Sexual Health Flashcards
(52 cards)
What is the epidemiology of STIs?
Infection with more than one STI is common - if have Chlamydia, may very well have gonorrhoea - so check for all
Why is it important to ask about whether STI patients have had Abx in the past few months?
(depending on the Abx) May have partly treated the STI and give a false result on swab culture for example - need to wait a couple of weeks then repeat again
Why is it important to ask men about their last voiding?
Bacteria like Chlamydia are urethral colonising - if recently voided, will give poor swab - need to be about 1.5hrs to allow good colony growth
What might you find in examination of inguinal lymph nodes?
Painful lymph nodes - herpes
Non painful lymoh nodes - syphilis (also single ulcers on penis - Shankar? or kissing lesions)
What are the baseline tests for an asymptomatic sexually active woman?
Self taken vulvo-vaginal swab:
Gonorrhoea/chalmydia nucleic acid amplification test (NAAT; type of PCR)
Bloods:
HIV + Syphilis
What are the baseline tests for an asymptomatic sexually active men?
First catch urine:
Important to be first catch as will be flushing of urethral bacteria
Chlamydia + Gonorrhoea NAAT
Bloods:
HIV + Syphilis
Additional tests in men who have sex with men (MSMs):
Pharyngeal + rectal swabs for Chlamydia/Gonorrhoea
Hep B (+/- C) bloods
What are the baseline tests for a symptomatic sexually active women?
Vulvo-vaginal swab for Gonorrhoea + Chlamydia NAAT
High vaginal swab (wet & dry slides) for Bacterial Vaginosis (BV); Trichomonas Vaginalis (TV); Candida
Cervical swab for slide + Gonorrhoea culture
Dipstick urinalysis (If has dysuria)
Blood:
HIV + Syphilis
What are the baseline tests for a symptomatic sexually active men?
Urethral swab for slide + Gonorrhoea culture ad sensitivity
First void urine for Gonorrhoea + Chlamydia NAAT
Dipstick urinalysis (If has dysuria)
Blood:
HIV + Syphilis
MSMs:
Test as for asymptomatic MSM
+ urethral and rectal slides
+ urethral, rectal, pharyngeal culture plates
What do different discharges indicate?
Gonorrhoea - thick gloopy, yellow
Chlamydia - thinner, white
Candidiasis - cottage cheese curds - not smelly
Trichomonas - green/yellow frothy - offensive
BV - thin, white/grey - fishy on whiff test (KOH drop added to discharge)
What are the characteristics of some genital lesions?
Molluscum - round, pale swellings with small dot/pore in the middle
Genital warts - HPV - fleshy, soft, possible cauliflower appearance bumps
Syphilis - single, painless ulcer (chancre)
Herpes - multiple, white raised bumps that burst to leave open red sores
What does Gonorhoea look like under the microscope
G-ve diplococci
Who is offered Hep B screening?
MSM
Commercial sex workers (CSW) +
IVDUs (including past) and their sexual partners
People from high risk areas and their sexual partners - Africa, Asia, Eastern Europe
Aim to vaccinate if non-immune
What are double and triple swabs?
Double swabs include a NAAT swab to test for both chlamydia and gonorrhoea and a high vaginal charcoal swab to test for fungal and bacterial infections such as candida albicans and bacterial vaginosis
Triple swabs include an endocervical chlamydia swab (usually in a pink wrapper), an endocervical sample using a charcoal swab to pick up gonorrhoea and a third sample, using a charcoal high vaginal swab to test for fungal and bacterial infections.
How does confidentiality work in GUM?
Can’t tell anyone outside clinic, GUM stuff kept within clinic, not told GP (unless other professional involvement required e.g. in HIV?)
Can’t tell sexual partners what is going on, done formally though contact tracing - left for partner to tell
How does contact tracing work?
Contact identification: Once someone is confirmed as infected with a virus, contacts are identified by asking about the person’s activities and the activities and roles of the people around them since onset of illness. Contacts can be anyone who has been in contact with an infected person: family members, work colleagues, friends, or health care providers.
Contact listing: All persons considered to have contact with the infected person should be listed as contacts. Efforts should be made to identify every listed contact and to inform them of their contact status, what it means, the actions that will follow, and the importance of receiving early care if they develop symptoms. Contacts should also be provided with information about prevention of the disease. In some cases, quarantine or isolation is required for high risk contacts, either at home, or in hospital.
Contact follow-up: Regular follow-up should be conducted with all contacts to monitor for symptoms and test for signs of infection.
How does Chlamydia present?
Usually between 1-3 weeks post infection, symptoms may be persistent or self resolve - if resolves doesn’t mean is cured, may still be an infection risk
Men: Dysuria Red, itchy urethral meatus Thin white non smelling discharge Dysparunia Painful testicles - epididymoorchitis
Women:
Most are asymptomatic
If they do present - as above + bleeding with sex or between periods
May end up with pelvic inflammatory disease, risk of infertility and ectopic pregnancies if untreated - why contact tracing is especially important
How do you treat Chlamydia?
1st line:
Doxycycline - 100mg PO BD for 7days
- contraindicated in pregnancy
2nd line:
Azithromycin - 1g PO on day one then 500mg OD for 2days
What are some complications of Chlamydia infection?
Reactive arthritis - cant see/wee/climb tree - TREATMENT?
Can cause infertility in women if left undiagnosed and untreated
How does Gonorrhoea present?
Asymptomatic - in 1/10 men and 50% of women
Thick yellow discharge from penis or vagina
Dysuria
Intermenstrual bleeding
If congenital - eye signs e.g. conjunctivitis, eye discharge
How is Gonorrhoea treated?
Should do MC+S before prescribing to check for resistance
Some options are:
Ceftriaxone 1g IM as a single dose
Ciprofloxacin 500mg PO as a single dose
Pharyngeal gonorrhoea is harder to get rid of than genital/anal
How does Syphilis present?
Bacterial infection= Treponema pallidum
4 stages:
Primary- lesion an the site of sexual contact = syphilitic chancre (painless, firm skin ulceration 1-2cm), solitary raised painless lymph node
Secondary- palmar-plantar erythematous rash (also whole body), systemic features of illness (fever, malaise, headache, weight loss)
Latent - split into early and late, late not as contagious, neither are symptomatic but still seropositive, may relapse
Tertiary- 1-46yrs later depending on manifestation, 3x main types: gummatous = soft tumour-like balls of inflammation in bones, skin, liver etc; neruosyphilis = dementia mimic (memory loss, personality change..), apathy seizures; cardiovascular = aortitis and aortic aneurysms
Also a congenital form - dental defects; 1-3yrs after birth = splenomegaly, fever, rash, neurosyphilis
How is Syphilis treated?
Benzypenicilin - IM
Contact tracing, sex abstinence and condoms
What is vaginal candidiasis? How does it present and how is it manged?
Caused by Candida albicans
Presentation:
Itching + reddening around the vulva
‘Curdy’ white discharge with a pH <4.5; no odour
Dysparunia
Management:
Topical clotrimazole cream
What is Bacterial vaginosis? How does it present and how is it managed?
Caused by: an imbalance in natural national flora - reduction of lactobacilli and increased in e.g. gardinerella vaginalis
Presentation:
Offensive, thin, white/grey, ‘fishy’ smelling discharge
Clue cells on microscopy
Associated with premature birth so still needs managing if discovered
Management: metronidazole PO; avoid shower gels, douching etc that would upset the flora
