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

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

3. 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…

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

5. 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…

6. 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…

7. 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…

8. 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…

9. 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…

10. 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…

11. 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…

12. 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…

13. 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…

14. 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…

15. 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…

16. 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…

17. 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…

18. 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…

19. 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…

20. 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…

21. 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…

22. 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…

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