Sexual medicine & STI's

Question 1

A 58yr old poorly controlled diabetic presents with increased D/C that is white and thick. She also has itching and superficial dyspareunia.
What investigation would you do and how would you treat?

Answer 1

Thursh
Ix: vaginal swab for microcopy and culture
Rx: Fluclonazole - pessary and capsules

Question 2

A 24 year old presents with increased vaginal D/C which is a white/grey colour and is very perfuse.
What investigation would you request and what would you suspect would be the cause?

Answer 2

Bacteria vaginosis
Cause: Gardnella vagunalis
Dx: Wet microscopy - clue cells, +ve whiff cells, pH >4.5

Question 3

How do you treat bacteria vaginosis?

Answer 3

Metronidazole

Question 4

Describe how trichomoniasis would present?

Answer 4

V bad
Yellow frothy D/C, offensive smell
Itching, soreness, dyuria, abdopain, superficial dyspareunia

Question 5

What is trichomoniasis caused by?

Answer 5

Tricomonas vaginalis

Question 6

How do you diagnose and treat gonorrhoea?

Answer 6

Dx: Charcoal swabs NAAT
Rx: Im Ceftriaxone and PO azithromycin

Question 7

How do you diagnose and treat chlamydia?

Answer 7

Dx: 1st void urine or endocervcical swabs NATT tets
Rx: Doxycycline

Question 8

How do you diagnose and treat HSV?

Answer 8

Dx: swabs for DNA PCR
Rx: Acyclovir

Question 9

A 34yr old female presents with very foul d/c that is mucopurulent. O/E she has a fever and has cervical motion tenderness and bilateral pelvic pain.
What do you think is the causes and how would you treat?

Answer 9

PID - from chlamydia or gonococcus
Dx: endocervical swabs / laparoscopy with fimbiral biopsy
Rx: IM cefriaxone then doxycycline +/- metronidazole

Question 10

What are the complications associated with chlamydia?

Answer 10

Pelvic infection
Tubual damage - sub fertility + chronic pelvic pain
Reiters syndrome - 1) urethritis 2) conjunctivitis 3) arthritis

Question 11

What are the complications associated with gonorrhoea?

Answer 11

Bacteraemia

Acute monoarticular septic arthritis

Question 12

What are the differentials for genital ulceration?

Answer 12

Genital herpes (HSV1 & 2) 
Syphyilis 
Trauma 
Candidia
Neoplasm

Question 13

When would you suspect syphilis?

How would you treat it?

Answer 13

Painless ulcers that are thicker and with a negative herpes test
Send them for a syphilis blood test
Rx: Benzylpenicillin

Question 14

What causes genital warts and how are they prevented?

Answer 14

Human papillomavirus HPV

Prevented with HPV vaccine given to 12-13year old school girls

Question 15

A 19 year old presents with some warty type things on his buttock. They are painful vesicles and he also has a lump in his groin. What could be the cause and how would you treat?

Answer 15

Genital herpes from HSV

Rx: Acyclovir

Question 16

How long should someone live in their preffered gender to receive a diagnosis of gender dysphoria?

Answer 16

2 years

Question 17

What is the treatment for male to female conversion?

Answer 17

Hormonal

Oestrogen’s, facial hair removal and vaginoplasty

Question 18

What is the treatment for female to male conversion

Answer 18

Hormonal
Testosterone (patch/injection)
Oestrogen blocker
Surgery - bilateral mastectomy then phalloplasty

Question 19

What is hypoactive sexual desire disorder?

Answer 19

Hypoactive sexual desire disorder (HSDD) or inhibited sexual desire (ISD) is considered a sexual dysfunction and is characterized as a lack or absence of sexual fantasies and desire for sexual activity, as judged by a clinician.

Question 20

What is a sexual growth program?

Answer 20

Enabes patients to overcome their own sexual needs through exploration of physical responses - works with a therapist to understand and overcome negative beliefs and unhelpful thinking patterns

Question 21

What is erectile dysfunction?

Answer 21

Difficulty in developing/maintaining an erection suitable for satisfactory intercourse

Question 22

RF for ED

Answer 22

CVD, DM, neurological disorders

Iatrogenic anti hypertensives, post prostate surgery, antidepressents

Question 23

Causes for ED

Answer 23

Age related, ineffective sexual stimuli, pain,

veno-occulsive disorder

Question 24

What are the non-pharmacological treatments options of ED?

Answer 24

Vaccum device, scrotal ring, enhancing lubricants/vibrators

Question 25

What medications for ED

Answer 25

Sildenafil (viagra) | Tadalafil (SE: headaches, flushing) weekend one

Question 26

Treatment for female sexual arousal disorder

Answer 26

couples psychosexual therapy - CBT, psychodynamic

Question 27

Behavioural intervention device which is proven for orgasmic disorder

Answer 27

The Eros therapy device - greater clitoral and genital engorgement - increased vaginal lubrication and enhanced ability to achieve and orgasm

Question 28

Causes of dyspareunia (S+D)

Answer 28

PID (D), Endometriosis (D), | Thursh (S), Herpes (S), vaginismus (S)

Question 29

Causes of rapid ejaculaiton

Answer 29

Genetic susceptibility, penile hypersensitivity, hyperthyroidism, prostasis

Question 30

Psychological causes of rapid ejaculation

Answer 30

Lack of experience, anxiety states, early learned experience, relationship issues

Question 31

Treatment options for rapid ejaculation

Answer 31

Couple psychosexual therapy, behavioural interventions and topical local anaesthetic spray

Question 32

What medication can you give someone who is change from man into a woman?

Answer 32

Synthetic oestrogen = ethinylestradiol | Anti-androgen = finesteride

Question 33

What medication can you give someone who is change from woman into a man?

Answer 33

Testosterone