Sexual and Reproductive Health 2 Flashcards
What are the two different types of morning after pill?
levonella
ulipristal (ellaOne)
How does levonellse work?
single 1.5 mg dose of progesterone
best taken within 24 hours and no later than 72 hours
affects sperm function, endometrial receptivity and prevents follicular rupture
vomiting and menstrual disturbances in following cycle
How does Ulipristal work?
selective progesterone receptor modulator
prevents/delays ovulation, reduces embryo implantation
as effective as levonelle can be used up to 120 hours
blocks action of progesterone therefore reduces the effectiveness of progesterone containing contraceptives
How can the IUD be used as emergency contraception?
Insertion of IUD usually prevents implantation
Can be inserted up to 5 days after unprotected intercourse or expected day of ovulation
Antibiotic prophylaxis given at time of insertion
What are the causes for failure to use adequate contraception?
major problem
contraception must be appropriate to woman’s lifestyle
misunderstandings and dislikes lead to non-compliance
fully counsel woman on major problems and minor Res
What are the failure rates of the different types of contraception?
Combined oral contraceptive pill/combined transdermal patch/combined vaginal
ring – 0.2 per 100 woman years
Male condom/female condom - 2-15 per 100 woman years
Diaphragms/caps – about 5 per 100 woman years
Female sterilisation – 1 in 200 lifetime risk of failure
Male sterilisation – 1 in 2000 lifetime risk (after 2 negative semen analyses)
Intrauterine device – <0.5 per 100 woman years
What are the surgical methods used for abortion?
suction curettage - between 7-13 weeks
dilation and evacuation,, proceeded by cervical preparation - after 13 weeks safe and effective
What are the medical methods for abortion?
antiprogesterone and prostaglandin are most effective at <7 weeks - can also be used 7-9 weeks and mid trimester 13-24 weeks
foeticide preformed (KCL into umbilical cord or fatal heart) beyond 22 weeks
What are the complications of abortions?
haemorrhage infection uterine peroration cervical trauma at time of surgical abortion failure
What is candidiasis/thrush?
infection with candida albicans
found in 20% women
What are the RFs for candidiasis?
pregnancy
diabetes
antibiotic use
How does candida present?
asymptomatic
cottage cheese discharge with vulval irritation and itching
superficial dyspareunia and dysuria
vagina is inflamed and red
What is the treatment for candidiasis?
topical imidazole
oral fluconazole
What is bacterial vaginosis?
normal lactobacilli overgrown by mixed flora
12% women
How does bacterial vaginosis present?
grey-white discharge but vagina not red/itchy
characteristic fishy odour
raised vaginal pH
How is bacterial vaginosis managed?
metronidazole or clindamycin cream
What are the other causes of vaginal discharge?
foreign bodies
sexual abuse
atrophic vaginitis
retained tampon - toxic shock syndrome
How does chlamydia present?
usually asymptomatic
urethritis
vaginal discharge
can cause pelvic inflammation leading to tubal damage –> sub fertility +/- chronic pelvic pain
How is chlamydia diagnosed?
PCR swabs
What is the treatment of chlamydia?
azithromycin 1g PO STAT
or
doxycycline 100mg PO BD 7 days (rectal infection)
Contact tracing
How does gonorrhoea present?
usually asymptomatic vaginal discharge urethritis barthonlinitis cervicitis pelvis commonly infected can cause bacteraemia and acute septic arthritis
How is gonorrhoea diagnosed?
culture of endocervical swabs
What are the treatment options for gonorrhoea?
Ceftriaxone 500mg IM STAT and Azithromycin 1g PO STAT
Contact tracing
test of cure
How do genital warts present?
tiny patches of vulval skin to small papillifrom swellings
usually multiple and may affect cervix
How are genital warts treated?
cryotherapy
topical podophyllin or imiquimod cream
high recurrence rate
How does genital herpes present?
HSV type 2 primary infection causes multiple small painful vesicles and ulcers around introitus local lymphadenopathy dysuria systemic symptoms rare: secondary bacterial infection
Does genital herpes reactivate?
virus lies dormant in dorsal root ganglia
75% reactivate but less painful/severe
How is the diagnosis of genital herpes made?
examination
viral swabs
What is the treatment of genital herpes?
acyclovir 200mg PO 5 a day for 5 days
analgesia
valaciclovir/gamciclovir in severe infections
What is the cause of syphilis?
treponema pallidum
common in the developing world
How does primary syphilis present?
solitary painless vulval chancre
How does secondary syphilis present?
weeks later
rash, influenza like symptoms, warty genital or perioral growths
How does tertiary syphilis present?
rare aortic regurgitation dementia tabes dorsalis gummata in skin and bone
What is the investigations for syphilis?
bloods
How is syphilis treated?
benzathine penicillin 2.4MU IM
contact tracing
