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Overview
Sexual history
Embarassing! Matter of fact Alone/with someone else Posture Language Silence The history!
Sexual history
Sexual history
Warning
I need to ask some intimate questions about your sex life which may be helpful.
Reassure confidentiality
Id like to remind you that just with other things you have told me, this is also kept confidential and only the team here involved in your care will have access to the information on a need to know basis
Sexual history
Embarassing! Matter of fact Alone/with someone else Posture Language Silence The history! Summarise
Sexual history
If no symptoms:
Clarify asymptomatic
When? Regular/non-regular partner? If regular, how long for? Gender Origin (place of birth) Type of sex Condom use?
Sexual history
If symptomatic:
The problem as the patient sees it How long has the problem been present? Is the problem related to the time, place, or partner? Is there a loss of sex drive or dislike of sexual contact? Are there problems in the relationship? What are the stress factors as seen by the patient and by the partner? Is there other anxiety, guilt, or anger not expressed? Are there physical problems such as pain felt by either partner?
Sexual history
LMP Cycle Contraception Cervical smear (if >25yrs) Pregnancy? TOP/miscarriage/birth? Dates!
Social aspects
The patients marital state How many previous sexual partners have there been Who the current partner is and for how long How many children the patient has Which of them lives with the patient Whether there is obvious stress in the family Whether there are financial worries
Medical aspects
Allergies
INFECTIONS
Most common STI Intracellular, ATP dependent, tiny! (0.5 1.0m) Squamocolumnar cells (D-K serovars) LGV
Transmissibility ~ 10%.
Condoms 6% Incubation 7 21 days
Asymptomatic ~ 50% (m), 80% (f) Dysuria, abnormal discharge, testicular swelling, sore throat, red eye NAAT test PID, epididymitis, prostatitis, chronic pelvic pain, ectopic pregnancy, urethral stricture Fitz-Hugh-Curtis syndrome, SARA, Azithromycin 1g stat Doxy 100mg bd 7 days No SI for 1/52 PN + Rx
Neisseria gonorrhoeae
Neisseria gonorrhoeae Transmissibility 60%-80%(mf), 20%(fm) Incubation 5-8 days (1 14 days) Asymptomatic, abnormal discharge, dysuria, abdominal pain, IMB, sore throat, red eye Microscopy Culture + Sensitivity NAAT
Ceftriaxone 500mg IM (with lidocaine) + Azithromycin 1g PO stat Abscesses, Urethral strictures, Cowperitis, Prostatitis, PID Fitz-Hugh-Curtis syndrome, DGI, Endocarditis, Hepatitis, Meningitis (very very rare). PN + treated
Bacterial vaginosis
NOT an STI Blacks, IUCD, smokers, sexually active Imbalance in vaginal flora Thin, white (malodorous) discharge, pH Microscopy lack of lactobacilli of varying degrees, anaerobes predominate Amsel criteria/Hay-Ison criteria Metronidazole 400mg bd for 5 7 days Avoid douching, tight clothing, using perfumed products
Trichomoniasis
Trichomonas vaginalis Flagellated protozoan Associated with other STIs Incubation 4 28 days
Asymptomatic, abnormal discharge, dysuria, abdo pain, vulval discomfort, malodorous discharge Direct microscopy
Trichomoniasis
Candidiasis (thrush)
Candida species, usually albicans Itching/irritation White discharge Superficial dyspareunia External dysuria Erythema, fissuring, discharge (curdy but may be thin), oedema Clotrimazole 1% cream and/or Clotrimazole pessary
Candidiasis (thrush)
Advice:
Avoid using soaps or washing internally Avoid tight clothing Avoid local irritants
Genital warts
Genital warts
QUESTIONS?