infections/contraception Flashcards
1
Q
Male symptoms of STIs?
A
Burning whilst peeing, discharge, blood, swelling, pain in testicles, anal symptoms, rash/lump/bump
2
Q
What do you ask about in sexual history taking for GUM’?
A
when did you have sex? regular/casual? male/female? oral/anal? giving/receiving? when did you sleep with someone else?
3
Q
What questions do you need to ask the individual about the type of people they’ve slept with?
A
Any one from outside the UK? any one using IV drugs? ever paid for sex?
4
Q
How would you determine if the patient has had any BBV?
A
any transfusions? surgery abroad? had a HIV test? vaccinations?
5
Q
What do you need to ask about in SH at GUM?
A
smoking, drinking, recreational drugs? ever not consented? OTC?
6
Q
What and where do you test in male (homosexual) GUm clinic?
A
swab throat and penis for G, urine sample for C, rectal swab for C and G, blood test for HIV/S/hepatitis
7
Q
Symptoms of female STI?
A
Discharge, itch, bleeding IMB/PC, pain, burn when peeing, bowel changes, painful sex, fever, lumps/bumps/rashes
8
Q
Specific questions you need to ask a female at GUM clinic?
A
period history, pregnancy, smear
9
Q
How many days before period does ovum get released?
A
14 days
10
Q
How many hours does ovum survive for?
A
48 hours
11
Q
How many mls is each ejaculate and how many sperm present?
A
3-5mls with 350,000,000 sperm
12
Q
How long does sperm survive in female genital tract for?
A
3-4 days
13
Q
What physical changes are monitored as signs of fertility in the natural family planning method?
A
cervical mucus changes, basal body temp, knowledge of regular cycles
14
Q
why is coitus interruptus not recommended?
A
sperm found in preejaculate
15
Q
Name a contraceptive patch, how often does it need to be changed, what hormones does it secrete
A
EVRA, every week change, 4th week no patch, Combined
16
Q
Name a vaginal contraceptive ring, how often does it need to be changed, what hormones are secreted
A
NUVARING, 3 weeks with the ring in and then 1 ring free week, Combined
17
Q
What questions do you need to ask someone wanting the emergency pill?
A
What happened, LMP, cycle, casual/regular, any chronic health issues, any medication, any other risks in cycle
18
Q
Name 2 types of emergency pill?
A
Levonelle, EllaOne
19
Q
How many days is levonelle effective for?
A
3
20
Q
What is contained within Levonelle?
A
1500ug of Levonorgestrel
21
Q
What is the mode of action of Levonelle?
A
Delays ovulation
22
Q
What types of drugs do Levonelle interact with? How do you combat
A
Liver enzyme inducing drugs so need increased dose
23
Q
Ho many days is EllaOne effective for?
A
5 days
24
Q
What is contained within EllaOne and dosage?
A
Ullipristal acetate 30mg
25
How does EllaOne act to prevent pregnancy?
Progesterone receptor blocker and delays ovulation
26
Contraindications for giving EllaOne?
breast feeding, cardiac arrhythmias, severe liver or renal disease, severe asthma
27
What types of drugs do EllaOne interact with? How do you combat
Liver enzyme inducing drugs, you cannot give EllaOne. Anything that raises gastric ph like PPIs,
28
How many days after USPI can the CUD be inserted?
5 days
29
What is pearl index and what is the value for cocp
pearl index is the failure rate per 100 woman years and for cocp it is 0.5
30
What are the pack sizes of cOCP
21 day or 28 day with 7 dummy pills
31
what is the 7 day rule in pill taking?
If you miss a pill then it takes 7 days for the effectiveness to return
32
Contraindications for cOCP
circulatory disease, focal migraines, hypertension, liver disease, gallstone history, steroid dependant cancers, undiagnosed genital tract bleeding, pregnancy, BMI over 34
33
What is it important to ask about in FH of someone wanting to start cOCP?
any TE in the under 45s
34
What is the pearl index and what is it for POP?
pearl index is a measure of how many women will get pregant in 100 years of taking the pill, for POP it is 2-4
35
If you miss a POP, how many days till its effects are restored?
2 days
36
Mode of action of the POP?
alters cervical mucus, alters endometrium, affects tubal motility
37
Contraindications to POP?
undiagnosed bleeding, steroid dependant cancer, severe arterial or liver disease
38
Progestogenic SEs?
headache, skin changes, mood changes
39
What is the newest POP available?
Ceraxette
40
What are 2 risks of taking the POP?
ectopic pregnancy and functional ovarian cysts
41
What is contained within Ceraxette and what is pearl index?
ceraxette contains desogestrel with pear index of 0.4-1
42
What does LARC stand for and what is classified as one?
Long acting reversible contraception which lasts longer than 4 weeks
43
What is nexplanon? contains what? Pearl index?
subdermal implant, etonorgestrel, 0.1,
44
What is depoprovera? how often? drug and dose?
IM depot injection every 12 weeks, depomedroxyprogesterone acetate 150mg
45
What is the main risk of depoprovera?
osteoporosis
46
How do you assess for osteoporosis risk?
unexplained fractures, poor diet, low BMI, heavy alcohol use, steroid use, under 20 or over 45
47
SE of depoprovera?
progestogenic SE (mood changes, acne, headache)
48
What is found on the stem of the mirena coil?
Progestogen
49
What is the pearl index of the mirena coil?
0.3
50
contraindications for the mirena coil?
ongoing undiagnosed vaginal bleeding, recent trophoblastic disease, delivery in the last 4 weeks, CV disease, steroid dependant cancers, active pelvic infection
51
Risks of mirena coil and copper coil?
Perforation, ectopic pregnancies, PID (from preexisting), fall out
52
When is Jaydess IUS preferred over mirena?
in women you cant fit the mirena
53
Pearl index of copper IUD
0.5-2
54
When is the copper IUD contraindicated?
When there is ongoing bleeding, trophoblastic disease, recent delivery within the last 4 weeks, active PID
55
2 materials that condoms can be made from?
polyurethane or latex
56
What are female condoms made from?
Polyurethane
57
What does the female diaphragm lie between?
anterior pubic ramus to the posterior fornix
58
What is the failure rate of male sterilization
1/2000
59
What is the delayed effectiveness of male sterilization?
3-6 months
60
What is the failure rate of female sterilization?
1/250
61
During an ESSURE procedure what material is placed in the fallopian tubes (2)?
titianium and nickel
62
Which 2 STIs do not need sexual contact but only close contact in order to be spread?
Public lice and scabies
63
At risk groups of HIV?
Black/Afrocarribean, gay men, IV abusers, young adults
64
Sexual health history symptoms to ask about?
dysuria, dyspareunia, discharge, itch, pain/discomfort (superficial/deep), bleeding after sex or between periods, smell, rash, lesions
65
What specific extra STD tests do homosexual men recieve?
Hep b and c
66
How is chlamydia vs gonorrhoea tested for in a laboratory?
C = PCR, G = gram stain microscopy
67
5 Cs of a consultation?
Cure, Contact tracing, Condom, Complication, Chance to educate
68
Questions to ask about discharge?
Amount, smell, blood, consistency
69
BV symptoms?
very foul smelling discharge, minimal itch
70
What happens to the vaginal bacteria in BV infection?
Lactobacilli are eradicated and replaced with anaerobes and some aerobes
71
What are the 4 features of the AMSELs criteria in BV diagnosis and how many features are needed to diagnose?
pH over 4.5, amine test positive with KOH, appearance of discharge frothy and white, clue cells on microscopy
72
What medication is given to treat BV? what does it do?
metronidazole to kill anaerobes and allow lactobaccilli to grow
73
What is risk with BV infection in pregnancy?
PRoM
74
Presentation of vaginal candidiasis?
Itchy, red, satellite lesions, discomfort, curdy discharge
75
What topical treatment is available for candidiasis?
clotrimazole cream or pessary
76
What oral treatment is available for candidiasis?
fluconazole or itraconazole
77
Presentation of trichomonas?
Itch, discomfort, dyspareunia, discharge, acute vulvovaginitis
78
Why are trichomonas infection presentation often named strawberry cervix?
punctate haemorrhages
79
If punctate haemorrhages are seen on the cervix what infection do you suspect?
trichomonas
80
Treatment of trichomonas infection?
Oral metronidazole
81
Why do you have to use PCR/NAAT to diagnose chlamydia
cannot be seen on gram stain as an intracellular pathogen
82
What 3 serovars of chlamydia are the leading cause of infectious blindness?
A b c
83
What serovars of chlamydia are most common STis in the Uk
d/e/f/g/h/i/j/k
84
Serovars L1/L2 and L3 of chlamydia lead to what? what does it invade?
lymphogranuloma venereum invading genital lymph nodes leading to inguinal syndrome or rectal syndrome
85
Symptoms of chlamydia in women?
change in discharge, deep dysparunia, post coital bleeding, itch, PID, infertility, acute urethritis, proctitis, pelvic pain, ectopics, conjunctivitis, reactive arthritis
86
Symptoms of chlamydia in men?
Urethritis, discharge, bleeding, epididymo-orchitis, proctitis, rectal involvement, conjunctivitis, reactive arthritis
87
SARA? gained from what infection?
sexually acquired reactive arthritis usually from chlamydia
88
3 symptoms of PID found on bimanual examination?
pelvic tenderness, cervical excitation, adnexal tenderness
89
List some differentials of PID?
Ectopic pregnancies, endometriosis, UTI, ovarian cyst complications, acute appendicitis, IBD, diverticulitis, dka, Addisonian crisis
90
Investigations into suspected PID?
Urinalysis and urine culture
91
Treatment/management of PID?
antibiotics, fluids, analgesia, antipyrexial
92
What is the identifying feature of non specific urethritis in men?
excess polymorphonuclear leukocytes (PMNLs) in anterior urethra
93
What type of bacteria is gonorrhoea?
gramnegative diplococci
94
Treatment of chlamydia?
Azithromycin 1g
95
Gonorrhoea treatment?
Cefixime 400mg
96
PID drug treatment ?
Ofoxacin 400mg BD and metronidazole 400mg BD
97
What causes genital warts?
HPV
98
2 most common benign HPV strains?
6 and 11
99
Type of people you would be worried about HPV reoccurence?
Pregnant, immunocompromised or diabetic
100
2 ablative methods of genital wart treatment?
Cryotherapy or electrocautery
101
3 chemical methods of treating genital warts?
podophylotoxin, TCA (trichloracetic acid), imiquimod cream
102
Most cervical cancers are caused by which 2 strains of HPV?
16 and 18
103
Name of the HPV vaccine that protects against strains 16 and 18 only?
Cerovex
104
Name of the HPV vaccine that protects against 6,11,16,18
Guardosil
105
Molluscum contagiosum - describe, identifying feature, spread, treatment
smooth papules, umbilicated centre, skin contact, spontaneously regress
106
How does herpes infection initially present?
Prodrome of flu, ulcer, tender inguinal nodes
107
2 complications of herpes infection? (pain/obstruction)
post herpetic neuralgia, urinary retention
108
First line treatment of herpes infection?
Aciclovir
109
What trimester can herpes infection develop into neonatal herpes?
3rd trimester
110
If someone presents with a solitary painless ulcer what are you concerned about? how would you test?
Primary syphilis, ulcer exudate shone under dark ground microscopy and repeat in 12 weeks
111
2 potential complications of lichen sclerosis on the penis if left untreated?
Meatal stenosis and phimosis
112
Complications of lichen sclerosis on the vulva?
Vulval stenosis, fusiolabia
113
2 causative agents of pediculosis?
crabs or nits
114
What is the treatment of pediculosis?
Malathione 0.5% over effected area
115
What is it that causes itchy inflammatory reaction in scabies?
the excrement from the mites
116
Treatment for scabies?
Malathione 0.5%
117
If a baby is born to a HIV positive mother, what prophylactic treatment is given to the baby?
4 weeks of ART
118
Presentation of primary syphillis and how long after infection does it present?
2-6 weeks with a painless ulcer
119
How does secondary syphilis present?
generalised rash on body, arms and palms, lymphadenopathy, aseptic meningitis, transient hepatitis or cranial nerve palsy
120
Causative agent of syphilis? identified with what light?
Treponema pallidum, dark ground microscopy
121
What are the tests available for treponema infection?
serological treponema animo assay or treponema pallidum particle agglutination (TPPA)
122
What are VDLR tests useful for in syphilis?
Monitoring treatment response
123
3 systems that are mainly invovled in 3rd stage syphilis?
eyes, neuro, CV
124
What is done to prevent Hep B being transmitted from mother to baby?
Hep B specific immunoglobulins and vaccine to baby
125
Risk factors for erectile dysfunction?
older age, hypertension, heart disease, dyslipidaemia, less physical exercise, diabetes, neuro disorders, radiotherapy, trauma,
126
What are the 2 main classes of medications that can cause erectile dysfunction?
antihypertensives, antidepressants
127
What are 3 baseline blood tests for erectile dysfunction?
Lipid levels, testosterone, fasting glucose
128
What drug class is used for erectile dysfunction?
PDE5 inhibitors
129
Example of PDE5 inhibitors
sildenafil (viagra), tadalafil (cialis), vardenafil (levitra)
130
What type of contraception is nexplanon?
subdermal implant
131
How often do you get the depo provera contraception?
Injected every 12 weeks
132
3 strengths of oestradiol in the cOCP?
20/30/35 mcgs
133
Safety window for taking the cOCP?
12 hours
134
Miss a cOCP how long does it take to get back up to full coverage?
7 days
135
SE of the cOCP?
low mood, headache, tiredness, nausea, bloating, acne
136
Contraindications to the cOCP
BMI over 35, smoker aged over 35, focal migraines, uncontrolled hypertension, liver problems, breast cancer presently or last 5 years, trophoblastic disease
137
What is contained within EVRA and what dosage?
progesterone and 20mcgs of oestrogen
138
How much oestrogen is contained within NUVARING?
15 mcgs
139
How long does it take to return POP to a normal level after missing a dose?
2 days
140
What is the safety window of the POP?
3 hours
141
How does POP work?
Makes cervical mucus thicker to stop sperm passing through
142
Side effects of POP?
headache, low mood, acne, loss of libido
143
How does Levonelle prevent pregnancy?
Delays the LH surge and therefore ovulation by up to 5 days until sperm dies
144
What situation will Levonelle be ineffective?
Any one who has been on contraception in the last 5 days
145
How does EllaOne act to prevent pregnancy?
Progesterone receptor competitor which acts to prevent follicular stimulation and growth
146
Emergency contraception is ineffective if the patient is taking what 2 medications?
PPI, steroids
147
When in the cycle can Cu IUD be fitted?
5 days after the earliest potential ovulation
148
When is a uterus not suited for Copper coil insertion?
if it is distorted by fibroids etc
149
Why is Desogestrol different to other POP?
has a 12 hour window instead of a 3 hours window and takes 7 days to return to normal cycle after missing a dose unlike other progesterones which only take 2
150
Which contraceptive method leads to nearly all women being amenorrhoeic within 3 months?
Depo Provera
151
Major potential side effect of Depo Provera?
Decreased bone mineral density
152
How long does it take to regain fertility after stopping depo provera?
up to a year
153
What disease makes Copper IUD contraindicated?
Wilson's Disease
154
How long does mirena and jaydess last?
mirena for 3 years, jaydess for 5 years
155
How does mirena effect HRT dosing?
Mirena provides progesterone therefore only need to take oestrogen
156
What is needed to be used with the diaphragm method of contraception?
Spermicide
157
In male sterilization when is the first sperm sample taken post op? when is the second taken?
First after 2 weeks post op then second after 3 months
158
What is the Essure method of sterilization in women?
LA, springs in isthmus, fibrosis, occlusion
159
When taking a contraception consultation what is it important to ask about in the medical history?
Migraines, DVTs, breast cancer in the last 5 years, any illnesses
160
What is it important to ask about in a contraception clinic history?
medical history, contraceptive needs, choices, gynae history, obstetric history, sexual history, drug and allergy history, FH of DVTs or breast cancer,
161
What must you explain about each contraceptive method?
What it is, failure rate, how to take it, SE, risks, benefits, informed choice
162
What 3 tests and examinations are needed before starting on contraception (pills specifically)
BMI, BP, smear
