PH1122 - Sexual Health

Question 1

Describe the symptoms of Chlamydiain both women and men.

Answer 1

Women: bleeding between periods/heavier periods, bleeding after sex, lower abdominal pain, unusual discharge, pain when passing urine

Men: white/cloudy discharge from penis, pain when passing urine, pain in the testicles

Question 2

How is chlamydia spread ?

Answer 2

Spread through unprotected vaginal, oral or anal sex, sharing unwashed sex toys

Question 3

what percentage of people with chlamydia are asymptomatic ?

And what can occur if untreated ?

Answer 3

50% of men and 80% of females will be asymptomatic

If Chlamydia is left untreated, it can cause Pelvic Inflammatory Disease (PID) in women
Long-term pelvic pain, blocked fallopian tubes, infertility and ectopic pregnancy
In men, can cause testicular infection (epididymo-orchitis) and decreased fertility

Question 4

How is gonorrhoea spread ?

Answer 4

Spread through unprotected vaginal, oral or anal sex, sharing unwashed sex toys

Question 5

What are the symptoms of gonorrhoea for women and men ?

Answer 5

Symptoms
Women: bleeding between periods/heavier periods, lower abdominal pain, unusual discharge, pain when passing urine

Men: green/yellow discharge from penis, pain when passing urine, pain in the testicles

Question 6

How is genital herpes spread ?

Answer 6

Spread through intimate sexual contact, vaginal, anal or oral sex

Question 7

What are the symptoms of genital herpes ?

Answer 7

Symptoms
Blistering of genitals, leaving open red sores
Tingling/burning/itching/pain on urination

Question 8

How can Genital herpes be treated ?

Answer 8

Can be treated, but not cured

Recurrent infection (POM)- Acyclovir 800mg 3 times a day for 2 days, alternatively 200mg 5 times a day for 5 days, alternatively 400mg 3 times a day for 3-5 days

Question 9

How is genital Warts spread ?

Answer 9

Spread by skin-to-skin contact, such as that during vaginal or anal sex or they may be transferred by sharing sex toys
Can be spread even if no active warts seen

Question 10

What are symptoms of genital warts ?

Answer 10

Small, fleshy growth that appear on or around genital area

Usually not painful

Question 11

How is syphilis spread ?

Answer 11

Spread through vaginal, anal, oral sex or by sharing sex toys. Through contact with the ulcers of someone with syphilis

Question 12

What are the symptoms of syphilis ?

Answer 12

Primary: Genital ulcers
Secondary: Rash on hands and feet, fever, headaches, tiredness
Tertiary: If left untreated, can spread to the brain and cause long term damage

Question 13

How is trichomoniasis spread ?

Answer 13

Nearly always passed on through unprotected vaginal sex
You can’t get trichomonas from anal or oral sex
Need to treat partners

Question 14

What are symptoms of Trichomoniasis ?

Answer 14

Symptoms

Abnormal, pale-green smelly discharge, soreness, redness, itching, pain when urinating

Question 15

How is HIV spread ?

Answer 15

Spread through infected blood, semen, vaginal and anal fluids, breast milk

Question 16

What are symptoms of HIV ?

Answer 16

Symptoms
Shortly after infection: flu-like fever, rash, joint and muscle pain
Late stage: diarrhoea, night sweats, weight loss, recurrent infections
If untreated, leads to AIDS

Treatable but not curable

Question 17

How is pubic lice spread ?

Answer 17

Spread through skin-to-skin contact so condoms may reduce transmission but do not prevent

Question 18

What are the symptoms of pubic lice ?

Answer 18

Symptoms

Often visible, itching, irritation, black powdery droppings from the lice in your underwear

Question 19

what are the advantages and disadvantages of COCP (Combined Oral Contraceptive Pill )?

Answer 19

ADVANTAGES
Effective in proper use
Pro-menstruation effects
Decreased risk of ovarian & endometrial cancers
Fertility returns to normal when pill is stopped

DISADVANTAGES
Mood changes, nausea, breast tenderness, weight gain, headaches
User dependent
Certain factors such as weight, malabsorption and drug interactions may contribute to contraceptive failure

Question 20

What does the COCP act as ?
How would it be taken ?
How effective is it ?

Answer 20

Oestrogen and progestogen

Take for 21 days, followed by a 7-day pill-free week (‘withdrawal bleed’)
New guidance: can take back-to-back
12hr window

Perfect use: >99% effective
Typical use: 91% effective

Question 21

What happens if you miss 1 or 2 pills whilst on a variant of the Combined oral contraceptive pill ?

Answer 21

If 1 pill is missed (at any time in the cycle)
take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
no additional contraceptive protection needed
If 2 or more pills missed
take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
Should use condoms or abstain from sex until they have taken pills for 7 days in a row.
if pills are missed inweek 1 (Days 1-7): emergency contraception considered if unprotected sex in the pill-free interval or in week 1
if pills are missed inweek 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception
if pills are missed inweek 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval

Question 22

What is the progesterone only pill ?
How would you take it ?
How effective is it ?

Answer 22

Progestogen only
‘Mini pill’
Take every day at the same time +/- 3-12hrs, no break (depending on the brand) 
Desogestrel newer 
Perfect use: 99% effective
Typical use: 91% effective

Question 23

What are the advantages and disadvantages of the progesterone only pill ?

Answer 23

ADVANTAGES
Used where COCP contraindicated
Not affected by broad spectrum antibiotics
DISADVANTAGES
Spotting, weight gain, headache, mood changes
Less effective than COCP

Question 24

What are advantages and disadvantages of the implant ?

Answer 24

ADVANTAGES
Not user dependent
Rapid return of fertility
Useful for those who are oestrogen sensitive
Periods may become lighter or stop altogether

DISADVANTAGES
Irregular bleeding
Headaches, mood swings, breast tenderness, acne
Doesn’t protect against STI’s
Involves a small procedure by HCP
The implant may wander…

Question 25

How long do people have the implant for ?

how effective is it ?

Answer 25

Progestogen
Lasts 3yrs
Inserted into inner part of upper arm just under the skin
>99% effective

Question 26

how often does the injection contraception need to be taken ?

Answer 26

Progestogen
Depo-Provera: every 3 months intramuscular
Noristerat: every 8 weeks intramuscular
Sayana Press: every 13 weeks subcutaneous
Perfect use: >99% effective
Typical use: 94% effective

Question 27

What are the advantages and disadvantages of injection contraception ?

Answer 27

ADVANATAGES
Not user dependent
Amenorrhoea 
DISADVANTAGES
Weight gain
Can take a while for fertility to return to normal
Involves a needle!

Question 28

How long does the Intrauterine System (coil) last and how effective is it ?

Answer 28

Progestogen 
‘Hormonal coil’ (Mirena)
Lasts 3-5yrs
Mirena lasts 5 years 
>99% effective

Question 29

What are the advantages and disadvantages of the intrauterine system ?

Answer 29

ADVANTAGES
Not user dependent
Decreased or no periods – first line treatment for menorrhagia
Rapid return of fertility
Hormones are mainly localised in the uterus so likelihood of hormonal side effects is less

DISADVANTAGES
Pain/discomfort on insertion
Risk of expulsion
Perforation of the uterus (<0.5%)
Risk of infection (Pelvic Inflammatory Disease)

Question 30

How long does the intrauterine device last and how effective is it ?

Answer 30

Copper coil- copper acts as a spermicide
Lasts 10yrs
>99% effective

Question 31

What are the advantages and disadvantages of intrauterine device ?

Answer 31

ADVANTAGES
Not user dependent
Non-hormonal
Regular periods

DISADVANTAGES
Heavier, more painful periods
Pain
Risk of expulsion
Perforation of the uterus (<0.5%)
Risk of infection (Pelvic Inflammatory Disease)

Question 32

How effective are condoms ?

Answer 32

Barrier method
Male and female condoms (‘femidom’)
Only form of protection against STIs
Perfect use: 98% effective
Typical use: 82% effective

Question 33

What are the advantages and disadvantages of condoms ?

Answer 33

ADVANTAGES
Available for free- C-Card scheme!
No serious side effects
Protection from STIs
Latex-free available for those with allergies

DISADVANTAGES
Can interrupt intercourse
Ineffective if wrong size/fitted incorrectly

Question 34

how long does sterilisation contraception last and how effective is it ?

Answer 34

Permanent method of contraception
Male: cutting, sealing or tying the vas deferens (the tube that carries sperm from the testicles to the penis)
Femalesterilisation(tubal occlusion) is done by cutting, sealing or blocking the fallopian tubes which carry an egg from the ovary to the uterus
>99% effective

Question 35

What are the advantages and disadvantages of sterilisation contraception ?

Answer 35

ADVANTAGES
Don’t have to worry about contraception again

DISADVANTAGES
Risk of tubes re-joining and becoming fertile
Can’t be easily reversed
Requires surgery

Question 36

what are the two emergency contraceptions and how effective are they ?

Answer 36

EHC- the ‘morning-after pill’ 
Levonelle (levonorgestrel)
Take up to 72hrs after unprotected sex.
95% success in 24hrs. 58% success in 72hrs
ellaOne (ulipristal acetate)
Take up to 120hrs after unprotected sex
As effective as Levonelle
DOES NOT REPLACE EFFECTIVE REGULAR CONTRACEPTION

Question 37

What is the general advise given to someone in which an STI is suspected ?

Answer 37

Refer to the GUM clinic
Explain that recent partner should be tested
Suggest using condoms to stop the spread of STI’s in the future.