OBS & GYNAE WK 2 Flashcards
mechanism of action of contraception
suppressing FSH and LH by negative feedback
prevention of ovulation
LARC
Long acting reversible contraception
-IUD
-permanent methods
permanent contraception methods
tubal ligation - female
tie off tubes
vasectomy - male, no scalpel technique
early and late failure rate
LNG releasing IUD
Levonorgestrel-releasing
more effective than copper IUD
MIRENA
irregular spotting / bleeding is common
COPPER COILS VS COPPER IUD - PROS AND CONS
coils - hormonal
long lasting 3-10 yrs
very effective
quick
uncomfortable, pain
invasive
small risk of perforation
IUD
Can last up to 10 yrs
non-hormonal
heavier periods and longer
SDI
subdermal contraceptive implant
-delivery of a steroid progestin from polymer capsules or rods placed under the skin
most effective of all conceptive methods
lasts 3 yrs
progesterone only
bleeding
UK MEC criteria
4 categories
1 = no restriction for use, always useable
2 = broadly useable
3 = caution
4 = DO NOT use
combined hormonal contraception, what are the 3 types - CHC
pill
patch
ring
combined pill = take daily, then a break
what factors may affect effectiveness of CHC??
impaired absorption
increased metabolism
pros and the risks of CHC
Combined hormonal contraception
-reduction in ovarian and endometrial cancers
-beneficial effect on acne
-fewer functional ovarian cysts
-VENOUS THROMBOEMBOLISM
-ARTERIAL DISEASE, MI
-ADVERSE EFFECTS ON SOME CANCERS, breast and cervical cancer risk
POP
progestogen only pill
taken daily
eg. cerelle
inhibits ovulation
usually taken day 1-5
v small increased risk of breast cancer, so contraindicated in ppl w breast cancer
nausea, spots, bleeding, headache
depo provera / sayana press
injection into buttocks
or thigh, by professional, every 13 wks.
injection into thigh by yourself
weight gain
nausea
spots
stop depo after 50 yrs due to bone health
diaphragm
cup shaped w removal dome, made of silicon
emergency contraception - 3
levonorgestrel aka levonelle
72hrs after sex
ulipristal acitate aka ellaone
120hrs after sex
IUD - 5 days after
most common non-specific urethritis ?
chlamydia
cystitis vs urethritis vs dermatitis
c - bladder inflammation, wider symptoms (gut bacteria)
u - systemically well, dysuria and discharge (chlamydia, gonorrhoea)
d - rash, ulcers (candida)
investigations for urethritis
clinical exam
urethral swab for gram stain and microscopy
urethral swab for gonorrhoea culture
throat and rectal swabs for chlamydia and gonorrhoea NAAT (if they r having anal)
blood for syphilis and HIV
diagnosis of urethritis
> 5 polymorphs under microscope
gonococcal urethritis vs non-gonococcal urethritis
gonococcal - shorter incubation period, yellow/green, more urinary symptoms
chlamydia vs gonorrhoea
chlamydia - milky discharge, irregular bleeding, abdo pain, dysuria
gonorrhoea - more between younger ppl, men and men, greenish discharge
1st and 2nd line for gonorrhoea
- ceftriaxone usually
or ciprofloxacin (only where antimicrobial sensitivities are known) - cefixime
complications of gonorrhoea
tysonitis
bartholinitis
pretty rare
dyspareunia
pain associated with sexual intercourse
cervical excitation
cervical motion is tender on bimanual exam, sign of PID
symptomatic sampling for vaginal discharge
cervical microscopy
vaginal microscopy
urinalysis
VVS
HVS
amies swab
PID
lower abdo pain, discharge
tenderness on bimanual vaginal exam
under 25
not using barriers
chlamydia most likely causing this
use ceftriaxone, doxy
complications of Chlamydia Trachomatis
PID -> ectopic pregnancy
conjunctivitis
reactive arthritis
CT treatment
doxycycline
or
azithromycin if they can’t take doxy
MG - mycoplasma genitalium
asymptomatic
association w non-gonococcal urethritis and PID
NAAT test
high levels of macrolide resistance
bacterial vaginosis - why does this happen and what to use to treat it
white, frothy, milky discharge, smelly, fishy like cottage cheese
pH increases as there is no lactobacillus (due to entry of semen, blood, or douching)
use metronidazole
topical clindamycin
what cells are present in bacterial vaginosis under microscopy
clue cells
candidiasis
Not sexually transmitted
fungal infection
white, clumpy discharge
genital skin care advice
any azole - eg. fluconazole
trichomonas - most common non viral STI IN WORLD
TX
grey frothy discharge
red
smell
itch
strawberry cervix
METRONIDAZOLE
PARTNER NOTIFICATION
causes of genital ulceration
SEXUALLY TRANSMITTED
herpes
syphilis
HIV
monkeypox
NOT SEXUALLY TRANSMITTED
varicella zoster
crohn’s
trauma (chemical)
behcet’s
genital herpes - caused by what?
HSV
transmission - close contact thru mouth, anogenital tract
pain, dysuria, discharge, flu, fatigue, erythema
primary vs recurrent herpes
primary - first time, few days incubation period
recurrent - reactivation of latent virus, tingling, itching (prodrome)
mx of primary genital herpes simplex
swab lesion PCR
FULL STI SCREEN
aciclovir
supportive
HSV 1 vs HSV 2
over 50% of genital herpes are type 1
type 2 is associated w less stigma than type 1
neonatal herpes
most dangerous when mother has it during 6 months before delivery
syphilis
chancre - painless ulcer usually
incubation 10-90 days
primary is usually on mouth
primary -> secondary (whole body, swollen glands, fever, RASH) -> early latent -> late latent
secondary syphilis complications
meningitis
hepatiis
iritis
uveitis
pregnancy complications
syphilis ix and mx
swab lesion - PCR
bloods
antibodies - IgG and IgM, not very specific
benzathene penicillin - IM
genital lumps causes
SEXUALLY TRANSMITTED
warts
scabies
molluscum contagiosum
monkeypox
cyst
NOT SEXUALLY TRANSMITTED
folliculitis
lichen planus
skin tags
cancer
genital warts transmission - complications
skin-to-skin contact, in areas most susceptible to trauma eg. vulva posterior
NO LINK BETWEEN WARTS (HPV) AND HERPES (HSV)
HPV will be cleared but HSV is lifelong
COMPLICATION = intra-epithelial neoplasia
TX for genital warts
cryotherapy
imiquimod
molluscum contagiosum
pearly white spots
HIV is what type of virus, and how many types??
RNA retrovirus
HIV 1 and 2
HIV-1 group M -> global epidemic
HIV viral replication
v quick in early and late infection
mechanism of HIV
- binding - receptors
- fusion
- reverse transcriptase
- integration
- transcription
- translation
- budding - new variant to infect other cells
what receptors are target site for HIV and what type of protein are they
CD4+ T cells
glycoprotein
effect of HIV Infection on immune response??
REDUCED circulation of CD4+ cells
reduced proliferation of CD4+ cells
Reduced CD8+ cytotoxic T cell activation
susceptible to fungal, viral infections and some cancers
how long does HIV take from exposure to establish itself as an infection
72 hrs
PCP
pneumocystis pneumonia
dry cough, SOB
<200 CD4+ cells
interstitial infiltration
dx and tx of PCP
BAL
immunofluorescence
high dose co-trimoxazole
cerebral toxoplasmosis
from cats
<150 CD4+
reactivation fo latent infection, multiple cerebral abscess
headache, fever, seizures, raised ICP
CMV
CD4 <50
retinitis, colitis
floaters, abdo pain
AIDS related cancers - Kaposi’s sarcoma
HHV 8
Tx - anti retrovirals
non-hodgkins lymphoma
EBV
HIV - modes of transmission
sexual - 90% of cases
parenteral transmission - injection drug use
vertical transmission - mother to child
rapid HIV tests
POCT
fingerpick blood specimen or saliva
results within 20-30mins
PrEP
pre-exposure prophylaxis
prevention of vertical transmission
HAART during pregnancy
c-section if detected viral load, safe if not for vaginal delivery
exclusive formula feeding
