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