Seroconversion

Seroconversion usually occurs between 1 and 10 weeks after the onset of the acute primary exposure to HIV. If a patient is potentially seroconverting, i.e. has had a recent high-risk exposure (Table 4) and has indicative symptoms (Table 5) then a full physical examination and appropriate serological testing should be undertaken the patient should be handed over to the most senior doctor on duty, depending on the local clinic protocol. This acute primary seroconversion illness is self-limiting,...

Bacterial vaginosis

Bacterial vaginosis can be indicated if there is a grey white thin, homogeneous discharge with a pungent, unpleasant 'fishy' odour. There may be a minimal amount of discharge coating the vaginal walls or copious amounts, which may be present on the vulva prior to examination or pour into the speculum on insertion. BV is not usually associated with vaginitis however, there may be some physical irritation (such as itching) from the presence of the discharge. The discharge and associated odour can...

Tinea cruris

Tinea cruris is a fungal infection that occurs mainly in the groin of adult men. The rash has a scaly raised red border that spreads down the inner thighs from the groin or scrotum. It may form ring-like patterns and is similar to tinea cor-poris or ringworm. It is not often seen on the penis or vulva or around the anus. Genital warts are caused by human papillomavirus (HPV). Those with genital warts usually report the appearance of lumps or growths on their genitalia. Occasionally other...

Pelvic Inflammatory Disease

As has been indicated earlier, Pelvic Inflammatory Disease may be either acute or chronic. PID is a common cause of morbidity, and accounts for 1 in 60 consultations by women under the age of 45 (Simms et al., 2000). It has been reported that a delay of a few days in receiving appropriate treatment can increase the risk of sequelae, which include infertility, ectopic pregnancy and chronic pelvic pain (Hillis et al., 1993). The RCOG Guidance (2003) recommends that, owing to a lack of definitive...

Approaches To Health Promotion

Both Ewles and Simnett (2003) and Naidoo and Wills (2000) suggest that there are five key approaches to health-promotion work, each reflecting different objectives and ways of working. Table 7 explores each of these approaches using examples from sexual health. Broadly speaking the above approaches fall into two main categories - firstly, those that focus on the individual and, arguably, to be successful require clients to modify their behaviour and secondly, those methods that employ...

Allergic Reactions

Drugs or their reactive metabolites can cause an allergic reaction in patients that may be due to either cell-mediated or antibody-mediated reactions. There are various clinical manifestations of hypersensitivity reactions anaphylaxis, which can be life-threatening when respiration is impaired most deaths from this are due to penicillin haematological reactions - agranulocytosis, haemolytic anaemia or thrombocytopenia - may develop and can sometimes be irreversible some patients may have a...

Findings on anal inspection

Pruritus ani, perianal warts, perianal abscess, perianal haematoma, prolapsing haemorrhoids, thrombosed haemorrhoids, skin tags, anal discharge, anal fistulas, anal fissures, anal cancer, rectocele, rectal prolapse, threadworms, faecal soiling of the perineum are all possible findings (Rhodes & Hsin, 1995 Barkauskas, 2002). The anal tone can be observed at rest and on voluntary contraction. The patient should be asked to strain down as if opening bowels to show perianal descent, prolapsing...

Anatomy And Examination Of External Genitalia

The genitalia of males and females do not differentiate until week seven of embryonic life. Undifferentiated genitalia consist of a phallus, which becomes either a glans penis or a clitoris, the labio-scrotal swelling, which becomes the scrotal sac or the labia majora, a urogenital fold and the urogenital membrane. The penis around the urethra in males equates to the labia minora in females. The external genital examination for females involves examination of the mons pubis, the clitoris, the...

Inspection of the lips and face

If this is indicated by the history, inspect the eyes for signs of jaundice (BASHH, 2005a), and to see if they are bloodshot or if there is discharge (Barkauskas, 2002). Patients with extensive Phthirus pubis (public lice) may occasionally have lice in their eyebrows and eyelashes (BASHH, 2001a). Note if there are any molluscum contagiosum (MC) lesions (BASHH, 2003) on the face or any warts around the mouth (BASHH, 2002a). There is anecdotally evidence that MC facial lesions are associated with...

Vulvovaginal Candidiasis

The most common cause of vulvo-vaginal candidiasis is Candida albicans. Other non-albicans species, such as C. glabrata, account for less then 10 per cent of cases but it is this group that may be more resistant to treatment (Kinghorn and Priestly, 1998). Around 75 per cent of women will experience candidiasis at some time. It is usually related to pregnancy or follows antibiotic therapy. However, while sexual acquisition plays a small role in the aetiology of vulvo-vaginal candidi-asis, the...

Rectal pain

The most commonly complained of rectal pain is intermittent severe rectal pain that is not associated with defecation but may wake the sleeping patient. It is difficult to explain and does not usually result from organic disease. In men prostatitis is a common cause of rectal pain symptoms include perianal pain. Rectal pain will be worse on defecation (Hopcroft & Forte, 2003). Pelvic pain is a common presentation in women. Pelvic Inflammatory Disease, ectopic pregnancy, endometriosis,...

Vulval Pain Syndromes

It appears that as the classification and terminology of vulvodynia evolves it may be becoming more perplexing for many health professionals to comprehend. Typically, 'vulvodynia' is a term used to describe chronic burning and or pain in the vulva without objective physical findings to explain the symptoms (Lotery et al., 2004). Within the spectrum of vulvodynia, there are several subsets. The two main ones are vulval vestibulitis and dyaesthetic vulvodynia. Others described by Julius and Metts...

Groin And Pubic Area

Literature supports the examination of the male patient in both the supine Epstein et al., 2000 Swartz, 2002 and the standing position Walsh et al., 1999 Fuller amp Schaller-Ayers, 2000 . The exceptional case for not laying the patient down is when checking for scrotal hernias and varicoceles. In a standing position the groin or inguinal area should be examined for lymphadenopathy enlargement of lymph nodes and also noting any tenderness . Even in the absence of any sexually transmitted...

References

Abraham C, Sheeran P 1993 In search of a psychology of safer sex promotion beyond beliefs and texts. Health Education Research 8 2 245-54 Aggleton P, Tryrer P 1994 Sexual Health in Aggleton P, Rivers K, Warwick I, Whitty G eds , Learning About Aids Scientific and Social Issues, 2nd end. Churchill Livingstone HEA, London Alder M 2003 Sexual health report finds services to be in a shambles. British Medical Journal 327 12 62-3 Cooper Y 2001 Foreword Better Prevention, Better Services, Better...

Skin Anomalies Nonpathological

Fordyce spots are ectopic sebaceous glands, and are seen primarily on the labia minora and the shaft of the penis. They are large sebaceous glands seen through mucosal skin. Their appearance is that of small yellow spots. Angiokeratomas are more common in older people, and are tiny clusters of dilated blood vessels associated with keratinised tissue. They may be bright red, and will often darken to black with time. They are mainly seen on the scrotal skin in men and the labia majora in women....

Nurse Practitioner Praed Street Project The Jefferiss Wing St Marys NHS Trust

Jennifer trained at University College Hospital and The Middlesex Hospital in central London as a Registered General Nurse, qualifying in 1994. She worked initially in acute admissions and accident and emergency at University College Hospital. Jennifer's first post in sexual health was at St Thomas' Hospital, London, where she gained a solid foundation in sexual health and completed the ENB 934, the HIV and AIDS course. She then worked as a staff nurse at Archway Sexual Health Clinic for three...