Sexual and Reproductive Health 2 Flashcards

1
Q

What are the two different types of morning after pill?

A

levonella

ulipristal (ellaOne)

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2
Q

How does levonellse work?

A

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

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3
Q

How does Ulipristal work?

A

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

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4
Q

How can the IUD be used as emergency contraception?

A

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

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5
Q

What are the causes for failure to use adequate contraception?

A

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

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6
Q

What are the failure rates of the different types of contraception?

A

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

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7
Q

What are the surgical methods used for abortion?

A

suction curettage - between 7-13 weeks

dilation and evacuation,, proceeded by cervical preparation - after 13 weeks safe and effective

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8
Q

What are the medical methods for abortion?

A

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

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9
Q

What are the complications of abortions?

A
haemorrhage 
infection 
uterine peroration 
cervical trauma at time of surgical abortion 
failure
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10
Q

What is candidiasis/thrush?

A

infection with candida albicans

found in 20% women

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11
Q

What are the RFs for candidiasis?

A

pregnancy
diabetes
antibiotic use

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12
Q

How does candida present?

A

asymptomatic
cottage cheese discharge with vulval irritation and itching
superficial dyspareunia and dysuria
vagina is inflamed and red

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13
Q

What is the treatment for candidiasis?

A

topical imidazole

oral fluconazole

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14
Q

What is bacterial vaginosis?

A

normal lactobacilli overgrown by mixed flora

12% women

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15
Q

How does bacterial vaginosis present?

A

grey-white discharge but vagina not red/itchy
characteristic fishy odour
raised vaginal pH

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16
Q

How is bacterial vaginosis managed?

A

metronidazole or clindamycin cream

17
Q

What are the other causes of vaginal discharge?

A

foreign bodies
sexual abuse
atrophic vaginitis
retained tampon - toxic shock syndrome

18
Q

How does chlamydia present?

A

usually asymptomatic
urethritis
vaginal discharge
can cause pelvic inflammation leading to tubal damage –> sub fertility +/- chronic pelvic pain

19
Q

How is chlamydia diagnosed?

A

PCR swabs

20
Q

What is the treatment of chlamydia?

A

azithromycin 1g PO STAT
or
doxycycline 100mg PO BD 7 days (rectal infection)
Contact tracing

21
Q

How does gonorrhoea present?

A
usually asymptomatic 
vaginal discharge 
urethritis 
barthonlinitis 
cervicitis 
pelvis commonly infected 
can cause bacteraemia and acute septic arthritis
22
Q

How is gonorrhoea diagnosed?

A

culture of endocervical swabs

23
Q

What are the treatment options for gonorrhoea?

A

Ceftriaxone 500mg IM STAT and Azithromycin 1g PO STAT
Contact tracing
test of cure

24
Q

How do genital warts present?

A

tiny patches of vulval skin to small papillifrom swellings

usually multiple and may affect cervix

25
Q

How are genital warts treated?

A

cryotherapy
topical podophyllin or imiquimod cream

high recurrence rate

26
Q

How does genital herpes present?

A
HSV type 2 
primary infection causes multiple small painful vesicles and ulcers around introitus 
local lymphadenopathy 
dysuria 
systemic symptoms 
rare: secondary bacterial  infection
27
Q

Does genital herpes reactivate?

A

virus lies dormant in dorsal root ganglia

75% reactivate but less painful/severe

28
Q

How is the diagnosis of genital herpes made?

A

examination

viral swabs

29
Q

What is the treatment of genital herpes?

A

acyclovir 200mg PO 5 a day for 5 days
analgesia

valaciclovir/gamciclovir in severe infections

30
Q

What is the cause of syphilis?

A

treponema pallidum

common in the developing world

31
Q

How does primary syphilis present?

A

solitary painless vulval chancre

32
Q

How does secondary syphilis present?

A

weeks later

rash, influenza like symptoms, warty genital or perioral growths

33
Q

How does tertiary syphilis present?

A
rare 
aortic regurgitation 
dementia 
tabes dorsalis 
gummata in skin and bone
34
Q

What is the investigations for syphilis?

A

bloods

35
Q

How is syphilis treated?

A

benzathine penicillin 2.4MU IM

contact tracing