GUM Flashcards

Question

complications of chlamydia

Answer 1

– PID (women) – Epididymo-orchitis (swelling of testicles and/or epididymis) (men) – Conjunctivitis – Lymphogranuloma venereum (LGV) (men) – Sexually acquired reactive arthritis (SARA) – Adverse outcomes in pregnancy - premature delivery, low birth weight, infections in neonates – Anxiety and psychological distress

Answer 2

70% female 50% male

Answer 3

* Age under 25 years * A new sexual partner * More than 1 sexual partner in the last year * Lack of consistent condom use

Answer 4

* Vaginal discharge * Dysuria * Vague lower abdominal pain * Fever * Intermenstrual or postcoital bleeding * Deep dyspareunia * Pelvic pain/tenderness * Cervical motion tenderness * Inflamed or friable cervix

Answer 5

* Men tend to have either classical urethritis with dysuria and urethral discharge or * Epididymo-orchitis presenting as unilateral testicular pain ± swelling * Fever may also be a feature in men. * Reactive arthritis

Answer 6

Nucleic acid amplification tests (NAATs) – Highly specific and sensitive – Women: vulvovaginal swab (1st line) - Alternatives: 1st void urine sample or endocervical swab – Men: 1st void urine sample (1st line)

Answer 7

FIRST LINE: Doxycycline 100 mg BD for 7 days – c/i in pregnancy & bf – GI side effects common – photosensitivity ALTERNATIVES: – Azithromycin 1 g orally as a single dose for 1 day, followed by 500 mg orally OD for 2 days – Erythromycin 500 mg BD for 10–14 days – Ofloxacin 200 mg BD for 7 days

Answer 8

used 1g single dose azithromycin (SDA) or 7 days doxycycline Mycoplasma genitalium (MGen) - emerging, significant sexually transmitted pathogen, can get co-infection with chlamydia inc prevalence of macrolide resistance in MGen, because of use of SDA to treat STIs SDA less effective than doxycycline SDA no longer recommended

Answer 9

* Azithromycin 1g stat followed by 500mg for 2 days * Erythromycin 500mg twice daily for 14 days * Amoxicillin 500 mg three times a day for 7 days ** doxycycline and ofloxacin are c/i

Answer 10

* Avoid sexual intercourse (incl oral sex) until the person & partner completed treatment (or waited 7 days after Tx with azithromycin) * Failure of Tx can be due to re-infection * Screen for other STIs * Refer to a GUM clinic for partner notification. – Symptomatic males – all partners within 2 weeks – Asymptomatic - preceding three months should be notified

Answer 11

A test of cure not routinely recommended

Answer 12

– Sexual contact where infected secretions are passed from one mucous membrane to another – During childbirth

Answer 13

skin lesions arthralgia tenosynovitis arthritis

Answer 14

– Men – Epididymitis, prostatitis, infertility – Women – PID + dangers in pregnancy – Babies – blindness

Answer 15

Genital gonorrhoea infection is usually symptomatic in men * Urethral discharge * Dysuria Rectal and pharyngeal – asymptomatic

Answer 16

* A NAAT for the presence of N. Gonorrhoea Women: vulvovaginal swab Men - 1st pass urine sample * Culture required if patient is NAAT positive for gonorrhoea - to test for susceptibility and ID resistant strains

Answer 17

* No class of antimicrobials where resistance hasn’t developed * Strains of MDR are evident - ‘Super gonorrhoea’ - resistant to the most common antibacterials * change 1st line Tx: Tx was dual therapy of ceftriaxone with azithromycin * Ceftriaxone resistance remains rare in the UK

Answer 18

** Tx ideally based on susceptibility susceptibility is not known: - Ceftriaxone 1 g IM injection as a single dose - safe when pregnant/bf susceptibility is known: - Ciprofloxacin 500mg orally as a single dose - pregnancy/bf: Azithromycin 2g orally as a single dose

Answer 19

* Ceftriaxone 1g IM or IV every 24hrs * Cefotaxime 1g IV every 8hrs 24-48 hours after Sx begin to improve switch to * Cefixime 400 mg twice daily or * Ciprofloxacin 500 mg twice daily (switch should be made guided by sensitivities)

Answer 20

* Avoid sexual intercourse (including oral sex) until Tx completed (or waited 7 days after Tx with azithromycin) * Follow up about 1 week after Tx to: - confirm adherence to Tx and Sx resolution - ask about adverse reactions - confirm that partner notification has been carried out - ask about recent sexual Hx (and the possibility of reinfection) - reinforce advice about safe sexual practice TEST FOR CURE recommended for all people treated for gonorrhoea - asymptomatic - test with NAAT at least 2 weeks after completion of Tx - Sx - test with culture, at least 3 days after completion of Tx - consider additional testing with NAAT after one week if culture is -ve - GUM clinic notification - as for chlamydia - notified partners - test and treat empirically whilst awaiting results - advice on safer sexual practices, contraception and condom use

Answer 21

DOUBLE STRANDED dna VIRUS

Answer 22

HPV16 HPV18

Answer 23

Cevarix - used until 2012 - Bivalent - protects against 2 strains HPV16 & HPV18 Gardasil - quadrivalent vaccine - protects against 4 strains HPV16, HPV18, HPV6 & HPV11 Gardasil 9 - 2021-22 vaccine programme - same as Gardasil + also HPV31, HPV33, HPV45, HPV52

Answer 24

* best effectiveness, vaccine must be given before the patient becomes sexually active * usually 2 doses of the vaccine given 6 mths apart * U15yrs 15: - 1st dose of 0.5ml of HPV vaccine - 2nd dose of 0.5 ml 6mths (up to 24mths) after 1st dose * O15yrs - 3-dose schedule given at 0, 1, and 4–6mths

Answer 25

viral cause: HPV ondylomata acuminata

Answer 26

* direct skin to skin contact with a person who has clinical/subclinical HPV, or contact with genital secretions * most common - sexual contact, but also peri-natally and from hand warts * oro-genital transmission is also possible * can also occur from contact with contaminated surfaces/objects * auto-inoculation from one site to another common

Answer 27

* Often asymptomatic * Can be single, or multiple, and tend to occur in areas of high friction * Lesions may be disfiguring or embarrassing * Possible itching, bleeding or dyspareunia * Present as soft cauliflower-like growths of varying size * Less commonly - flat, plaque-like or pigmented * Colour can vary from whitish to flesh-coloured to hyperpigmented to erythematous * Usually less than 10 mm in diameter

Answer 28

1. No Tx - 30% warts disappear spontaneously within 6mths, not always indicated 2. Self applied Tx - Podophyllotoxin 0.5% solution or 0.15% cream (Warticon) - Imiquimod 5% cream (Aldara) - Sinecatechins 10% ointment (Catephen) 3. Abrasive methods - cryotherapy - excision - electrocautery 4. Specialist application - trichloroacetic acid (TCA) 80-90% solution

Answer 29

* All Tx have significant failure and relapse rates * Choice of Tx is dependent upon the: - type of warts - non-keratinised or keratinised - no. & volume of warts - response to previous Tx - site of lesions

Answer 30

* conflicting info on condom use * HPV persists after clinical clearance of warts for very variable lengths of time * Psychological distress is common - referral for counselling * 20% have concurrent STIs * Current partners and partners in the previous 6mths should be assessed * Advice about smoking cessation should be given - better Tx response

Answer 31

* Review after completion of Tx * Change treatment if: - intolerant of the current Tx - < 50% response to it by 4–5 weeks (8-12 weeks for imiquimod) * Follow up 3mths after Tx if concern re recurrences (timeframe recurrence is likely) * More frequent follow up if immunocompromised

Answer 32

herpes simplex virus (HSV) 1 or HSV-2

Answer 33

* Infectious secretions on oral (HSV-1) , genital or anal mucosal surfaces (HSV-2) * Contact with lesions from other anatomical sites * Most HSV infections (80%) are transmitted by people who are unaware they're infected

Answer 34

* Multiple painful blisters * Lesions are usually bilateral & develop 4–7 days after exposure to HSV infection * If symptomatic with lesions - report headache, fever, malaise, dysuria, or tender inguinal lymphadenopathy * Other symptoms include - vaginal/urethral discharge, local oedema * Tingling/neuropathic pain in the genital area, lower back, buttocks or legs * Lasts up to 20 days

Answer 35

* Usually occurs in the same area and may be preceded by localized prodromal tingling and burning Sx 48hrs before the appearance of lesions * Often less severe and last from 6-48hrs * Systemic symptoms, fever & malaise are less common * Lesions crust and heal in around 10 days

Answer 36

* Local trauma (sexual intercourse or surgery) * UV light * Physical illness, immunosuppression * Smoking * Drinking alcohol * Tight clothing, nylon or Lycra underwear * Stress

Answer 37

ORAL ANTIVIRALS: * start within 5 days of the start of the episode/while new lesions are forming for people with a first episode * BASHH guidelines - first-line treatment should be five days of: - Aciclovir 400 mg TDS or - Valaciclovir 500 mg BD * Self care measures ** only helps with the episode

Answer 38

* Supportive measures alone * Antiviral therapy as required * Suppressive therapy Episodic Tx: * BASHH advises short courses as options for 1st line therapy: - Aciclovir 800 mg TDS for 2 days - Famciclovir 1 g BD for 1 day - Valaciclovir 500 mg BD for 3 days

Answer 39

* Often indicated if >6 attacks per year. * Usual treatment: - Aciclovir 400 mg BD (or 200 mg QDS) - Famciclovir 250 mg BD - Valaciclovir 500 mg OD * The suppressive effect takes 5 days of therapy to establish * Discontinue after 12mths to reassess attack frequency (duration = 6-12mths) * Suppressive Tx also reduces the risk of asymptomatic shedding

Answer 40

* Saline bathing * Oral painkillers * Topical anaesthetics * abstain until lesions cleared * Pain on micturition (urination) - vaseline - micturition in a bath can help prevent urinary retention - inc fluid intake to dilute urine

Answer 41

* Saline bathing (prevent 2 infection) * Oral painkillers * Topical anaesthetics * abstain until lesions cleared * Pain on micturition (urination) - vaseline - micturition in a bath can help prevent urinary retention - inc fluid intake to dilute urine

Answer 42

* Advise to refrain from intercourse when have active lesions * Disclosure in relationships should be advised * No cure for genital herpes

GUM Flashcards

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