2. What should you ask
about in a sexual hx?
• Number of contacts ?in last 3 months
• Contraception- reliable? Compliance?
• Anal oral vaginal?
• Past sti?
• Sexual preference?
• Menstraul and medical history?
• Risk factors- paid for sex, injected drugs, msm etc
3. After the history what
would you examine?
• Genitalia
• Inguinal nodes
• Pubic hair
• Scrotum
• Pr exam
• Pv/ speculum exam (cusco speculum)
4. What could cause vaginal
discharge?
• Physiological- increased in pregnancy, sexual arousal, puberty, cocp
• Foreign body (tampon)
• Thrush (95% C.albicans). Non-offensive white curd.
• Trichomonas vaginalis- thin bubbly fishy
• Bacterial vaginosis- fishy
• Gonorrhoea
• Chlamydia
• Ref- p404 OCH and p284 OCHS
5. What are the symptoms
Chlamydia?
• Asymptomatic 70% women 50% men
• Discharge/ dysuria
• PCB/ IMB
• Abdo pain
6. What are the possible
complications of chlamydia?
• PID -> infertility, ectopic pregnancy, chronic
pelvic pain
• Epididymoorchitis
• Reiters syndrome
7. What is Reiters
syndrome?
• Reactive arthritis etc
• Conjunctivitis/ uveitis
• Urethritis
• Arthritis
• “can’t see, can’t pee, can’t climb a tree”
8. What is Fitz-Hugh Curtis
syndrome?
• Transabdominal spread of PID
• RUQ pain
• Perihepatitis
• http://www.patient.co.uk/doctor/Fitz-Hugh-
Curtis-syndrome.htm
9. How do you diagnose
Chlamydia?
• Chlamydia trachomatis- gram -ve
• High vaginal swab
• Stuarts medium -> culture and microscopy
• Endocervical swab
• Antigen detection or enzyme immunoassays (EIAs)
• Nucleic acid amplification tests (NAATs)
• With reactive arthritis, paired serology may detect
rising titres
10. How do you treat
Chlamydia?
• Azithromycin 1g stat dose (ok in pregnancy)
• Or Doxycycline 100mg bd for 1 week
• Abstain for 1 week
• Contact trace- treat partners as well even if
asymptomatic
• Alternative= erythromycin 500mg BD for 14
days or QDS for 7 days
11. Who is at higher risk of
thrush?
• DM
• Immunodeficeincy
• Steroid treatment
• Antibiotic treatment
12. How do you treat thrush?
• Clotrimazole pessary and cream
• Or oral Fluconazole single dose
13. What is Gonorrhoea?
• Gram –ve diplococcus
• Men- urethral pus, dysuria, tenesmus, proctitis,
pr discharge if msm.
• Women- often asymptomatic. Discharge,
dysuria, proctitis
15. How do you treat
Gonorrhoea?
• Cefixime 400mg PO stat
• Or Ciprofloxacin 500mg stat
• Usually treat for chlamydia at the same time
(Azithromycin stat or doxycycline)
• Contact trace
• No sex till cured
16. How could an HIV
infection present?
• Acute infection often asymptomatic
• Seroconversion- 2-6 weeks. Transient illness.
Fever, malaise, myalgia, pharyngitis.
• Persistent generalised lymphadenopathy
(>1cm at >2 sites for >3months)
Constitutional symptoms
Opportunistic infections
17. How do you diagnose
HIV?
• Anti-HIV antibodies in serum
• HIV RNA (PCR)
• Rapid diagnostic kit OraQuick- uses oral fluid
18. What causes genital
warts?
• HPV 6 & 11 most common (these types are
associated with cancer)
• Ds DNA
• Lifetime risk is 50% but most are asymptomatic
19. How do you treat warts?
• Podophyllotoxin or imiquimod topical
treatment
• Cryotherapy
• Need explanation and information possibly
counselling.
• Partner tracing not needed unless they have
symptoms.
20. What is herpes?
• Hsv 1 and 2
• Cold sores- herpes labialis (type 1)
• Painless anal or vaginal ulcers (hsv 2)
• Can be asymptomatic
• Febrile prodrome, neuropathic pain, genital blisters/
ulcers, tender inguinal nodes, dysuria, discharge
• Lies latent in sensory ganglia
• Recurrences are shorter and more mild
21. How do you diagnose
hsv?
• PCR for DNA detection
• Viral culture
• Treatment= Aciclovir if >5 attacks in a year. No
cure. Lifelong. Most will eventually stop having
recurrences.
23. What are the 4 stages of
syphilis?
• Primary syphilis- macule at site (any ulcer is
syphilis until proven otherwise) painless hard
ulcer.
• Secondary syphilis- 4-8wk later. Rash (trunk,
face, palms, soles), malaise, lymphadenopathy,
high temp, alopecia, condylomata lata, palatal
or buccal snail-track ulcers. Rarely- hepatitis,
meningism, nephrosis, uveitis
24. • Tertiary syphilis- >2yrs latency. Gummas-
granulomas in skin, mucosa, bone, joint, visera
• Quaternary syphilis:
• Cardiovascular- AAA, aortic regurg
• Neuro- cn palsies, stroke, general paralysis of
insane (dementia/ psychosis), tabes dorsalis
(sensory ataxia, numb legs and chest, upgoing
plantars, lightening pains, charcots joints)
25.
26. How is syphilis diagnosed
and treated?
• Cardiolipin antibody- detectable in primary
syphilis. Becomes –ve after tx
• Treponeme specific antibody- stays +ve after
tx
• Contact tracing
• Procaine benzylpenicillin 600mg/ 24h im for 28
days or Doxycycline 200mg/ 12h for 28 days
