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Obs and gynae > Sexual health > Flashcards

Sexual health Flashcards

1
Q

What is the failure rate for male condoms

A

Perfect use: 2%

Typical use: 16%

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2
Q

What is the failure rate for female condoms

A

Perfect use: 5%

Typical use: 21%

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3
Q

What is the failure rate for diaphragms

A

Perfect use: 6%

Typical use: 16%

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4
Q

What is the failure rate for nulliparous cervical cap

A

Perfect use: 9%

Typical use: 16%

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5
Q

What is the failure rate for parous cervical cap

A

Perfect use: 20%

Typical use: 32%

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6
Q

What is the mechanism of action of the combined hormonal contraceptives

A

Inhibition of ovulation

Inhibition of endometrial thickening

Increased thickening of cervical mucus

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7
Q

What happens in the pill-free break for COCP

A

Fall in hormone concentration

Degradation of endometrium

Menstrual bleeding

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8
Q

What are monophasic pills of COCP

A

Every pill contains same amount of oestrogen and progesterone

Most common type

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9
Q

What are phasic pills of COCP

A

Levels of oestrogen and progesterone change throughout cycle

Important to take pills in correct order

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10
Q

What is the contraceptive transdermal patch

A

A method of combined hormonal contraception

Applied every 7 days for 3 weeks, then a 7 day break for withdrawal bleed

Can be put on arm/abdomen/buttock/back

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11
Q

What is a contraceptive vaginal ring

A

A form or combined hormonal contraception

Plastic ring, inserted into vagina

Sits in vagina for 21 days, removed for 7 days

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12
Q

Which cancers do combined hormonal contraceptives reduce the risk of

A

Ovarian

Uterine

Colon

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13
Q

What are the contraindications for combined hormonal contraceptives

A

BMI >35

Breastfeeding

Smoking and age >35

Hypertension

Family history of VTE

Prolonged immobility

Diabetes with complications

Migraines with aura

Breast cancer

Primary liver tumour

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14
Q

What is the failure rate for COCP

A

Perfect use: 0.3%

Typical use: 9%

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15
Q

When is POP most commonly used

A

Where COCP is contraindicated

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16
Q

What are the mechanisms of action of progesterone only contraceptives

A

Thickening of cervical mucus

Inhibition of ovulation

Thinning of endometrium

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17
Q

What are the cancer risks associated with POP

A

Reduced risk of endometrial cancer

Increased risk of breast cancer

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18
Q

What are the contraindications for POP use

A

Current/past breast cancer

Liver cirrhosis/tumour

Low efficacy in <70 kg

Stroke/coronary heart disease

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19
Q

How do POP and progesterone implant affect periods

A

Irregular pattern

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20
Q

What are the contraindications for progesterone implant

A

Pregnancy

Unexplained vaginal bleeding

Liver cirrhosis/tumour

History of breast cancer

Stroke/TIA whilst using implant

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21
Q

How long do progesterone only injections last

A

Depo-provera - 12 weeks
- Deep IM injection

Others between 8 and 13 weeks

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22
Q

What effects does the progesterone only injection have on fertility and periods

A

Up to a year for fertility to return

A few months for periods to return to normal

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23
Q

What is the failure rate for POP

A

Perfect use: 0.3%

Typical use: 9%

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24
Q

What is the effectiveness for progesterone only implant

A

Perfect use: 0.05%

Typical use: 0.05%

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25
Q

What is the effectiveness for progesterone only injection

A

Perfect use: 0.2%

Typical use: 6%

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26
Q

What is the mechanism of action of the intrauterine device

A

Copper coil

Makes uterus unfavourable to sperm

Causes endometrial inflammatory reaction (inhibiting implantation)

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27
Q

What is the mechanism of action of the intrauterine system

A

Levonorgestrel-releasing coil

Thins endometrium

Thickens cervical mucus

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28
Q

How long does if take for IUD/IUS to become effective

A

IUD
- Immediately

IUS

  • Immediately if in first 7 days of cycle
  • 7 days if not in first 7 days of cycle
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29
Q

What are the indications for IUD/IUS

A

IUD
- Emergency contraceptive

IUS

  • 1st line for heavy menstrual periods
  • 2nd line for dysmenorrhoea
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30
Q

What are the contraindications for IUD/IUS

A

Infection (history of PID, recent STI)

Current pregnancy - 4 weeks post-partum

Uterine structural abnormality

Current gynaecological malignancy

Current unexplained vaginal bleeding

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31
Q

What do IUD/IUS increase the risk of

A

Ectopic pregnancy

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32
Q

What are the 2 types of emergency contraceptive pill

A

Levonorgestrel

  • Synthetic progesterone
  • Delays ovulation by 5-7 days
  • Within 72 hours of unprotected sex

Ulipristal acetate

  • Progesterone receptor modulator
  • Delays ovulation by 5-7 days
  • Within 120 hours of unprotected sex
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33
Q

How soon after unprotected sex does an IUD need to be inserted as an emergency contraceptive

A

5 days

Lasts 5-10 years

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34
Q

What are the contraindications for levonorgestrel emergency contraceptive

A

No absolute contraindications

Efficacy reduced by

  • Diseases of malabsorption
  • Enzyme inducing drugs
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35
Q

What are the contraindications for ulipristal acetate emergency contraceptive

A

Diseases of malabsorption

Hypersensitivity to ulipristal acetate

Severe hepatic dysfunction

Enzyme-inducing drugs

Breastfeeding

Asthma insufficiently controlled by corticosteroids

Drugs increasing gastric pH

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36
Q

What are the contraindications for IUD as an emergency contraceptive

A

Uterine fibroids with distortion to uterine cavity

Documented/suspected PID

Documented/suspected STI

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37
Q

What follow up advice should be given to women taking emergency contraceptive

A

Seek help if vomiting within

  • 2 hours for levonorgestrel
  • 3 hours for ulipristal acetate

Effectiveness declines as time since intercourse increases

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38
Q

What is pelvic inflammatory disease

A

Infection of the upper genital tract in females

May involve the uterus, endometrium, fallopian tubes, and ovaries

Mostly in sexually active women 15-24

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39
Q

What are the most common causative organisms of pelvic inflammatory disease

A

Chlamydia trachomatis

Neisseria gonorrhoea

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40
Q

What are the risk factors for pelvic inflammatory disease

A

Sexually active

15-24

Recent partner change

Intercourse without barrier contraceptives

History of STIs

Personal history of PID

Instrumentation of cervix

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41
Q

What are the clinical features of pelvic inflammatory disease

A

May be asymptomatic

Lower abdominal pain

Deer dyspareunia

Menstrual abnormalities

Post-coital bleeding

Dysuria

Fever and N+V in severe cases

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42
Q

What would you find on vaginal examination in PID

A

Tenderness of uterus/adnexae

Cervical excitation

Palpable mass in lower abdomen

Abnormal vaginal discharge

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43
Q

What are the differential diagnoses for PID

A

Ectopic pregnancy

Ruptured ovarian cyst

Endometriosis

UTI

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44
Q

What investigations are needed for PID

A

Endocervical swab (for gonorrhoea and chlamydia)

High vaginal swab (for trichomonas vaginalis and bacterial vaginosis)

Full STI screen

Urine dip

Pregnancy test

Transvaginal ultrasound/laparoscopy if uncertain

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45
Q

What is the management for pelvic inflammatory disease

A

Antibiotics
- 14 days, broad spectrum, start immediately

Simple analgesia

Rest

Avoid sexual intercourse until partner also treated

All sexual partners from last 6 months to be tested

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46
Q

When should you admit someone to hospital with suspected PID

A

Pregnant

Severe symptoms (nausea, vomiting, high fever)

Signs of pelvic peritonitis

Unresponsive to oral antibiotics

Need for emergency surgery

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47
Q

What are the complications of pelvic inflammatory disease

A

Ectopic pregnancy

Infertility

Tubo-ovarian abscess

Chronic pelvic pain

Fitz-High-Curtis syndrome

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48
Q

What is chlamydia

A

Infection due to chlamydia trachomatis

Most common bacterial STI in the UK

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49
Q

What are the different types of chlamydia infection

A

Serotypes A-C
- Cause ocular infection

Serotypes D-K
- Cause classical genitourinary infection

Serotypes L1-L3
- Cause infection in MSM, get proctitis

50
Q

How is chlamydia transmitted

A

Unprotected vaginal, anal or oral sex

Penetration not always necessary (can be through skin-skin contact)

If infected fluid enters eye, get chlamydial conjunctivitis

Vertical transmission during delivery

51
Q

What are the risk factors for chlamydia

A

<25

Sexual partner positive for chlamydia

Recent change in sexual partner

Co-infection with another STI

Sexual intercourse without barrier contraceptive

52
Q

What are the symptoms of chlamydia in women

A

Dysuria

Abnormal vaginal discharge

Intermenstrual bleeding

Post-coital bleeding

Deep dyspareunia

Lower abdominal pain

53
Q

What are the signs of chlamydia in women

A

Cervicitis and contact bleeding

Mucopurulent endocervical discharge

Pelvic tenderness

Cervical excitation

54
Q

What are the symptoms of chlamydia in men

A

Dysuria

Urethral discharge

Testicular pain

55
Q

What are the signs of chlamydia in men

A

Epidydimal tenderness

Mucopurulent discharge

56
Q

What investigations are needed for chlamydia

A

NAAT

Women
- Vulvo-vaginal swab, endocervical swab, first catch urine

Men
- First catch urine, urethral swab

Consider swab from rectum/eye/throat

Contact tracing

Full STI screen

57
Q

What is the management for chlamydia

A

7 days doxycycline or azithromycin single dose

Avoid sexual intercourse until partner also treated

If <25, repeat test in 3 months

58
Q

What are the complications of chlamydia infection

A

Women
- PID (perihepatitis, ectopic pregnancy, infertility)

Men
- Epididymo-orchitis, effects on fertility

59
Q

What are the complications of chlamydia in pregnancy

A

Premature delivery

Low birth weight

Miscarriage

Stillbirth

Treat with antibiotics

60
Q

What is gonorrhoea

A

Caused by Neisseria gonorrhoeae

Gram negative bacterium

Second most common STI in the UK

Mainly affects <25s and MSM

61
Q

Which parts of the body can gonorrhoea infection affect

A

Uterus

Urethra

Cervix

Fallopian tubes

Ovaries

Testicles

Rectum

Throat

Eyes

62
Q

What are the risk factors for gonorrhoea infection

A

<25

MSM

Living in high density urban area

Previous gonorrhoea infection

Multiple sexual partners

63
Q

What are the signs of gonorrhoea in women

A

Altered vaginal discharge (thin, watery, yellow/green)

Dysuria

Dyspareunia

Lower abdominal pain

Intermenstrual bleeding

Post-coital bleeding

64
Q

What are the signs of gonorrhoea infection in women

A

Mucopurulent endocervical discharge

Easily induced cervical bleeding

Pelvic tenderness

65
Q

What are the symptoms of gonorrhoea in men

A

Mucopurulent urethral discharge

Dysuria

66
Q

What are the signs of gonorrhoea in men

A

Mucopurulent urethral discharge

Epididymal tenderness

67
Q

What are the investigations for gonorrhoea

A

NAAT

Female

  • Endocervical/vaginal swab
  • Microscopy and culture of swabs

Male

  • First pass urine
  • Microscopy and culture of urethral swab

Consider swabbing throat/rectum/eyes

68
Q

What is the management for gonorrhoea

A

Empirical antibiotics whilst waiting for results

Single dose IM ceftriaxone once confirmed

Screen for other STIs

Avoid sexual intercourse until partner also treated

Test for cure at follow up appointment

69
Q

What are the complications of gonorrhoea

A

Female
- PID (chronic pelvic pain, infertility, ectopic pregnancy)

Male
- Epididymo-orchitis, prostatitis

Gonococcal meningitis (admit to hospital if have systemic symptoms)

70
Q

What are the effects of gonorrhoea in pregnancy

A

Increased risk of:

  • Perinatal mortality
  • Spontaneous abortion
  • Preterm labour
  • Early membrane rupture

Gonorrhoea conjunctivitis

Give prophylactic antibiotics in pregnancy

Urgent referral for newborns (prevent long term damage and blindness)

71
Q

What is HIV

A

Single stranded RNA retrovirus

Affects CD4+ T cells

Without treatment, leads to AIDS

72
Q

Who are the at risk groups for HIV in the UK

A

MSM

IV drug users

From high prevalence areas

Unprotected sex with someone from/travelled to Africa

73
Q

What are the clinical features of HIV

A

Seroconversion illness

  • Non-specific flu-like illness
  • 2-6 weeks after exposure

Symptomatic HIV

  • After latent phase (many years)
  • Weight loss, fever, diarrhoea, frequent minor opportunistic infections

AIDS-defining illness
- Malignancies, pneumonia, TB

74
Q

What are the investigations for HIV

A

Fourth-generation test

  • ELISA
  • Serum/saliva sample
  • Reliable result in 4-6 weeks

Rapid test kit

  • 30 mins
  • Not very reliable

Contact tracing

75
Q

What is the management for HIV

A

Highly active antiretroviral therapy (HAART)

  • Aims to reduce viral load to an undetectable level
  • Tablets of a combination of drug types
  • Must take medication for the rest of their lives

Post-exposure prophylaxis

  • Lowers risk of becoming infected after a contact
  • Must start within 72 hours of an event
  • 1 month course
76
Q

What can be done in pregnancy to reduce the chances of vertical transmission

A

Antenatal antiretroviral therapy during pregnancy and delivery

Avoid breastfeeding

Neonatal post-exposure prophylaxis

Can have a vaginal birth as long as mother has an undetectable viral load

77
Q

What is syphilis

A

Caused by Treponema pallidum

MSM most at risk

Incubation 2-3 weeks

Affects arteries

78
Q

What are the modes of transmission of syphilis

A

Sexual contact

Through placenta

Infected blood products

79
Q

What are the risk factors for syphilis

A

Unprotected sex

Multiple sexual partners

MSM

HIV infection

80
Q

What are the clinical features of primary syphilis

A

Get a papule

Ulcerates to become a chancre (painless ulcer)

Chancres heal in 3-10 weeks (take 9-90 days to develop)

81
Q

What are the clinical features of secondary syphilis

A

3 months post-infection

Skin rash (usually on hands/feet)

Fever, malaise, weight loss, headaches

Condylomata (plaques at moist areas of skin)

Painless lymphadenopathy

Silvery-grey mucous membrane lesions

82
Q

What are the clinical features of tertiary syphilis

A

Many years after initial infection

Gummatous syphilis
- Granuloma formation in bones/skin/mucous membranes

Neurosyphilis

  • Tabes dorsalis (ataxia, numb legs, absence of deep tendon reflexes…)
  • Dementia
  • Meningovascular complications (nerve palsies, stroke…)
  • Argyll Robertson pupil (constricted and unresponsive to light)

Cardiovascular syphilis

  • Aortic regurgitation
  • Angina
  • Dilation and calcification of ascending aorta
83
Q

What are the investigations for syphilis

A

Dark ground microscopy of chancre fluid

PCR of swab from active lesions

Serology testing

Lumbar puncture (CSF antibody test for neurosyphilis)

84
Q

What is the management for syphilis

A

Penicillin

Avoid sexual contact until treatment successful

Screen for other STIs

Follow up serology

85
Q

What are the complications of syphilis in pregnancy

A

Miscarriage

Stillbirth

Pre-term labour

Congenital syphilis

Antenatal screening

Treat pregnancy women early

86
Q

What causes genital warts

A

HPV infection

90% due to HPV 6 and HPV 11

Skin-skin contact

87
Q

What are the risk factors for genital warts

A

Early age of first sexual intercourse

Multiple partners

Immunosuppression

Smoking

Persistent warts in diabetes

88
Q

Where can genital warts appear

A

Penis

Scrotum

Vulva

Vagina

Cervix

Perianal skin

Anus

May enlarge or multiply in pregnancy

89
Q

What are the differential diagnoses for genital warts

A

Vestibular papillomatosis

Molluscum contagiosum (viral infection causing firm raised papules on skin)

90
Q

What investigations are needed for genital warts

A

Full STI screen

Biopsy atypical lesions

91
Q

What is the management for genital warts

A

Most resolve spontaneously over time

Topical treatment

Physical ablation

Vaccination

92
Q

What are genital herpes

A

Herpes simplex virus on genitals

Transmitted via skin-skin contact during vaginal/anal/oral sex

Can get flare ups

HSV 1 affects genitals, mouth and nose

HSV 2 affects just genitals

Can be spread to genitals via penetrative or oral sex with someone with a cold sore

Stays dormant in ganglia of nerves

93
Q

What are the risk factors for genital herpes

A

Unprotected sexual contact

Multiple sexual partners

Oral sex with a partner with a cold sore

94
Q

What are the clinical features of genital herpes

A

Primary infection

  • Small, red blisters around genitals
  • Vaginal/penile discharge
  • Flu-like symptoms
  • Itchy genitals

Secondary (recurrent) infection

  • Each outbreak shorter and less severe than previous episode
  • Burning and itching around genitals
  • Painful red blisters around genitals
95
Q

What are the differential diagnoses for genital herpes

A

Aphthous ulcers

Varicella-zoster virus

Trauma

Vestibulobullous disorders

Underlying diagnosis of HIV (>5 outbreaks per year)

96
Q

What investigations are needed for genital herpes

A

Swab from open sores

97
Q

What is the management for genital herpes

A

Primary infection

  • Aciclovir
  • Avoid sexual contact during outbreaks

Recurrent outbreaks

  • Painkillers, ice packs
  • Episodic treatment (take aciclovir as soon as symptoms start)
  • Suppressive treatment (>6 outbreaks per year, take daily aciclovir)

Full STI screen

98
Q

What are the signs of herpes infection in a neonate

A

Skin, mouth and eye herpes

Disseminated herpes (affects internal organs)

CNS herpes (can cause encephalitis)

99
Q

When is herpes in pregnancy most dangerous

A

During 3rd trimester

100
Q

What is trichomoniasis

A

Infection caused by Trichomonas vaginalis

Transmitted through unprotected vaginal intercourse

Can get vertical transmission at delivery

Increased risk of contracting HIV

Symptoms develop after 28 days

101
Q

Which parts of the body does trichomoniasis affect

A

Female
- Urethra, vagina, paraurethral glands

Male
- Urethra, under foreskin

102
Q

What are the risk factors for trichomoniasis

A

Multiple sexual partners

Unprotected sexual intercourse

History of other STIs

Older women

103
Q

What are the symptoms of trichomoniasis in women

A

Offensive vaginal odour

Abnormal vaginal discharge (thick/thin, frothy, yellow/green)

Vulval itchiness or dryness

Dyspareunia

Dysuria

104
Q

What are the signs of trichomoniasis in women

A

Abnormal vaginal discharge

Vulvitis

Vaginitis

Strawberry cervix

105
Q

What are the symptoms of trichomoniasis in males

A

Urethral discharge

Dysuria

Urinary frequency

Pain/itching around foreskin

106
Q

What are the signs of trichomoniasis in men

A

Urethral discharge

Balanoprosthitis (inflammation of glans penis)

107
Q

What are the investigations for trichomoniasis

A

Female
- High vaginal swab

Male
- Urethral swab or first void urine sample

Full STI screen

Contact tracing

108
Q

What is the management of trichomoniasis

A

Anti-protozoan antibiotics

Test sexual partners

Avoid sex until treatment complete (or 1 week after single dose treatment)

109
Q

What are the risks of trichomoniasis in pregnancy

A

Premature labour

Low birth weight

Maternal post-partum sepsis

110
Q

What is bacterial vaginosis

A

Disturbance to normal vaginal flora

Infection of lower genital tract in females

Reduced lactobacilli in vagina

111
Q

What are the risk factors for bacterial vaginosis

A

New sexual partner

Multiple sexual partners

Receptive oral sex

Presence of an STI

Vaginal douching

Vaginal deodorants

Recent antibiotic use

Black ethnicity

Smoking

112
Q

What are the clinical features of bacterial vaginosis

A

Offensive fishy smelling vaginal discharge

No soreness, itching, or irritation

Thin, grey-ish homogenous discharge

113
Q

What are the differential diagnoses for bacterial vaginosis

A

Vaginal candidiasis

Trichomonas vaginalis

STIs

114
Q

What are the investigations for bacterial vaginosis

A

High vaginal smear

KOH whiff test (rarely used)

115
Q

What is the management of bacterial vaginosis

A

Metronidazole

Advise stop vaginal douching

Remove IUD if contributing

High rates of recurrence

116
Q

What are the complications of bacterial vaginosis in pregnancy

A

Prematurity

Miscarriage

Chorioamnionitis

117
Q

What is vulvovaginal candidiasis

A

Fungal infection of lower urinary tract

Thrush

Highest in 20-40s

Due to candida albicans

More likely in pregnancy (higher oestrogen)

118
Q

What are the risk factors for vulvovaginal candidiasis

A

Pregnancy

Diabetes

Use of broad spectrum antibiotics

Use of corticosteroids

Immunosuppression

119
Q

What are the clinical features of vulvovaginal candidiasis

A

Itchy vulva

Vaginal discharge

Dysuria

Erythema/swelling of vulva

Satellite lesions

120
Q

What are the differential diagnoses for vulvovaginal candidiasis

A

Bacterial vaginosis

Trichomonas vaginalis

UTI

Contact dermatitis

Eczema

Psoriasis

121
Q

What is the management for vulvovaginal candidiasis

A

Antifungals

Advise to seek further attention if not cleared in 14 days

Obs and gynae (6 decks)

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