A6- Sexual health risk assessment: Flashcards
Components of a sexual history
- Reasons for attendance.
- Past medical and surgical history.
- Medication, smoking, alcohol and recreational drugs.
- Obstetric, gynae and cervical screening history.
- Asymptomatic / symptoms review.
- Past history of STIs.
- Safeguarding concerns; CSE, Intimate Partner Violence…
- Last sexual contact and type of sex.
- Previous sexual partners.
- Risk assessment for blood-borne viruses.
- Protection from STIs.
- Prevention of pregnancy.
Which questions to ask for sexual history?
- Last time you had any sexual contact?
- Regular or casual partner? Are your sex partners men, women, or both?
- Do you have vaginal, oral, anal sex or other?
- In the past 12 months, how many sex partners have you had?
- Do you have any symptoms?
- Have you ever been diagnosed with an STI? When? Was it treated?
- When was the last time you were you tested for any STIs?
- Has any of your partners ever been diagnosed with an STI?
- Have you ever had sex with a partner from a country outside Europe ?
- Have you ever injected drugs ?
- Have you ever paid for sex or being paid for sex
Symptoms of STI
- Dysuria.
- Genital skin problems.
- Vaginal or urethral discharge.
- Post-coital and inter-menstrual bleeding.
- Abdominal pain/ dyspareunia.
- Lumps and bumps.
- Testicular discomfort or swelling
Who may be at higher risk of STIs?
- Multiple sexual partners.
- age under 25
. - Men that have sex with men(MSM).
- History of IV drug using.
- Using recreational drugs or excessive alcohol.
- Sex workers and their partners.
- Not using condoms.
- Sexual partners outside Europe
Bacterial STIs include:
Chlamydia. Trachomatis
Neisseria Gonorrhoeae
Syphilis
Which is the most common STI
Chlamydia Trachomatis
Neisseria Gonorrhoeae
presentation?
Syphilis
Treponema pallidum
Explain the stages?
Primary stage: Chancre: single, painless, firm ulcer.
Secondary syphilis: Generalised rash including palm of hands and sole of feet.
Latent syphilis: No symptoms.
Tertiary syphilis: Gummatous, neurological, cardiovascular complications.
Viral STIs include:
- HIV.
- genital herpes.
- genital warts
Herpes Simplex Virus (
What are they and what are the trearment?
Multiple painful blisters.
Treatment : Aciclovir
Genital warts HPV
What are they
Treatment
Painless lumps
Treatment
Topical applications: Podophyllotoxin, Imiquimod Cryotherapy Cautery Curettage
Non hormonal contraception:
- Male and female condoms
- copper IUD (Cu-IUD) LARC.
- Caps and diaphragms
- Male and female sterilisation
Hormonal contraception.
- Combined hormonal contraception (CHC): Combined pill. Vaginal ring. Contraceptive patch.
- Progesterone only contraception (POC): Levonorgestrel Intrauterine system (IUS) LARC. Progestogen only pill (POP). Depo Provera injection LARC. Contraceptive Implant LARC.
Advantages and disadvantages of CHC
Combined pill, vaginal ring, contraceptive patch.
Advantages regular bleeding, less dysmenorrhoea, very well known, lower risk of some cancers ( ovarian, bowel).
Disadvantages contraindicated if VTE, high BMI, HBP, some medical conditions, user dependent, higher risk of some cancers (breast), interactions with other drugs, no protection against STIs
Advantages and disadvantages of POC
POP, depo, Implant, IUS
Advantages no oestrogen , can be taken till menopause generally, suitable if breastfeeding, no serious side effects
Disadvantages irregular bleeding/amenorrhoea, need procedure ( implant, IUS), or repeat injections every 12 weeks ( depo)
