Sexual health Flashcards
(44 cards)
Gram negative diplococci on microscopy with STI symptoms= ?
Neisseria gonorrhoea
First line treatment for keratinised HPV anogenital warts?
Topical imiquimod for 8 weeks
Second line treatment for keratinised HPV anogenital warts?
Ablative cryotherapy
Dark ground microscopy is used for the diagnosis of which STD?
Syphilis
A 28-year-old female attends your GP surgery complaining of a 2-week history of change in vaginal discharge. Her LMP was 2 weeks ago, her period are regular and of moderate flow. She is sexually active with her regular male partner of 2 years. She has an intra-uterine device in place that was fitted 2 years ago. She denies other partners. The discharge is clear to grey, watery and malodorous. She denies any symptoms of itch, pain, dysuria or abnormal bleeding. Most likely diagnosis?
Bacterial vaginosis
Name 3 RFs for BV
Afro-Caribbean race, IUD, presence of other STI, douching, new sexual partner, receptive cunnilingus, smoking
First line treatment of BV?
PO metronidazole
Either 2g stat or 400mg BD for 5 days
If allergic to metronidazole, what is second line treatment for BV?
Clindamycin
2 risks associated with BV in pregnancy?
Late miscarriage
Post-partum endometritis
Premature rupture of membranes
Pre-term birth
Posterior fornix swab for wet mount is the investigation to diagnose what?
Trichomonas vaginalas
A male patient presents to Sexual Health Sheffield due to the presence of an indurated ulcer on his penis, with lymphadenopathy of the inguinal lymphnodes. He has had 8 sexual encounters in the last 6 months, all with men, some using protection but some without.
Given the likely diagnosis, what is the causative organism?
What Ix should you do?
What Ix is most sensitive and specific for this condition?
What is the first line treatment?
Second line?
Treponema pallidum
Full STI screen including HIV. For syphilis: Treponemal Enzyme Immunoassay. If these indicate syphilis, would do VDRL or RPR tests.
Dark field microscopy is most sens and spec
IM benzathine penicillin
2nd line = azithromycin
On average, how long after primary infection does secondary syphilis occur?
How does it present?
6 weeks
Variable presentation e.g. fever, myalgia, lymphadenopathy, generalised maculopapular rash over palms, soles, trunk and face.
What is condylomata lata?
Possible characteristic of 2ndary syphilis. Buccal ‘snail-track’ ulcers and warty genital lesions.
What is latent syphilis?
Positive serology without clinical features, with infection being acquired less than 2 yrs preior.
What proportion of untreated syphilis will go on to have tertiary syphilis?
What are possible manifestations?
1/3
Syphilitic gummas, cardiovascular sequelae (aortitis, aortic regurgitation, aortic aneurysm), neuro (Argyll-Robertson pupils, tabes dorsalis, ataxia, behavioural disturbance, paralysis, seizures)
What is tabes dorsalis?
Demyelinating disorder of the dorsal columns related to syphilis. Features = loss of proprioception and vibration, weakness, ataxia, positive Romberg sign.
What is first line investigation for gonorrhoea?
What else would you do with a specimen?
NAAT of urine or gential specifimes
Culture and sensitivities
What is the treatment for gonorrhoea and what follow up is required?
Ceftriaxone 1g IM
What is the classic triad of symptoms of disseminated gonococcal infection?
Tenosynovitis, migratory arthritis and dermatitis
A male patient presents to GUM clinic with dysuria, discharge and testicle pain. You suspect gonorrhoea and/or chlamydia. What Ix would you do to confirm this?
NAAT of urine (or genital for girls), and MC+S.
What is first line method of NAAT in a) F and b) M?
a) Vulvovaginal swab
b) First void urine sample
When should chlamydia screening take place following potential exposure?
2 weeks after
First line treatment of chlamydia?
Alternative if CI?
7 days 100mg BD doxycycline
1g azithromycin stat
Which types of HPV are responsible for the majority of anogenital warts?
6 and 11
