Sexual Health Flashcards
Contraception (overview)
Most effective (99% +)
- Contraceptive implant
- IUD
- Sterilisation
- Tubal ligation
Moderately effective (91% +)
- Depot injection
- Vaginal ring
- COCP
- Mini pill
Least effective (76% +)
- Diaphragm
- Male condom
- Female condom
- Withdrawal method
- Fertility awareness
Contraception - combined OCP (contraindications absolute vs. relative)
Absolute contraindications
- < 6 weeks postpartum
- Smoker over 35 (> 15 cigarettes per day)
- Hx VTE
- IHD, Hx CVA
- Migraine with focal neurology
- Current breast cancer
Relative contraindications
- Smoker over 35 (< 15 cigarettes per day)
- Adequately controlled HTN
- Migraine headache
- Current symptomatic cholelithiasis/cholestasis
- Mild cirrhosis
Contraception - progesterone only pill
Key points
● Only effective if taken at exactly the same time everyday
● If taking more than 3 hours last then considered a missed pill - take ASAP and use barrier contraception for
48 hours
● GI losses can decrease effectiveness of mini pill
● Takes 3 days for this method to work (if used properly)
Contraception - depot (medication, immediate effectiveness, exclusion of pregnancy, ADRs)
Medication: medroxyprogesterone 150mg IM every 12 weeks
Immediately effective if:
● Started on day 1-5
● Started less than 21 days postpartum
● Starting within 5 days of abortion
● Repeating depot
● Switching from implant
● Switching from copper IUD during 1-5 days of regular cycle
Pregnancy can be excluded if:
● No unprotected sex since depot due
● Last sexual encounter was 3 weeks ago and urine bHCG negative
ADRs:
● Altered bleeding patterns
● Other - headache, mood change, breast tenderness, loss of libido
Not suitable for those > 50 years
Contraception - implanon (contraindications, advantage vs. disadvantage, effectiveness, quick start method)
Contraindications
● Absolute: current breast cancer
● Potential: unexplained vaginal bleeding, past breast cancer, severe cirrhosis , hepatocellular adenoma or
malignancy, IHD/stroke/TIA
Advantage
- Effective
- Minimal user involvement
- Long-acting
Disadvantage
- Altered bleeding patterns
- Requires procedure
- Can result in implant migration
Effectiveness: takes 7 days
Quickstart
- Pregnancy test if unprotected sex in previous 3 weeks
- Can be immediately be started after emergency contraception
- Advise condom for 7 days
- Urine test in 4 weeks
Contraception - cessation for women > 50 yrs
Mirena IUD, minipill, implanon
IF amenorrhoeic for >12 months:
- Check 2x FSH at least 6 weeks apart and if both >30 then contraception is only required for another 12 months.
- Continue until > 55 years
Copper IUD, barrier contraception
- Stop method after 12 months of amenorrhoea
Depot
- Not recommended beyond 50 years of age.
- Switch to non-hormonal for 24 months or minipill as above.
COCP
- Not recommended beyond 50 years of age.
- Switch to non-hormonal for 24 months or mirena/minipill/implanon as above.
Genital warts (key point, general advice, reactivation, treatment)
Key point
● Treatment is not essential but indicated if pain or for cosmetic reasons.
● Uncommon in patients vaccinated against HPV - consider normal variant, Fordyce spots, Tyson glands or vestibular papillae.
General advice: transmitted via genital-to-gential contact, HPV types that cause genital warts have not been directly
associated with cancer.
Reactivation: skin trauma, immune compromise.
Treatment:
● Topical (ideal for numerous or bulky lesions)
○ Imiquimod 5% cream topically 3 times a week on alternate days until warts resolve
● Cryotherapy
HIV - Risk factors
Unprotected sex
Multiple partners
Concurrent STIs
Substance use
No use of pre-exposure prophylaxis
Uncircumcised
Trichomoniasis
Not notifiable
All partners to be notified
Metronidazole 2g PO single dose
Chlamydia
Notifiable (by lab - not Dr requirement)
Partners in last 6 months
Azithromycin 1g PO single dose
No sex for 7 days
Gonorrhoea
Notifiable
Partners in last 2 months
Azithromycin 1g PO + ceftriaxone 500mg in 2mL of 1% lidocaine IM injection
No sex for 7 days
Syphilis
Notifiable
Primary - partners in last 3 months
Secondary - partners in last 6 months
Benzathine penicillin 1.8g IM once off
OR
Doxycycline 100mg BD for 14 days
