Week 9 Reproductive System Flashcards

Question

Threatened Abortion

Answer 1

→ unexplained vaginal bleeding in the first trimester of pregnancy → also called threatened early pregnancy loss → often associated with pelvic cramping with no cervical dilatation → may result in complete or incomplete abortion or the pregnancy may continue without any further concerns.

Answer 2

→ all products of conception are spontaneously expelled within the first 20 weeks of gestation → also called complete abortion → physically and emotionally painful → associated with heavy vaginal bleeding, severe cramping, vaginal loss of fluid and tissues, moderate to severe pain to pelvis and lower back

Answer 3

→ same as for spontaneous abortion but with only partial expulsion of the products of conception (usually the foetus) → it is important to note that the term incomplete can be confusing for women and therefore providing false hope should not be encouraged.

Answer 4

→ A threatened abortion becomes an inevitable miscarriage when cervical dilation starts to occur, and the products of conception are expelled.

Answer 5

→ gynaecological emergency → severe uterine infection that occurs just prior to, immediately after, a spontaneous abortion.

Answer 6

→ occurs when a pregnancy stops developing and the products of conception remain in the uterus → also referred to as an early pregnancy failure → surgery is required to remove the products of conception → common clinical manifestations include pelvic pain and cramping, or the patient will be asymptomatic

Answer 7

→ a history of three or more abortions

Answer 8

Identification of associated clinical manifestations → you need to be vigilant in your assessments and health history to be able to promptly identify the clinical manifestations of a spontaneous abortion, such as vaginal bleeding, pelvic pain, and the passage of tissue. Prompt recognition allows for timely intervention and emotional support. Emotional Support → miscarriages can be emotionally distressing for the woman and their partner / family. You must develop empathetic and compassionate skills to address their feelings of grief, loss, and sadness. Providing a safe space for the patient and their family / support, to express their emotions is crucial. Physical assessments → Monitoring and assessing the patient’s physical health is essential. This includes assessing vital signs, managing bleeding, and identifying any signs of complications. Collaboration with the interprofessional team ensures appropriate interventions are implemented. Grief Support and Coping → You can equip your patients and their families with resources for grief counselling and support groups. Facilitating coping mechanisms helps the patient and their family to navigate the emotional aftermath of a miscarriage. Consider the interprofessional team and who you can refer to → specialised nurses, social worker, grief counsellors.

Answer 9

An ectopic pregnancy occurs when an embryo is growing in the wrong area by implanting outside of the uterus → usually in the fallopian tube. Typically, for conception to occur, the ova and sperm will meet in the fallopian tube. Once fertilised, the egg continues its journey into the uterus where it will attach to the wall of the uterus which will trigger the placenta to form. Once the placenta starts to grow, human chorionic gonadotropin will start to be released in urine and blood. With an ectopic pregnancy, the fertilised egg stays and implants in the fallopian tube. The uterus can stretch and grow with a pregnancy. However, the fallopian tube cannot expand in the same way. Ultimately, an ectopic pregnancy cannot continue to develop. The stretching of the fallopian tube that occurs when the pregnancy progresses, results in severe pain and, if the tube tears or ruptures, vaginal bleeding → most ectopic pregnancies rupture between 6-16 weeks → 2:100 pregnancies will be ectopic → In 95% of cases, the most common site of implantation are the fallopian tubes → occurs due to an obstruction such as adhesions from previous infections, congenital malformations, scars from tubal surgery or tumours An ectopic pregnancy is a gynaecological emergency and, if left untreated, can result in maternal death. This is due to the significant internal bleeding that often occurs.

Answer 10

Increased risk of an ectopic pregnancy with: In-vitro fertilisation (IVF) History of pelvic infections → salpingitis Previous ectopic pregnancies Damaged fallopian tubes, e.g., from adhesions or scarring History of previous gynaecological surgery Woman who become pregnant while using an IUD or taking the progesterone only pill Infertility

Answer 11

Clinical manifestations of an ectopic pregnancy usually occur 6-8 weeks after the last normal menstruation: Abdominal pain → usually left / right lower quadrant A missed menstrual period Vaginal bleeding, which may be minimal Symptoms of pregnancy → breast tenderness, frequent urination, or nausea Feelings of dizziness or light-headedness Signs and symptoms of haemorrhage → collapse, tachycardia, hypotension

Answer 12

In some cases, the fertilised egg dies quickly and is broken down systematically before symptoms occur → ectopic pregnancy in these cases are rarely diagnosed → no treatment / management required If the fertilised egg continues to grow, the fallopian tube will stretch → clinical manifestations will be experienced tube will rupture → internal bleeding → urgent surgery required to remove the fallopian tube and fertilised egg

Answer 13

Health history Ultrasound scan Pregnancy test 3 treatment options → Keyhole laparotomy → to remove fertilised egg from the fallopian tube → Laparotomy → to remove ectopic pregnancy option determine if pregnancy has advanced and there is significant haemorrhaging → IM injection of methotrexate → option for cases that are asymptomatic or mild symptoms → dissolves pregnancy to avoid surgery

Answer 14

Pre and post operative care → monitor vital signs as per guidelines, assess for shock, wound care, DVT prevention, fluid support, analgesia Educating your patient around the procedure and any side effects, especially of using medication therapy to treat the ectopic pregnancy. Emotional support and education.

Answer 15

The primary organs are the testes Secondary organs include the epididymis, urethra, ejaculatory duct, prostate gland, seminal vesicles, the penis and the scrotum. Those that were assigned male at birth, men who have transitioned to a woman and non-binary people can also have, or had, male reproductive organs and be impacted by disorders related to this body system.

Answer 16

Produce and secrete male sex hormones Produce and maintain sperm and semen Transport semen into the female reproductive tract

Answer 17

Benign prostatic hyperplasia (BPH) is an age related condition in which there is abnormal prostate cell proliferation, resulting in an abnormally enlarged prostate with associated prostatic tissue expansion. Due to the enlargement of this prostatic tissue, prostatic urethra compression occurs resulting in urinary system dysfunction and lower urinary tract symptoms (LUTS). This will include thickening of the bladder wall, interrupted urine flow and incomplete bladder emptying. Exact aetiology is unknown Mortality rate is low Associated with severeLUTS and sexual dysfunction Significant impact on quality of life Sadness Depression Anxiety Body image changes

Answer 18

Age >50 → risk will continue to rise with age → hormonal changes associated with aging Male family member with BPH Obesity and sedentary lifestyle Erectile dysfunction Metabolic syndrome Frequent urinary tract infections History of cardiovascular disease and T2D

Answer 19

The clinical manifestation associated with BPH occur gradually and can be dividing into 2 categories: Obstructive → voiding related issues → urethral constriction from enlarged prostate gland: Reduced flow Feelings of incomplete emptying Post-void dribbling Straining to void Urinary intermittency Hesitancy Irritative → bladder and urinary storage issues → increased force required to urinate → detrusor muscle hypertrophy → thickening and hardening of the bladder wall → loss of elasticity and reduction in compliance: Nocturia Urinary frequency Urgency Dysuria Bladder pain Urge incontinence

Answer 20

Urinary retention → sudden and painful inability to urinate → urgent intervention required → insertion of IDC Frequent urinary tract infections → related to inability to empty bladder → bacterial growth → can result in sepsis Bladder calculi → occurs due to alkalinisation of residual urine Acute kidney injury → can lead to kidney failure → caused by hydronephrosis from urine unable to be voided

Answer 21

Health history and physical assessment Digital rectal examination (DRE) → performed to estimate size & symmetry of prostate Urinalysis → to determine blood and presence of inflammatory cells → WBC & RBC Prostate-specific antigen (PSA) blood test → slightly elevated with BPH → can significantly rise with prostate cancer Routine bloods → renal function test → kidney function and inflammatory mediators → creatinine Transrectal ultrasound→ ordered if PSA elevated and abnormalities detected with DRE → allows for accurate assessment of prostate size and for differentiating with prostate cancer Cystoscopy → internal visualisation of the urethra and bladder → can be used to confirm diagnosis

Answer 22

Goals of treatment → Restore bladder function, particularly drainage → Symptom management → Prevent complications Treatment plan will be based on symptom severity and history of complications, not the size of the prostate Active surveillance → watch & wait → chosen if the patient is relatively asymptomatic → focuses on lifestyle changes (avoiding spicy food, increase exercise, weight reduction, decrease fluid intake at night), education and routine reviews Timed voiding → scheduling specific times for voiding → going to the toilet to void based on a fixed time as opposed to sensation to urinate → can help the individual to regain bladder control → can reduce symptoms → reduces the need for medication or more invasive interventions Double voiding → relax before urination to reduce anxiety and tension → urinate, relax for a few minutes, then attempt again Medication therapy → designed to reduce size of prostate and minimise symptoms → 5α-reductase inhibitors → α-adrenergic receptor blockers → combination therapy Surgery → Transurethral resection of the prostate → removal of prostate tissue through the urethra → gold standard for surgical intervention Postoperative complications → pain, bleeding and clot retention, transurethral resection syndrome, retrograde ejaculation Erectile dysfunction unlikely → Open prostatectomy → option for men with enlarged bladders and other complicating factors Often results in erectile dysfunction, increased risk of infection, long term urinary incontinence and significant postoperative pain, bleeding, and clot retention

Answer 23

Nursing care is rarely required unless admission to hospital is needed for investigations or surgical intervention. Nursing care considerations relate to pre and postoperative care: Health history → subjection and objective data collection → major illnesses, previous surgeries, medication history, previous STIs, current symptoms, urinary output history, sexual function, pain history Symptom management and education Preoperative → Education → the type of surgery, why it is needed, the benefits, complications/risks and if they have any concerns or questions. → Assessments → Prophylactic antibiotics administration may be required → Maintaining fluid intake until NBM. Postoperatively → Postoperative assessments → as per usual postoperative nursing care considerations and guidelines → Bladder irrigation Aim is to reduce the risk of occlusion and urinary retention from clotted blood from the bladder and to ensure drainage of the urine → blood clots are expected in the first 24 - 36 hours postoperatively. → Pain management – bladder spasms are common. → Fluid balance management → Reducing risk of infection → Discharge planning

Answer 24

Common post-surgery Aim is to reduce the risk of occlusion and urinary retention from clotted blood from the bladder and to ensure drainage of the urine → blood clots are expected in the first 24 - 36 hours postoperatively. May be intermittent or continuous. Nursing care considerations: Care as per all IDC care & considerations Assess for bleeding & clots Assess catheter patency Strict FBC with input and output hourly measures Manually irrigate if bladder spasms occur or with decreased output If IDC becomes obstructed → discontinue and escalate to medical team Education

Answer 25

Prostatitis is an umbrella term that includes a group of inflammatory and non-inflammatory disorders of the prostate gland. While prostatitis can affect men of all ages, these conditions are the most common urological issue for younger men, being mostly prevalent between the ages of 36-50 years. Can be diagnosed as either acute or chronic, bacterial, or non-bacterial Symptoms can occur without signs of infection.

Answer 26

Acute bacterial prostatitis Chronic bacterial prostatitis Chronic prostatitis/chronic pelvic pain syndrome → urinary & prostate pain with an absence of an infectious process → may occur after a viral infection → also associated with recent STI Asymptomatic inflammatory prostatitis → no symptoms are experienced with this type of prostatitis, but inflammatory processes of the prostate occur and are evident with medical assessment

Answer 27

Escherichia coli → most common Klebsiella Pseudomonas Enterobacter chlamydia trachomatis Neisseria gonorrhoeae

Answer 28

If infectious cause → fever, rigours, chills Back pain Perineal pain Acute urinary symptoms → dysuria, urinary frequency, urgency, cloudy urine Urinary retention Severely inflamed prostate → swollen, boggy, painful to touch

Answer 29

Erectile dysfunction Epididymitis Cystitis Post-ejaculation pain Decreased libido Prostatic abscess Irritative voiding symptoms → dysuria, urinary frequency, urgency Recurrent UTIs

Answer 30

Health history & full physical assessment Urinalysis Urine culture & sensitivity Routine bloods +/- blood cultures

Answer 31

Acute management usually involves hospital admission for administration of IV antibiotics → trimethoprim, ciprofloxacin, cefalexin, doxycycline orally for 4 weeks once discharged Antibiotic therapy continues for 8 - 12 weeks Infection / fever management Pharmacological pain management → NSAID & simple analgesia → pain can last months with chronic prostatitis Non-pharmacological pain management → sitz baths, heat packs → ejaculation can reduce pain (best not to practice while in hospital) Repetitive prostatic massage - removes excess prostate secretions. Education → associated with antibiotics, symptom management, encourage increased fluid intake

Answer 32

Scrotal swelling caused by a collection of fluid within the tunica vaginalis

Answer 33

Congenital → chronic hydrocoele → men >40 years → imbalance between production and reabsorption of fluid Acquired → trauma, infection, tumour

Answer 34

Increased scrotal mass Usually painless but can experience a dull ache in the scrotum Difficulty walking Progressive heaviness

Answer 35

Acute, painful inflammation of the epididymis Usually caused by a infection, trauma, urinary reflux gonorrhoea, chlamydia, E.coli Mostly unilateral Swelling will often increase until epididymis and testis are indistinguishable Treated with oral antibiotics if STI related Otherwise → bed rest, elevation of scrotum, ice packs, analgesia

Answer 36

Acute inflammation of the testis Clinical manifestations include painful swollen testes Often occurs after a bacterial or viral infection → mumps, syphilis, tuberculosis, epididymitis Can also occur after trauma such as catheterisation Treatment as per epididymitis Concurrent orchitis with epididymitis → epididymoorchitis

Answer 37

Twisting of the spermatic cord that supplies blood to the testes and epididymis Medical emergency due to loss of blood supply, requiring urgent surgical intervention → ischaemia occurs within 4-6 hours More common in males <20 years Can occur spontaneously, from an anatomical abnormality or as a result of trauma Associated with severe, unilateral scrotal pain, tenderness, swelling, nausea and vomiting

Answer 38

Infertility is considered as a disorder that affects a couple, that being both the male and female. For this reason, both partners need to be tested when infertility is considered to determine which partner the infertility relates to. Approximately ⅓ of infertility is caused by the factors affecting the man.

Answer 39

Anatomical or genetic abnormalities Systemic or neurological diseases Infections Trauma Iatrogenic injury Gonadotoxins Development of sperm antibodies

Answer 40

A vasectomy is a simple surgical procedure where bilateral vas deferens (vas) are cut to cause sterilisation. Prevents the flow of sperm into the ejaculate. The procedure can be performed with local anesthetic in a clinic or as an outpatient or with general anaesthic as a day patient → takes 15 - 30 minutes Considered permanent but can be reversed in some cases. Does not affect production of hormones, ability to ejaculate or the ability to develop an erection

Answer 41

Standard nursing pre and postoperative care is required if general anaesthetic is to be administered Shave the area pre-operatively. Pharmacological pain management → paracetamol and ibuprofen. Non-pharmacological pain managment include the use of ice packs → frozen pea's make a great ice pack! Education → postoperative self-care

Answer 42

Sexual health is relevant throughout a person’s life, from adolescence into older age. It encompasses physical, emotional, mental, and social well-being related to sexuality. It’s not just about the absence of disease; it also involves positive and respectful sexual relationships, pleasurable experiences, and the fulfillment of sexual rights. Neglecting sexual health can lead to serious consequences, such as infertility, ectopic pregnancy, preterm birth, neonatal death, pelvic inflammatory disease, depression and anxiety, impaired urological function and haematological dysfunction. Sexual health is an essential aspect of overall well-being, impacting individuals, couples, families, and communities. Sexuality is a human right. It consists of sex, identity, gender role, sexual orientation, intimacy and reproduction. Every individual has the right to make personal decisions related to their sexual health.

Answer 43

Access to accurate and reliable information Knowledge about risks and consequences of unprotected sex Practicing safe sex Equal access to inclusive and safe healthcare According to the Department of Health and Aged Care (2023), sexual health includes: Respect for the right to healthy relationships, equality, and safety Safety to express individual sexuality, sexual orientation, and gender identity Freedom from coercion, discrimination, violence, and stigma Access to information and health care Protection from, and treatment of, STIs

Answer 44

Obtaining an in-depth sexual health history is not always necessary. But there are times when it is an important part of a focused health assessment. You don't need to know everything about your patient's sexual health and what you do need to know, depends on their concerns. To guide your approach, consider obtaining some background history prior to your patient encounter. You can then target your health history questions to what you do need to know. Environment Dialogue Consider the 5 P's to guide your assessment End of Assessment

Answer 45

Create a welcoming, safe, trustful environment Identify yourself and your role → #hellomynameis Establish your patient's name Ask their sexual orientation / gender identity / sex assigned at birth → these are not the same and should be asked separately → it is okay if your patient declines to answer Never make assumptions We are not to make judgements on our patients → keep your opinion to yourself If you are embarassed by asking direct questions about sexual health, your patient will pick up on this and you will loose the opportunity of having a trustful, open discussion. Your patient will not feel safe to talk openly and honestly with you. Consider how the following will influence your assessment: Culture Age Domestic Violence

Answer 46

Consider the language you use → use common language Use open-ended questions that are focused on the information you need Start the discussion with a introduction and gain your patient's permission to continue. Acknowledge that the questions you are going to ask are very personal but that they are an important part of your nursing assessment. Let your patient know that you ask these same questions with all patients regardless of age, gender, sex, marital status, orientation, profession Reassure your patient that the information they provide is strictly confidential, unless someone is being hurt or in danger, and that you are not there to pass judgement, just to provide holistic person-centered care May I ask you some questions about your sexual health? I'd like to ask some questions about your sexual life. Would that be okay? Do you have any questions before we get started? Do you have any concerns about your sexual health?

Answer 47

Partners Practices Protection Past history of STIs Pregnancy intentions Additional considerations when obtaining a sexual health history from a female: Menstrual history → Date of first day of her last period → Menstrual flow and problems (any changes) → Age of menarche/menopause Pregnancy history → Number of pregnancies → Number of living children → Number or pregnancy losses → Gestational age of birth → What sort of birth did you have (vaginal, caesarean, assisted forceps or vacuum) Are you taking hormone replacement therapy?

Answer 48

Used to assess risk of STIs Determine number and gender of sex partners and risk factors such as drug / alcohol use and concurrent partners Have you had/are you having sex of any kind? If so - oral, anal, vaginal? In the last 3 months, how many sex partners have you had? What is/are the gender/s of your sex partners? Do you or your partner currently have other sex partners?

Answer 49

Guides assessment of risk, risk-reduction strategies, and interventions such as testing and what sites of the body need to be tested When was the last time you had sex? What kind of sexual contact do you have/have had? What parts of your body are involved when you have sex? Do you have genital / anal / oral / top and/or bottom sex? Do you meet your partners online? Do you exchange money/drugs/housing for sex?

Answer 50

Used to determine level of STI risk and risk-reduction needed Do you discuss STI prevention? What do you use to prevent STIs How often do you use these? If only sometimes, can you talk me through your decision? Have you had your vaccinations against hepatitis? Are you aware of PrEP, a medication that can prevent HIV?

Answer 51

Used to understand your patient's risk Have you ever been tested for STIs? Have you ever been diagnosed with an STI? Have you been experiencing any symptoms? If so, have you had these checked? Has your recent/current partner every been diagnosed for an STI? Do you know your partner's HIV status?

Answer 52

Based on the responses, you can determine your patient's risk of becoming pregnant Do you think you would like to have children at some point? When do you think that may be? How important is pregnancy to you? Are you using contraception? If so, what type? Condoms Hormonal methods Barrier method Intrauterine device 'Natural' method Sterilisation Emergency contraception 'Pull out' method

Answer 53

Thank your patient for their honesty and for being open Your patient may have some additional questions that they were not ready to discuss earlier → Acknowledge and provide responses as best you can → If you don't have the answer → refer → do not dismiss Eduction → Treatment options → Symptom management → depends on diagnosis but can include: → Simple analgesia, NSAIDs, opioid analgesics → Heat packs, Sitz baths, Rest → Sexual abstinence until infection is cured → Avoid sexual contact with partners from at least the last 2 months until they have been tested → Partner notification → provide support for this discussion → Prevention - condoms must be used even if other forms of birth control are used, contraception → Support groups → How to get help → Handouts → Importance of follow up reviews and testing Encourage safe practices and illness prevention → be proactive

Answer 54

Sexually transmitted infections are those that are caused by a virus, bacteria, fungi, protozoa, or parasite with the portal of entry being the mouth, genitalia, urinary meatus, anus, rectum and skin. These infections are a major public health concern in Australia, with the focus being on prevention and control. Approximately 16% of Australians have had an STI in their lifetime In 2020, >29 000 Australians were living with HIV In 2020, there were approximately 57 500 new STIs among females and 67 400 among males By 2019, STI notification rates increased 79% for gonorrhoea and 95% for infectious syphilis

Answer 55

Education / prevention Early detection Diagnosis Treatment of the infection (bacterial, viral, fungi, parasite) Counselling of sexual partners of people who are infected.

Answer 56

Transmission occurs during sexual activity → can be non-penetrating in nature. Sexual partners of the infected person must also be treated >2 STIs can co-exist in the one person

Answer 57

< 25 years Aboriginal and Torres Strait Islander people Pacific Islander people Men who have sex with men Sex workers People who inject drugs

Answer 58

Bacterial STIs can result in serious health consequences, increasing the risk of: Acquiring HIV Mother-baby transmission → stillbirth, neonatal death, congenital syphilis Pelvic inflammatory disease Infertility Some important facts about bacterial STIs: They can be cured with antibiotics <25 years and those from culturally and linguistically diverse backgrounds have higher reported rates of infection Barriers to review, assessment & treatment include: culture, concerns about discrimination, stigma, and language barriers

Answer 59

Cause → Neisseria gonorrhoea Notifiable infection → major public health challenge Highest rates → men who have sex with men, young heterosexuals, Aboriginal and Torres Strait Islander people living in remote and very remote communities Previous infection does not provide immunity to new infection Spread → sexual contact with an infected person → vaginal, oral, anal Incubation → 3-8 days

Answer 60

Men: dysuria, penis urethral discharge serous/milky/purulent Women: dysuria, urinary frequency, abnormal menses, increased vaginal discharge, dyspareunia Conjunctivitis → purulent → sight-threatening

Answer 61

Epididymoorchitis Prostatitis Pelvic inflammatory disease Bartholin gland abscess Meningitis Endocarditis Mother-baby transmission

Answer 62

First-pass urine test Swabs → penile urethral, self-collected vaginal, clinician-collected endocervical, anorectal, pharyngeal

Answer 63

Swabs collected prior to commencing antibiotics but treatment is not delayed while waiting for results Oral + IMI antibiotics → increasingly resistant to penicillins, sulphonamides and tetracyclines Ceftriaxone → IMI Azithromycin → PO No sexual contact for 7 days No sex with partners from last 2 months until they have been tested Partner notification recommended Follow up in 1 week

Answer 64

Cause → Treponema pallidum Highly infectious, transmissible, and contagious infection → during the first 2 years → if left untreated, will cause serious, systemic problems Notifiable infection → major public health challenge due to increasing rates Spread → skin to skin contact during unprotected sexual contact with an infected person → vaginal, oral, anal sex Highest rates → men who have sex with men, Aboriginal and Torres Strait Islander people living in remote and very remote communities and general population living in major cities 50% of people will be asymptomatic 4 stages

Answer 65

Primary stage Secondary stage Latent stage Tertiary stage

Answer 66

Incubation period 14-21 days Small, round, firm and painless lesions called chancre erupt at the site of infection usually 3 weeks after infection → can be in the mouth, anus, genitals, cervix, or on the fingers Last for 3-6 months and heal spontaneously Without treatment, will lead to secondary syphilis

Answer 67

Associated with rash (reddish/brown spots usually found on palms of hands & soles of feet), skin lesions, fever, sore throat, lymphadenopathy, arthralgia, large grey/white wart-like papules develop on warm moist areas such as labia, anus or corner of mouth and axilla, flu like symptoms, lethargy, and alopecia. Symptoms last 3-12 weeks and can spontaneously resolve Without treatment, person will be infectious for up to 2 years and then transition into latent stage

Answer 68

Begins when clinical manifestations associated with secondary stage have disappeared → usually 12 - 24 months after initial infection Asymptomatic but person still infectious Without treatment, can remain latent for life or will progress to tertiary stage

Answer 69

Occurs with approximately ⅓ of infected people Clinical manifestations can appear up to 30 years after exposure Disease will involve multi-systems → brain, CNS, eyes, cardiovascular system, liver, bones, and joints → degree of severity depends on organ system affected Often fatal No longer infectious

Answer 70

Infection during pregnancy → mother-baby transmission → congenital syphilis → severe multi-organ disease with very high mortality and morbidity Early neurosyphilis → involves CNS → blindness, tinnitus, deafness, meningitis

Answer 71

Blood test Swab of lesions → repeated after 2 weeks if suspicious History and clinical assessment

Answer 72

IMI antibiotics → benzathine benzylpenicillin No sexual contact for 7 days after treatment has commenced No sex with partners from last 3 months, 6 months or 12 months (depending on phase) until they have been tested Partner notification recommended Repeat testing required at 3, 6 and 12 months

Answer 73

Cause → Chlamydia trachomatis Most reported communicable disease in Australia Spread → vaginal, anal, or oral sex with someone who is infected Highest rates → <30 years men and women Incubation → 7 - 21 days but can be up to several months

Answer 74

→ occur 2-14 days after infection Almost 90% of cases are asymptomatic → still infectious and can transmit Dysuria, anal discharge Men → penile urethral discharge, testicular pain, swollen testicles Women → vaginal discharge, pelvic pain, intermenstrual bleeding, postcoital bleeding, dyspareunia, anorectal symptoms

Answer 75

Mother-baby transmission Epididymoorchitis Pelvic inflammatory disease Infertility Ectopic pregnancy Conjunctivitis Pelvic adhesions Chronic pelvic pain Recurrent urethritis in men arthritis

Answer 76

First-pass urine test Penile urethral swab Self-collected vaginal swab Clinician-collected endocervical swab Anorectal swab Pharyngeal swab

Answer 77

Oral antibiotics → doxycycline for 7 days Full STI check Avoid sexual contact for 7 days No sex with partners from last 6 months until they have been tested Partner notification Follow up → retesting in 3 months → reinfection is common

Answer 78

A syndrome of inflammatory disorders that occur when an infection spreads from the vagina to the upper genital tract → may involve cervix, ovaries, fallopian tubes, and pelvic peritoneum. Causes → polymicrobial, STIs and bacterial vaginitis → 70% of cases have no identifiable cause Up to 20% of women with untreated chlamydia can develop PID Highest risk → < 30 years

Answer 79

Gradually increasing pelvic pain → typically bilateral, but can be unilateral → is worse on movement → refers to RUQ Deep dyspareunia Vaginal/cervical discharge → blood stained or purulent Post coital vaginal bleeding Intermenstrual bleeding Fever Nausea and vomiting

Answer 80

Health history and clinical assessment with pelvic examination Endocervical swab

Answer 81

Oral + IMI antibiotics Ceftriaxone IMI + metronidazole PO + doxycycline PO Severe cases will require IV antibiotic treatment Treatment is not delayed for results Avoid sexual contact for 7 days Rest Simple analgesia

Answer 82

Just like bacterial STIs, viral STIs are associated with a gamut of clinical manifestations, some of which are very serious and life-threatening. Viruses are: Smaller organisms than bacteria Need a living host to reproduce When entering the body, they invade cells and manipulate them to reproduce Cannot be treated with antibiotics Viral STIs include genital herpes, anogenital warts, human immunodeficiency virus (HIV) and Hepatitis B and C.

Answer 83

Cause → human papillomavirus (HPV) Spread → direct skin to skin contact with lesions and genital secretions → micro-abrasions allow viral access Not a notifiable disease Incubation period → 2-3 months

Answer 84

Most cases are asymptomatic Wart-like growths or lesions, in and around anogenital area or mouth Lesions can be itchy, slightly painful Perianal itch Rectal bleeding after using bowels Distorted urinary stream Bleeding from lesions Can cause significant psychological distress

Answer 85

Can become malignant → cervical, anal, penile, vaginal, oropharynx cancer

Answer 86

Health history and clinical examination → visual inspection Lesion biopsy

Answer 87

Wart paint applied topically Avoid shaving or waxing over lesions will → facilitate spread Health prevention → HPV vaccination administered to girls in high school

Answer 88

Incurable → life long disease → can remain dormant and inactive for many years but will remain live in the nerve pathways (dorsal root ganglia) for life Characterised by typical herpetic infectious process → primary lesion eruption → period of latency → reactivation → local reoccurence close to site of initial portal on entry → Reoccurence precipitated periods of extreme stress, trauma, intercurrent disease, environmental factors and immunosuppression Notification is not required Cause → 2 organisms → a person can be infected by both organisms Herpes simplex virus (HSV) type 1 → referred to as cold sores → most common with 75:100 Australians having HSV 1 HSV type 2 → referred to as genital herpes → not as common with 12:100 Australians having HSV 2 Highly stigmatised & poorly understood in the community Spread → direct skin to skin contact, entry via micro abrasions in the skin Incubation period → 2-12 days

Answer 89

→ depends on portal of entry, age, immune status and type Both types begin with early warning signs → tingling, itching, and pain in the infected area → followed by eruption of clusters of blisters (clear vesicles) → lesions ulcerate → then crust and heal → process lasts approximately 1 week HSV 1 Usually found on lips and mouth → can also be transmitted to the genital / anus region Primary infection can be mild → 10% of cases will be severe and associated with fever and malaise HSV 2 Usually found around the anus, perineum, genitals, cervix, vulva → can also be transmitted to the lips and mouth Secondary infections can be found on the lower back, legs, thighs and buttocks

Answer 90

Erythema multiforme Bell's palsy Chronic cutaneous infection with crusted lesions located on visceral organs Severe system toxicity Lymphadenopathy Pneumonitis Radiculitis Hepatitis Aseptic meningitis Encephalitis Sacral radiculopathy

Answer 91

Swab of lesions Blood test → HSV1 and HSV2

Answer 92

Antiviral medication → valacyclovir or acyclovir PO → supresses symptoms only → doesn't cure Analgesia Topical lignocaine Avoid sexual contact until symptoms resolved

Answer 93

Cause → human immunodeficiency virus → single-stranded RNA virus Notifiable infection → contract tracing is important to prevent re-infection Spread → direct contact with body fluids (blood, semen, anogenital fluid) from an infected person who has a viral load must enter through and open wound, direct injection or a mucous membrane (rectum, vagina, tip of penis, mouth) → can also be transmitted mother to baby during pregnancy or when breastfeeding

Answer 94

Acute infection → lasts up to 2 weeks fever, rash, lymphadenopathy, pharyngitis, myalgia, diarrhoea Can be asymptomatic after initial seroconversion → can last several years Immune deficiency oral thrush, diarrhoea, weight loss, skin infections, herpes

Answer 95

After 10 years of infection (but can be between 2-20 years) Chronic immune deficiency Acquired immunodeficiency syndrome → AIDS Opportunistic infections pneumocystis, oesophageal candidiasis, cerebral toxoplasmosis, skin cancers Cardiovascular disease Chronic kidney disease Osteoporosis non-AIDS malignancies

Answer 96

Blood tests → tools have been developed to assist with guidelines for diagnosis, decision-making and management

Answer 97

Antiretroviral therapy (ART) → taken daily, for life Post-exposure prophylaxis (PEP) → offered within 72 hours of potential exposure Pre-exposure prophylaxis (PrEP) → offered to high-risk people to reduce risk of infection Close follow up required → once stable, follow-up required every 3-6 months

Answer 98

Hepatitis Hepatitis means swelling of the liver Can occur from infectious or non-infectious sources → viruses, alcohol, drugs, impaired immune system, and other toxins 5 types (strains) Hepatitis A Hepatitis B Hepatitis C Hepatitis D and Hepatitis E are the remaining types of hepatitis → you can complete your own research on these types

Answer 99

Acute liver infection → results in lifelong immunity → does not cause chronic hepatitis Source → hepatitis A virus → HAV Highly contagious Transmission → faecal-oral transmission → during sexual contract or contaminated food and water Incubation → 15-50 days → average 28 days Infectious period → 2 weeks before onset of symptoms to 1 week after onset of jaundice Clinical Manifestations → fever, malaise, lethargy, nausea, jaundice, pale stools, dark urine → resolves within 1 month Complications → liver failure Diagnosis → blood test → liver function, hepatitis antibodies screen Treatment Conservative → symptomatic management No sexual contact during acute illness and for 1 week after onset of jaundice Risk of occupational transmission Contact tracing → back 50 days Follow up Prevention → vaccination

Answer 100

Acute liver infection → highly infectious, vaccine preventable → does not cause chronic hepatitis Source → hepatitis B virus → HBV Mostly a short-term illness → 95% of infected adults will completely recover → can lead to a chronic, life-long infection Transmission → Percutaneous, mucosal, blood, semen, or other bodily fluids of an infected person through sexual contact, sharing contaminated needles or childbirth→ entry to liver through bloodstream Incubation → 40-90 days → average 60 days Infectious period → up to 3 months before symptoms develop and until infection eliminated → virus will remain infectious for 7 days on the surface of the skin Clinical Manifestations → fever, malaise, lethargy, nausea, anorexia, abdominal pain, jaundice, pale stools, dark urine, arthralgia Complications → chronic liver failure, cirrhosis, liver cancer, death Diagnosis → blood test → liver function, hepatitis antibodies screen Treatment Conservative → symptomatic management No sexual contact during acute illness and for 1 week after onset of jaundice Risk of occupational transmission Contact tracing

Answer 101

Source → hepatitis C virus → HCV Transmission → blood to blood contact from skin penetration → contaminated needles, sexual contact (oral, anal and vaginal), unscreened blood transfusions, sharing toothbrushes or razors → amount of blood needed for transmission is microscopic 95% of HCV cases can be cured through antiviral medications Incubation → 15-50 days → average 28 days Infectious period → 3 weeks prior to the onset of symptoms Clinical Manifestations → mostly asymptomatic → occasionally, upper right quadrant pain, fever, malaise, lethargy, anorexia, jaundice, pale stools, dark urine → can last up to 6 months Complications → chronic liver failure, cirrhosis, liver cancer Diagnosis → blood test → liver function, hepatitis antibodies screen Treatment Symptomatic management Direct acting antivirals (DAAs) Contact tracing Partner notification Prevention → no vaccination available, avoid risky behaviours

Answer 102

Trichomoniasis Candidiasis

Answer 103

Source → trichomonas vaginalis → a protozoan Common in older people living in regional and remote areas Affects the vagina, urethra and paraurethral glands Transmission → sexual contact with an infected person → oral, vaginal and anal Incubation → 3 - 28 days

Answer 104

50% of cases are asymptomatic Urethritis Urethral discharge Dysuria Malodourous vaginal discharge → profuse and frothy Vulval itch and discomfort

Answer 105

Prostatitis Vaginitis Increases risk of contracting HIV Pregnancy related → premature ruputre of membranes with pregnancy, low-birth weight, post-partum sepsis

Answer 106

High vaginal swab First-pass urine test

Answer 107

Oral antibiotics → metronidazole Avoid sexual contact for 7 days after treatment has commenced Treat sexual partner Follow up review in 7 days Retest after 4 weeks

Answer 108

Source → candida albicans → fungal infection → can be normal flora Transmission → sexual contacxt but not considered a STI

Answer 109

Excoriation and erythema Rash on genitals → often itchy Swelling of the foreskin Fissures, superficial erosions Thick, white clumping vaginal discharge Genital burning and soreness Superficial dyspareunia External dysuria

Answer 110

Swabs → high-vaginal, penis, self-collected

Answer 111

PO antifungal medication Anti-fungal vaginal cream → applied nocte intravaginally Hydrocortisone cream to reduce itch

Answer 112

Prostatectomy

Answer 113

Obstruction

Answer 114

Polycystic ovary syndrome

Answer 115

Endometriosis

Answer 116

Alpha adrenergic receptor blocker

Answer 117

Threatened miscarriage

Answer 118

Sexual function can gradually return over 2 years.

Answer 119

Endometriosis

Answer 120

Ceftriaxone