GUM

Question 1

Chlamydia

Answer 1

Often asymptomatic but can have discharge, pain, bleeding, epididymitis
diagnosis - NAAT swab
Treat w/doxy 100mg PO BD 7 days
if pregnant azithromycin 1g
contact trace, notify, abstain from sex

Question 2

STI swabs

Answer 2

Charcoal - endocervical or high vaginal
Confirms BV, candida, gonorrhoea if EC, trichomonas (posterior fornix), GBS
NAAT - endocervical or urethral
Confirms chlamydia, gonorrhoea

Question 3

Sexual history

Answer 3

last sexual contact, type of sex
regular or casual partner, M/F
contraception use
other partners in last 3 months
STI screening
consent

Question 4

HIV risk assessment

Answer 4

partners from abroad
partner known to be HIV positive
any recreational drugs
any previous partners having ever injected drugs
paid someone or been paid for sex
had any sex you’ve not consented to

Question 5

HIV PEPSE

Answer 5

Raltegravir
2 tablets every 24 hours
Tenofovir/emtricitabine
1 tablet every 24 hours
SE - nausea, fatigue, dizziness, diarrhoea, headache, stomach ache

Question 6

Vasectomy

Answer 6

cut cas deferens, stop sperm entering semen - permanent contraception
failure rate 1 in 2000
LA injection, cut skin, cut vas deferens, stitch up - 15 mins ish
risks - wound infection, bruise, pain
after 8 weeks give 2 semen samples 3-6 weeks apart, check for sperm

Question 7

Emergency contraception

Answer 7

copper coil - 5 days after UPSI or 5 days after earliest ovulation date, most effective, can worsen periods
levonorgestel - 72h after UPSI, 1.5mg single dose (N&V, menstrual changes)
ulipristal - 120h after UPSI, 30mg single dose (N&V, menstrual) - no asthma, no breastfeeding for 1 week, OCP not work
take pregnancy test in 3 weeks