present
What are the signs/symptoms of chlamydia infection in females?
- Increased vaginal discharge secondary to cervicitis
- Urethritis (dysuria, frequency, urgency)
- PCB and IMB
- Deep dyspareunia
- Lower abdo pain
- +/- contact bleeding
What complications can arise from chlamydia infection in women?
PID (10-30% infections) Tubal infertility Increased risk of ectopic pregnancy Perihepatitis - Fitz-Hugh-Curtis syndrome Reactive arthritis (more common in men)
What is Reiters disease (Reactive Arthritis)?
Triad of:
- Arthritis
- Urethritis
- Conjunctivitis
(occurs after infection, esp of GI or urogenital tract)
Can’t pee, see or climb up a tree
What are implications of chlamydia infection in pregnancy?
PROM and premature delivery
Low birth weight
Postpartum endometriosis
Infection can spread from the cervix into the uterine cavity causing chorioamnionitis
What are the signs/symptoms of chlamydia infection in males?
- Dysuria
- Urethral discharge = white, cloudy or watery
- Testicular pain due to epididymo-orchitis
- Scrotal pain / swelling
What complications can arise from chlamydia infection in men?
- Acute epididymo-orchitis (usually unilateral pain)
- Proctitis
- Infertility
- Reactive arthritis
How does chlamydia present in neonates?
- Neonatal conjunctivitis (30% within first 2 weeks)
- Neonatal pneumonia (15% within first 4 months)
- Otitis media
- Can develop vaginal infection
What investigations are done for chlamydia? What is the window period?
Women:
- Vulvovaginal swab + NAAT
- First catch urine sample
Men:
- Urethral swab + NAAT
- First catch urine sample
Window period = 2 weeks
What is the treatment for chlamydia?
Doxycycline 100mg PO BD for 7 days
If doxycycline contraindicated :
Azithromycin 1g PO STAT
If doxycycline and azithromycin contraindicated:
Erythromycin 500mg BD for 10-14 days
Oflaxacin 200mg BD or 400mg OD for 7 days
Abstinence until partner is treated and Abx completed
What is the treatment for chlamydia in pregnancy?
Azithromycin 1g PO STAT
Test of cure
If azithromycin contraindicated:
Erythromycin 500mg BD for 10-14 days
Test of cure
What is the causative organism of Gonorrhoea infection? Describe it
Neisseria gonorrhoea - intracellular gram negative diplococcus
What are the initial sites of infection of chlamydia and gonorrhoea?
Columnar epithelium of urethra, endocervix, rectum, pharynx or conjunctiva (depending on mode of exposure)
What is the incubation period of gonorrhoea?
2-5 days (in 80% men who develop urethral symptoms)
Asymptomatic gonorrhoea is particularly common in which sites?
Pharynx, cervix and rectum (common in both sexes)
What are the signs/symptoms of gonorrhoea infection in females?
Symptoms • Altered/increased vaginal discharge - thin, watery, green/yellow • Dysuria • Dyspareunia • Lower abdominal pain • IMB or PCB - rarely
Signs
• Mucopurulent endocervical discharge from cervical os, urethra, Skene’s glands or Bartholin’s glands
• Easily induced cervical bleeding
• Pelvic tenderness
What are complications of gonorrhoea infection in females?
- PID (approx 15% infections)
- Bartholin’s or Skene’s abscess
- Tubal infertility
- Increase risk of ectopic pregnancy
- Disseminated gonorrhoea = fever, pustular rash, migratory polyarthralgia, septic arthritis
- Rarely gonococcal endocarditis (M&F)
What are the complications of gonorrhoea infection in pregnancy?
Chorioamnioitis
Postpartum endometritis
PROM, premature delivery and low birth weight