Safe sex and STDs Flashcards
Teenager asking for contraception- history
- General health
- Gynaecological
- Obstetric
- Complete sexual history
- HEADDS
- Advice on safe sex
- Contraception, including contraI
Examination and investigations
- General->BP
- Heart
- Lungs
- Abdomen
- Vaginal
- Endocervical swab for gonorrhea and chlamydia
Precautions for women taking the pill
- Take same time every day
- If miss one, take as soon as remember. Use barrier protection for 7 days of active pill
- GIT upsets may result in ineffective cover->barrier contraception and 7 day rule
- Broad-spectrum antibiotic may also affect pill absorption and result in contraceptive failure
- Regular check-up of BP
- Common and usual self limiting side effects include breast tenderness, nausea and headaches
Managing consult with +ve chlamydia
- Chlamydia is a common infection
- Sexually transmitted, but treatable
- In women can be symptomless, but can cause infertility through salpingitis and subsequent tubal blokage
- PID from chlamydia is a common cause of ill health
- Azithromycin and r/v in 2 weeks with repeat swab
“Where did I get it (chlamydia) from”
- Probably impossible to know
- Common, needs treatment now
- Should contact all sexual partners and let them know so they can be treated
Screening guidelines high risk asymptomatic
- All sexually active young people 15-29 ++if
under age 20 years
Aboriginal or Torres Strait Islander
inconsistent or no condom usage
recent change in sexual partner
- Urine or swab for chlamydia, every 12 months.
- Decision of other infections based on risk factors
Screening for asymptomatic MSM
++Risk when: unprotected anal sex, >10 partners in past 6 months, group sex, drugs during sex
- Urine and rectal PCR for chlamydia
- Throat and rectal for gonorrhea
- Serology for HIV, syphillis, hepatitis A/B if not vaccinated
- Offer hepatitis immunisations
- Every 12 months, 3-6 monthly in high risk men
Screening sexual contacts from last 6 months of infected
- Treat all contacts presumptively
- Consider other infections based on risk assessment
- Immunisations
- If chlamydia, repeat for reinfection after 3 months
Screening for low risk asymptomatic requesting STI checkup
- Urine PCR/genital PCR chlamydia
- Serology for hepatitis B (if not immune), syphillis and HIV
Treatment of gonorrhea
Ceftriaxone 500mg in 2ml lignocaine IM
Treatment of chlamydia
Azithromycin 1g PO + 1g one week later
Causes of vaginal discharge
- Physiological
- Candida->thick, cottage cheese
- Trichomonas->erythema, green, frothy
- Gonorrhea->friable, mucus, purulent
- Irritant, allergic, foreign body
- Bacterial vaginosis->homogenous, thin, fishy
Management of STI
- Primary prevention
- Offer immunisations->hep B/A, Gardasil
- Discuss STI risk factors
- ALWAYS use condoms
- Condoms not 100% effective
- STI not treated until partner treated
- Mandatory reporting
Treatment of genital warts
- Advise transmission genital-skin contact
- Usually transient, but cosmetic concerns
- Wart types are low risk for cancer
- Topical Imiquimod or podophyllotoxin
- Cryotherapy
Treatment of bacterial vaginosis
Metronidazole 400mg PO BD for 5 days
Treatment of trichomonas
Metronidazole 2g PO as single dose
Treatment of candida
- Vaginal imidazole (clotrimazole) or Nystatin vaginal cream
- If intolerant to topical therapy Fluconazole 150mg PO as single dose
Management of genital herpes
- Collect swab
- Antiviral therapy if started within 72 hours of onset of symptoms
- Initial Aciclovir
- Episodic/recurrent
Analgesia, saline bath Aciclovir 800mg PO tds for 2 days
- Suppressive therapy Aciclovir 40mmg BD, reassess at 6 month
- Simple analgesia
- SItz bath
- Screen for other STI
- Check pap smear
Treatment of chancre
Azithromycin 1g single dose
Treatment of donovanosis
Azithromycin 1g, once weekly for at least 4 weeks.
Treatment of syphillis
Procaine penicllin IM F/U to determine response
Stages of syphillis disease
- Primary->painless ulcer
- Secondary->flu like, myalgia, fever, MC rash, condylomata lata
- Latent: Dormant in liver and spleen, endarteritis and periarteritis
- Tertiary->neurosyphillis
HIV pre-test counselling
- Determine reasons for wanting test now
- Who’s idea
- Identify high risk activities ->MSM, highr isk partner, multiple, IVDU, STDs
- Check their knowledge of transmission
- Seroconversion illness symptoms
- Stress confidentiality
- Window period 3 months before test positive
- Implications for positive/negative test
- Procedure of venesection
- How long for results
- What is HIV
- Anti-retroV treatment
- Prognosis->incurable but management, near-normal LE
- HIV is not AIDS
- Lifestyle modification and protective behaviours
- How would they cope with a positive result
- Summarise
- Still happy to have test
Explaining herpes to patient
- Most (up to 75%) 1st-episode infections are picked up by an asymptomatic partner
- 1st-episode infections may be asymptomatic or, like in your case, cause painful ulcerating genital lesions
- These tend to heal over 2 weeks and the medications we give will help to reduce the severity
- Once it all heals this virus tends to remain dormant in your nerves
- When your immune system is a bit down (ie. head-colds, menstruations or stress) this virus can “sneak out” and cause recurrent infections
- These recurrent infections may be asymptomatic or cause an outbreak of similar lesions on your genitals but these are almost always milder than the 1st time
- Sometimes the recurrence is preceded by a funny tingling or burning sensation on your genitals, which is known as the prodromal period
- It’s important to realise that you are infectious during the prodrome and when the lesions are present so it’s important to avoid all sexual contact until it has resolved
- It’s also wise to always practise safe sex by encouraging any partners to wear a condom as you don’t always know when you are having a recurrence!
Woman has unprotected sex, presenting with discharge and concern about pregnancy
- Common situation and there are solutions
- History
LMP, Contraception->if recent cessation, cycle, bleeding etc->determine stage of cycle
When the intercourse happened, consensual, vaginal/oral/anal, number of partners
Symptoms of STD->burning, pain, discharge
Past history of STD/testing, pap smears
- Full medical history, allergies, medications
- Emergency contraception available->TC from pharmacist
- Regimen 2 X levenorgestrel 750ug->take first one ASAP, second in 12 hours.
- If w/i 72 hours= 75-85% effective at preventing, 2% of those who have had unprotected and have MAP will become pregnant.
- Will not dislodge or abort an established, not teratogenic
- Chance of pregnancy also dependent on stage of cycle
- Insertion of IUCD w/i 5 days also option, failure rate of 1%->not choice in nulliparous with risk of STD
- Exaplanation about the MAP
- STD screen->vaginal examination, swabs high vaginal (chlamydia/trichomonas) and endocervical for gonorrhea and chlamydia. Serology for HIV, hep B, syphillis
- F/U in 7 days.
- Remind of importance of safe sex, use condoms always
Other advice about MAP
- Period may be earlier, longer
- If no period by expected date should have pregnancy test->if positive, return to discuss options
- Future contraeption
