Sexual Medicine Josie and Jess The Peer Teaching Society is not liable for false or misleading information…

Topics Vaginal discharge Urethral discharge STIs The Peer Teaching Society is not liable for false or misleading information…

Vaginal discharge Changes, colour, consistency, smell Physiological Sexually and non sexually transmitted infection Chlamydia Gonorrhoea Candida BV Trichomoniasis The Peer Teaching Society is not liable for false or misleading information…

Urethral discharge Chlamydia Gonorrhoea Trichomonas (Urethritis) The Peer Teaching Society is not liable for false or misleading information…

Other STIs Syphilis HSV Not covered in this talk HIV Hepatitis B & C The Peer Teaching Society is not liable for false or misleading information…

Sexual history PC/HPC Previous STIs and treatment Sexual history (3-12 months) Who When What Condoms Orientation Women – LMP, pregnancy, contraceptives, smears Men – last urine void The Peer Teaching Society is not liable for false or misleading information…

Investigations Asymptomatic Symptomatic Men First void urine CT/GC NAAT Syphilis/HIV serology Dipstick Urethral swab GC culture MSM Plus pharyngeal/rectal swabs CT/GC NAAT Hepatitis B serology Plus pharyngeal/rectal swabs for NAAT, gram stain and culture CT/GC NAAT Women Endocervical or self taken vulvo-vaginal swab CT/GC NAAT Wet and dry high vaginal swabs for candida, BV and trichomonas CT/GC NAAT, gram stain and culture The Peer Teaching Society is not liable for false or misleading information…

Candida (thrush) Candida albicans (90%) *Itching*, soreness, non-malodorous discharge, (pain) Clinical diagnosis (+HVS) Rx antifungals Clotrimazole pessary Oral fluconazole Topical antifungal to relieve itching Should resolve 7-14 days Complicated infection – pregnancy, severe, recurrent, immunocompromised patients The Peer Teaching Society is not liable for false or misleading information…

Bacterial vaginosis Anaerobes Increased pH>4.5 50% symptomatic white, fishy smelling discharge Usually no itching or soreness Rx metronidazole 5-7 days The Peer Teaching Society is not liable for false or misleading information…

Trichomonas Trichomonas vaginalis protozoa 50% symptomatic Swabs Frothy yellow-green thick discharge Offensive odour Soreness, itch Pain Strawberry cervix Swabs Rx metronidazole Treat partners concurrently The Peer Teaching Society is not liable for false or misleading information…

Chlamydia Chlamydia trachomatis 70% women, 50% men asymptomatic High index for suspicion Discharge, bleeding, pain NAAT and swabs Rx azithromycin 1g stat dose Or doxycycline 7 days Contact tracing The Peer Teaching Society is not liable for false or misleading information…

Gonorrhoea Neisseria gonorrhoeae 50% women asymptomatic, most men are symptomatic Discharge, pain, vaginal bleeding Swabs, NAAT Rx ceftriaxone 500mg IM + azithromycin 1g stat dose Contact tracing The Peer Teaching Society is not liable for false or misleading information…

Syphilis Treponema pallidum spirochete Primary – chancre Secondary Non-pruritic maculopapular rash esp. soles and palms Condylomata lata – moist wart like lesions Snail tract lesions Viral type illness Latent – positive serology with no symptoms Tertiary Neurosyphilis Cardiovascular Gummatous The Peer Teaching Society is not liable for false or misleading information…

Syphilis Blood test Rx IM benzylpenicillin Contact tracing Often coinfection with HIV, worse prognosis The Peer Teaching Society is not liable for false or misleading information…

Herpes HSV type 1 (oral) or 2 Multiple painful blisters external genitalia and surrounding skin Can have viral illness, discharge etc. Recurs after latent period, usually not as severe Viral culture Rx oral aciclovir Abstain from sex until lesions have cleared The Peer Teaching Society is not liable for false or misleading information…

Quiz! A 23 year old woman comes to see you because her boyfriend has recently noticed some discharge from his penis. He says it’s ‘fine’ but she is worried it might be something sinister. She has no symptoms herself. You take endocervical swabs and culture shows a gram negative bacteria that is sensitive to doxycycline. What organism is causing her infection? Chlamydia trichomatis The Peer Teaching Society is not liable for false or misleading information…

A 24 year old man sees you in GUM clinic A 24 year old man sees you in GUM clinic. He has recently had unprotected sex with his male housemate. He admits to having tried IV drugs in the past. What investigations are appropriate? First void urine, pharyngeal/rectal swabs, Syphilis/HIV/Hepatitis B serology He has Syphilis. What is the next 2 appropriate management steps? IM benpen and contact tracing The Peer Teaching Society is not liable for false or misleading information…

A 27 year old woman is complaining of a fishy smelling discharge A 27 year old woman is complaining of a fishy smelling discharge. She has no other symptoms. What is the most likely cause? BV How would you treat this? Metronidazole The Peer Teaching Society is not liable for false or misleading information…

How do you treat Chlamydia How do you treat Chlamydia? Azithromycin 1g stat dose or doxycycline 5-7 days. Contact tracing The Peer Teaching Society is not liable for false or misleading information…

Briefly describe the natural history of syphilis Briefly describe the natural history of syphilis. Primary – chancre lesion Secondary – palmar/sole rash (maculopapular), flu like symptoms Latent phase Tertiary – neuro, CV, Gummatous The Peer Teaching Society is not liable for false or misleading information…

A man has some mouth ulcers A man has some mouth ulcers. Which virus is most likely causing his symptoms? HSV1 If she were to give oral sex to his girlfriend, can she get genital herpes? Yes. HSV1 can cause genital as well as HSV2 The Peer Teaching Society is not liable for false or misleading information…

A 19 year old female visits you in GP A 19 year old female visits you in GP. She is worried because she has noticed some ‘unusual’ discharge from her vagina. It doesn’t smell particularly and though she admits to being sexually active, she says she always uses condoms. What investigations would you want to do? Wet and dry high vaginal swabs, endocervical swabs, offer HIV/syphilis serology All her swabs come back clear. What would you advise this patient? The discharge is physiological, may be cycle related Return to GP if any change or unusual odours The Peer Teaching Society is not liable for false or misleading information…

Questions? Thanks for listening The Peer Teaching Society is not liable for false or misleading information…