Sexual and Reproductive Health Flashcards
Which organism causes syphilis?
Treponema Pallidum
What is the primary lesion in syphilis caused?
A chancre
What is the treatment of syphilis?
1 injection of IM long-acting benzathine penicillin
What causes genital herpes?
Herpes simplex virus (types 1 and 2)
How do you test for genital herpes?
Swab in virus transport medium of deroofed blister for PCR test – this is highly sensitive and specific
What is the treatment of genital herpes?
400mg of oral acyclovir TDS for 5 days (may be helpful if taken early enough) and pain relief
Consider topical lidocaine 5% ointment if very painful (do patch test before though)
What is the presentation of trichomonas vaginalis?
Causes frothy/musty/green vaginal discharge and irritation in females
Strawberry cervix appearance on examination
What is the treatment of trichomonas vaginalis?
Oral metronidazole BD for 7 days (should probably treat the male partner(s) too as there are no good tests for males)
What is the treatment of pubic lice?
Malathion lotion
Which strains of HPV cause genital warts?
HPV 6 and 11.
What does neisseria gonorrhoea look like under the microscope and what is its gram stain (positive/negative)?
Gram-negative intracellular diplococcus.
How does gonorrhoea present in males?
Purulent discharge and pain with urination
How do you treat gonorrhoea?
1 injection of 500mg IM ceftriaxone (used to be IM ceftriaxone + oral azithromycin)
How does chlamydia present in females?
Postcoital bleeding or inter-menstrual bleeding, lower abdominal pain, dyspareunia, mucopurulent cervicitis
How do you treat chlamydia?
Oral doxycycline 100mg BD for 7 days (previously was 1g single oral dose of Azithromycin)
Which complication can arise in females as a result of chlamydia?
Pelvic Inflammatory Disease (PID)
How are most female STIs investigated with i.e. what is the test of choice?
Self-taken vulvo-vaginal swab
How are most male STIs investigated with?
First pass urine sample
What is ‘quick start’ contraception?
Describes the initiation of a contraceptive method prior to day 1-5 of the menstrual cycle
When can the copper coil be inserted?
Any time of the cycle (as long as ongoing pregnancy is excluded).
What do you need to examine prior to inserting the copper coil?
Do a PV exam to check the uterus size/shape.
How does the copper coil work?
Copper is toxic to sperm and prevents fertilisation from occurring by creating an inhospitable endometrium.
How long is the intra-uterine system (IUS) licensed for?
5 years.
When would you ideally insert the IUS?
In the first 7 days of period.
How long is the progesterone only implant licensed for?
3 years.
How does the implant work?
Thins endometrium and thickens cervical mucus.
When would you ideally start the progesterone only implant?
In the first 5 days of period.
What is a total contraindication to starting the progesterone only implant?
Current breast cancer.
How often can the progesterone-only injectable (depo-provera) be given?
12-weekly intervals.
How does the depo-provera work?
Inhibits ovulation
When would you ideally start the depo-provera?
In the first 5 days of period.
Can you name some associated risks with the depo-provera?
- Irregular bleeding
- Weight gain due to increased appetite
- Beware of the use in young woman and in women with low body weight due to concern about the bone mineral density
- Return of normal fertility may be delayed on discontinuation
How does the progesterone-only pill (POP) work?
Inhibits ovulation.
When would you ideally start the POP?
In the first 5 days of period.
How does the combined oral contraceptive pill (COCP) work?
Primarily inhibits ovulation.
When would you ideally start the COCP (same for patch and ring)?
In the first 5 days of period.
What are some risks of the COCP and things you need to measure/check before prescribing the COCP?
- Risk of VTE
- Measure BP and BMI before starting
- Check smear status
- Reduces the risk of developing both endometrial and ovarian cancer
- Small increased risk of cervical cancer with use of >5 years
Name some contraindications of the COCP?
- Migraine with aura
- Current breast cancer
- Age ≥ 35 AND smokes ≥15 cigarettes per day
- Systolic ≥160 mmHg or
- diastolic ≥100 mmHg
- Vascular disease (CHD, angina, stroke, PVD, hypertensive retinopathy, and TIA)
- History of VTE or current VTE
- Atrial fibrillation
- Positive antiphospholipid antibodies
What is the most effective form of emergency contraception?
The copper IUD.
Ulipristal Acetate (UPA) is licensed for how long after UPSI?
120 hours.
Levonorgestrel (LNG) is licensed for how long after UPSI?
72 hours.
When should the dose of LNG be doubled?
When weight is >70kg or BMI is >26.
When can both the copper IUD and IUS be used post-partum?
- Insertion within the first 48 hours OR >4 weeks of vaginal or c-section delivery is safe
- Can also be inserted immediately after first- or second-trimester, surgical or medical abortion
When can you use the COCP post-partum?
- If breastfeeding – delay use until at least 6 weeks after birth due to risk of VTE (UKMEC 4)
- If not breastfeeding – can start after 3 weeks (UKMEC 4)
When can you use the POP post-partum?
- Can use post-partum immediately
- No effect on breastfeeding
- Not required in non-breastfeeding women for contraception until day 21
- Can be started immediately following surgical abortion or medical abortion
