O&G:GU Med Flashcards
What are two non sexually transmitted infections?
Candidiasis
Bacterial Vaginosis
What is the causative organism in candidiasis?
Candida Albicans
Risk factors for candidiasis?
- Pregnancy
- Diabetes
- Antibiotics
Symptoms of candidiasis?
- Cottage cheese discharge
- Vulval irritation
- Itching
- Superficial dysparaeunia
Treatment of candidiasis?
Clotrimazole
What is BV?
Mixed bacterial overgrowth
Symptoms of BV?
- Grey-white discharge
- Fishy odour
- no itching/redness
Diagnosis of BV?
- Raised vaginal pH
- Positive whiff test
- Clue cells on microscopy
What is the whiff test?
Perform the whiff test (amine odor test) by adding several drops of 10% potassium hydroxide to a sample of vaginal discharge. A strong fishy odor is indicative of a positive test result.
Treatment of BV?
- Metrondizole or clindamycin cream
Risk factors for STIs?
- Multiple/new partner(s)
- No barrier contraceptive use
- Prev or current STI
- Partner has STI
- 25 or younger
- Sex worker
What is causative organism in Chlamydia?
Chlamydia Trachomatis
Symptoms of chlamydia?
- Asymptomatic (70%)
- Discharge
- Urethritis
- Irregular bleeding
Investigations for chlamydia?
- NAATs or PCR
Treatment of chlamydia?
Azithromyicin single dose
What is the causative organism in Gonorrhoea?
Neisseria Gonorrhoea
Symptoms of gonorrhoea?
- Asymptomatic
- Urethritis
- Vaginal discharge
- bartholinitis
- Cervicitis
Treatment of gonorrohoea?
IM Ceftriaxone
What causes genital warts?
Human Papilloma Virus (HPV)
Treatment of genital warts?
Imiquimod cream
What is the most common cause of genital herpes?
Type 2 HSV
Symptoms of herpes?
- Multiple small painful vesicles and ulcers
- Local lymphadenopathy
- Systemic sx
- Dysuria
Investigations for herpes?
Viral swabs
Treatment of herpes?
Aciclovir
Causative organism of syphilis?
Treponema Pallidum
Features of primary and secondary infection of syphilis?
Primary: Solitary painless ulcer (chancre)
Secondary: Weeks later, rash, flu-like sx, warty genital growths
Tertiary: Years later, severe
Treatment of syphilis?
IM Penicillin
What is trichomonas?
Protozoan infection
Symptoms of trichomonas?
- Offensive grey/green discharge
- Vulval irritation
- Superficial dysparaeunia
- Strawberry lesions on cervix
Investigations for trichomonas?
Wet film shows protozoa
Treatment of trichomonas?
Metronidazole
What is contraception?
The deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse.
Why should you use contraception?
- Control level and timing of fertility
- Increase births after age of 30years
- Decrease in family size
- Increase rate of teenage pregnancy and second subsequent unplanned pregnancies
- Increase abortion rates
What are the considerations for contraception?
- Age
- Medical contra-indicatios
- Headches, acne
- Sexual Hx- STI screen, cervical smearsAny medications/herbal remedies which may interact?
- Bleeding patterns
- Smoking
- BP and BMI
- Family Hx
What would the ideal contraceptive be like?
- 100% effective
- 100% safe
- 100% reversible
- Free from SE
- Independent of intercourse
- Cheap/free
- Free from medical intervention
- Acceptable to all cultures and religions
- Prevents STIs
- Non-contraceptive benefits
What are the oral contraceptive options?
Combined hormonal contraception (CHC) “the pill”
COCP
POP
When are oral contraceptives CI?
- Migraine with aura
- VTE
- HTN
- BMI>35
- Breast cancer
- IHD
- Stroke
- Smoker >35years
What are oral contraceptives protective against?
Ovarian, endometrial and colon cancer. Small increased risk of breast cancer.
What is COCP?
Contains oestrogen and progesterone
- negative feedback effect on gonadotrophin release
- inhibit ovulatino
What are the advantages of COCP?
- Reversible, reliable, 12hr window
- Regular predictable cycle
- menorrhagia, dysmenorrhoea
- May help with acne
- risk of PID (due to thickened Cx mucous)
- May help reduce PMS
- Protective against ovarian, endometrial & colorectal cancer
What are the disadvantages of COCP?
- (P) drug interactions (eg anti-epileptics, antibiotics, barbiturates, herbals)
- Doesn’t protect against STI’s
- efficacy if taken late or after D&V
- Possible small risk of breast cancer
- Possible small risk of cervical cancer
- Risk of thromboembolic disease (x2)
What is POP?
Progesterone only pill
- Makes cervical mucus hostile to sperm, thickens cervical mucus + thins endometrium and decreases tubal motility.
- Can use up to menopause, don’t need to double dose in obese women
- Affected by liver enzyme inducing drugs
- SE: vaginal spotting, weight gain, mastalgia, PMS
What are the advantages of POP?
- Can be used to prevent oestrogenic side effects (e.g. breast tenderness, headache, nausea)
- Suitable smokers > 35yrs
- Can be used in grossly obese
- Used with medical problems (e.g. migraine, increased BP)
What are the disadvantages of POP?
- Less effective than COC (except Cerazette)
- 3hr window (Cerazette 12 hrs)
- increased risk of ectopic (due to slow ovum transport)
- Disrupts menstrual pattern
- Functional ovarian cysts may develop
What are the common SE of oestrogen hormones?
Nausea Headaches Increased mucus Fluid retention + weight gain HTN occasionally Breast tenderness and fullness Bleeding
What are the common SE of progesterone hormones?
Depression Postmenstrual tension-like Sx Bleeding; amenorrhoea/irregular bleeding Acne Breast discomfort Weight gain Reduced libido
Complications of sex hormones contraception?
Venous thrombosis
- More common with 3rd generation pills containing the progesterogens gestodene or desogestrel
MI
- Risk if multiplied by smoking, increased age and obesity
Increased risk of:
- Strokes
- Focal migraines
- HTN
- Jaundice
- Liver, cervical and breast carcinoma
What are some reasons for condom failure?
- Condom put on after genital contact
- Condom not completely unrolled onto penis
- Condom slipped off when withdrawing penis or during SI
- Use of fat soluble lubricants (e.g. massage oils, moisturisers)
- Leakage of sperm when penis withdrawn
- Condom rupture
- Mechanical damage (e.g. fingernails, sex toys)
Advantages of female condoms?
- Protects from STI’s
- Inserted any time before intercourse
- Not affected by oils, no restriction with choice of lubricant
- Non latex
Disadvantages of female condoms?
- Failure rate higher than male condoms
- Needs careful insertion
- Easy for penis to miss it!
- Can be noisy and intrusive
- Do not use with male condom as they can stick together causing slippage or displacement
What are contraceptive diaphragms/caps?
Fit over the cervix in advance of SI to allow spontaneity. Requires good pelvic muscle tone.
If weight changes yb >3kg different size needed. Used in conjunction with spermicides.
Advantages of diaphragms/caps?
- Woman in control
- Inserted anytime before intercourse
- Can offer protection against some STI’s (not demonstrated for HIV)
Disadvantages of diaphragms/caps?
- Requires correct initial fitting by trained staff
- Requires spermicide which can be “messy”
- May become dislodged
- Must remain in position for 6hrs after intercourse
Explain contraceptive implants
- Single rod (Nexplanon)
- Contains progesterone (Etonogestrel 68mg ) – slow release
- Easy insertion & removal
- Fitting following abortion or miscarriage – within 5days.
- Contains barium sulphate – located by x-ray, USS, MRI
What are the advantages of implants?
- Low dose, long acting (3 yrs), reversible
- No oestrogenic side effects
- Minimal medical intervention (insertion and removal)
- Decrease dysmenorrhoea & menstrual blood loss
What are the disadvantages of implants?
- Irregular bleeding
- Requires minor op for insertion and removal
- Occasional discomfort
- Rarely infection at site
Explain the copper itra-uterine device?
Copper: causes FB reaction within uterus, toxic to sperm and egg = significantly reducing chance of fertilisation. Precents implantaion.
• Complications: device may be expelled, device may perforate the uterine wall
• Heavier and morepainful menstruation with copper device
• Increased risk of ectopic pregnancy
What are the advantages of copper coil?
- Long term (5-10 yrs), reliable and reversible
- Effective immediately
- Effective as emergency contraception
What are the disadvantages of copper coil?
- May cause menstrual irregularities, spotting & IMB
- May cause menorrhagia & dysmenorrhoea
- increase risk of PID first 20 days of insertion (screen for STD’s)
- Risk of ectopic pregnancy
- Perforation at insertion
- Risk of expulsion
Explain the mirena coil?
• Mirena: contain levonorgestrel (progesterone), local effects, reduces menstrual bleeding and pain. Also used for menorrhagia and progesterone HRT.
- Causes endometrial atrophy and may suppress ovulation
Advantages of mirena?
- Very effective
- Decrease menstrual blood loss
- Decrease dysmenorrhoea
- Decrease risk of ectopic
- Lowest hormone level of all methods, lower risk of side effects/ weight gain
- Lasts 5 years
Disadvantages of mirena?
- Can cause irregular bleeding especially in first 3 months
- Fitting may be painful
- Increase risk of PID after fitting
- Should not be used for emergency contraception (not licensed)
What is female sterilisation?
Interruption of fallopian tubes by removing parts so egg cannot travel to the uterus. Patients must be absolutely certain that they do not want children in the future.
Advantages of female sterilisation?
- Highly effective
- Immediately effective
- Permanent
- No hormonal effects
Disadvantages of female sterilisation?
- Surgical procedure
- General anaesthetic
- Not easily reversible (not reversible on NHS)
- Associated complications
Short term complications of female sterilsation?
Anaesthesia
Surgical
Long term complications of female sterilisation?
Increased risk of ectopic pregnancy
No effect on menstruation
Regret
(e.g. vasectomy - men, hysterectomy or tube clipping- women)
Explain hormonal emergency contraception?
- progesterone only (Levonelle – Levonogestrel 1.5mg, ellaOne – Ulipristal acetate 30mg)
- Widely available from GP’s, A&E, FPC, chemists
- Decrease viability of ova, decrease sperm numbers and may prevent implantation
- Does not dislodge an implanted embryo
- Advice pregnancy test if expected period is more than 7 days late
- Resume ‘regular’ contraception within 12hrs + barrier method for 7 days with oestrogen containing contraception, 2 days for progesterone
Advantages of hormonal emergency contraception?
- Effective, low failure rate
- Easily available
- Levonelle - taken up to 72 hrs after SI (50% efficacy up to 120 hrs)
- ellaOne – same efficacy up to 120hrs
- Can be repeated in same cycle if necessary
Disadvantages of hormonal emergency contraception?
- Associated N&V
- Can disrupt menstruation, cause intermenstrual bleeding
- Does not protect against STI’s
Explain non-hormonal emergency contraception? (IUD)
- Prevents implantation
- Can be fitted up to 5 days after the calculated earliest day of ovulation or for a single episode of UPSI at any stage in the cycle
- Needs professional fitting
Advantages of non-hormonal emergency contraception?
- Can be used if multiple episodes of SI if within 5 days of ovulation
- Can be used if vomits hormonal method
- Ideal if IUD choice of long term contraception
- Most effective method especially after 72 hrs
Disadvantages of non-hormonal emergency contraception?
- Can be painful to insert especially in primip
* Increased risk of PID
What are some new developments in contraception?
- NuvaRing
- Qlaira
- Male pill
- Synthetic testosterone & progesterone
- reversible inhibition of sperm under guidance (RISUG) (non toxic chemical)
- Intra Vas Device (plug)
- Mifepristone as EC
What is the triple swab STD check?
Triple swabs include:
1) an endocervical chlamydia swab (usually in a pink wrapper)
2) an endocervical sample using a charcoal swab to pick up gonorrhoea
3) a third sample, using a charcoal high vaginal swab to test for fungal and bacterial infections.
How is HIV transmitted?
- MTCT
- Sex
- Needle sharing
- Needlestick injury
- Transfusion of blood products without screening
Symtpoms of HIV?
Triad: Sore throat, high temp, blotchy red rash.
How do you measure HIV illness statues?
- Viral RNA count
- CD4 cell count
Management of HIV?
HAART
Highly active anti-retroviral therapy
Who should be freq tested for HIV?
- Anal sex without a condom
- Have multiple partners
- Other STIs
- Symptoms of HIV
