SEXUAL HEALTH REVISION
- ‘Double swabs’ - x1 endocervical NAAT swab for CT and NG, x1 high-vaginal charcoal swab for
bacterial and fungal infections
- ‘Triples swabs’ - x1 endocervical NAAT swab for CT, x1 endocervical charcoal swab for NG, x1
high-vaginal charcoal swab for bacterial and fungal infections
Symptoms Diagnosis Treatment
Chlamydia 80% asymptomatic; endocervical Azithromycin stat or doxycycline
Chlamydia discharge (white), NAAT swab
trachomatis dysuria, cervicitis, Complications:
7-21d incubation bleeding, pelvic pain first-pass urine PID, Bartholin’s abscess
NAAT lymphogranuloma venereum
50% asymptomatic; (ideally 2w post- (painless ulcer → inguinal
discharge, dysuria UPSI) lymphadenopathy → proctocolitis) -
doxycycline, non-specific urethritis
urethral strictures, reactive
arthritis
Gonorrhoea 50% asymptomatic; endocervical Azithromycin stat + ceftriaxone IM
Neisseria discharge NAAT swab or stat
gonorrhoea (gram (mucopurulent), endocervical
neg diplococci) dysuria, cervicitis, charcoal swab Complications:
2-5d incubation bleeding, pelvic pain PID (with Fitz-Hugh-Curtis
first-pass urine syndrome), Bartholin’s abscess,
80% asymptomatic; NAAT urethral strictures
discharge, dysuria urethral strictures, septic
arthritis
Herpes Painful ulcer, dysuria, Swab ulcer for Aciclovir ( until birth via c-section)
HSV-1, HSV-2 pyrexia, inguinal PCR or culture
lymphadenopathy
Syphilis 1o - painless ulcer Swab ulcer for Benzathine benzylpenicillin IM
Treponema 2o - rash, general PCR stat
pallidum lymphadenopathy, Jarisch-Herxheimer reaction (fever +
constitutional sx, rash + tachycardia a few hours after
condylomata lata, first dose)
tingling
Anogenital warts Small (2-5mm) fleshy Clinical dx but Podophyllotoxin cream (3d on, 4d
(condylomata protuberances with screen for other off until healed) or cryotherapy
acuminata) slight pigmentation, STIs
HPV-6, HPV-11 may bleed or itch
Chancroid Papule → pustule → Swab lesion for Azithromycin stat
Haemophilus painful ulcer (multiple PCR
ducreyi in , single in ),
Developing inguinal
countries lymphadenopathy
PID Discharge, pelvic pain, Double or triple Doxycycline or ofloxacin +
- ‘Double swabs’ - x1 endocervical NAAT swab for CT and NG, x1 high-vaginal charcoal swab for
bacterial and fungal infections
- ‘Triples swabs’ - x1 endocervical NAAT swab for CT, x1 endocervical charcoal swab for NG, x1
high-vaginal charcoal swab for bacterial and fungal infections
Symptoms Diagnosis Treatment
Chlamydia 80% asymptomatic; endocervical Azithromycin stat or doxycycline
Chlamydia discharge (white), NAAT swab
trachomatis dysuria, cervicitis, Complications:
7-21d incubation bleeding, pelvic pain first-pass urine PID, Bartholin’s abscess
NAAT lymphogranuloma venereum
50% asymptomatic; (ideally 2w post- (painless ulcer → inguinal
discharge, dysuria UPSI) lymphadenopathy → proctocolitis) -
doxycycline, non-specific urethritis
urethral strictures, reactive
arthritis
Gonorrhoea 50% asymptomatic; endocervical Azithromycin stat + ceftriaxone IM
Neisseria discharge NAAT swab or stat
gonorrhoea (gram (mucopurulent), endocervical
neg diplococci) dysuria, cervicitis, charcoal swab Complications:
2-5d incubation bleeding, pelvic pain PID (with Fitz-Hugh-Curtis
first-pass urine syndrome), Bartholin’s abscess,
80% asymptomatic; NAAT urethral strictures
discharge, dysuria urethral strictures, septic
arthritis
Herpes Painful ulcer, dysuria, Swab ulcer for Aciclovir ( until birth via c-section)
HSV-1, HSV-2 pyrexia, inguinal PCR or culture
lymphadenopathy
Syphilis 1o - painless ulcer Swab ulcer for Benzathine benzylpenicillin IM
Treponema 2o - rash, general PCR stat
pallidum lymphadenopathy, Jarisch-Herxheimer reaction (fever +
constitutional sx, rash + tachycardia a few hours after
condylomata lata, first dose)
tingling
Anogenital warts Small (2-5mm) fleshy Clinical dx but Podophyllotoxin cream (3d on, 4d
(condylomata protuberances with screen for other off until healed) or cryotherapy
acuminata) slight pigmentation, STIs
HPV-6, HPV-11 may bleed or itch
Chancroid Papule → pustule → Swab lesion for Azithromycin stat
Haemophilus painful ulcer (multiple PCR
ducreyi in , single in ),
Developing inguinal
countries lymphadenopathy
PID Discharge, pelvic pain, Double or triple Doxycycline or ofloxacin +
