The 5 P’s to ask in a sexual history
- Partners: M/F, how many in last 6 months
- Practices: type of sex, use of condom in which type
- Past STIs + treatment
- Pregnancy plans, contraception
- Protection from STDS: monogamy, self-perception of risk
Risk factors for bacterial vaginosis
- New/ multiple sexual partners
- Vaginal douching
- Smoking
- Note: can occur in virgins
Best investigation for BV
At least 20% “Clue cells” & mixed flora on vaginal wet film
Which HPV strains cause genital warts
6 and 11
Which HPV strains cause cervical cancer
16 and 18
Clinical features of genital warts
- Pruritis, pain, tenderness, dysuria
* Bleeding, discharge
How to diagnose genital warts
Clinical diagnosis: pink lesions
biopsy if in doubt
Causes of urethritis (discharge, pain)
- Gonorrhoea
- Chlamydia
- Mycoplasma, ureaplasma (non-specific urethritis)
- HSV
- Trichomonas
- UTI
Difference in discharge for BV, candida, trichomoniasis
- BV = watery white/ grey with fishy smell
- Candida = white curdy discharge with vulval rash
- Trichomoniasis = smelly green/yellow discharge
Difference in discharge for BV, candida, trichomoniasis
- BV = watery white/ grey with fishy smell
- Candida = white curdy discharge with vulval rash
- Trichomoniasis = smelly green/yellow discharge
Causes of genital ulcers
- HSV
- Syphilis
- Tropical STIs eg chancroid
Causes of genital lumps
- Genital warts
- Secondary syphilis (condylomata lata)
- Molluscum contagiosum
Causes of genital infestations
- Pubic lice
* Scabies
Commonest STI in UK
Chlamydia
Gold standard investigation for gonorrhoea and chlamydia
Nucleic acid amplification test
also do microscopy, swabs, culture
Complications of passing gonorrhoea/ chlamydia on to neonate
- ophthalmia neonatorum
- mucous membrane infections
- pneumonitis
Difference in symptoms of genital ulcers (HSV) in 1st vs recurrent episodes
1st episode: VERY SEVERE
- very very painful, burning vesicles
- flu-like symptoms: fever, cough, headache, sore throat, lymphadenopathy
Recurrent episodes: MILDER (due to formation of antibodies)
How to detect HSV
- Viral culture
- Viral antigen detection tests
- PCR
How to detect syphilis
- PCR
- dark ground microscopy
- serology
Clinical features of primary syphilis
- PAINLESS ulcer
- regional lymphadenopathy
Clinical features of secondary syphilis
- Maculopapular rash (trunk, limbs, palms, soles)
- Condylomata lata
Condylomata vs acuminata
- what they look like
- what causes them
LATA
- secondary syphilis
- flat, smooth, moist
ACUMINATA
- HPV 6n11
- cauliflower-like, pearly, dry
Clinical features of CVS syphilis
- aortic regurgitation
- ascending aortic aneurysm
Clinical features of neuro syphilis
- Meningitis without fever
- Stroke
- Cervical myelopathy
- Hemiplegia
