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GOSH > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

Multiple missed COCP pill week 3. No sexual intercourse. What do you advise?

A

Take the last missed pill, finish the pack and start a new pack immediately.
Use barrier contraception for 7 days.

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2
Q

Multiple missed pills, COCP week 1. What do you advise?

A

Emergency contraception if UPSI in last 7 days.
Take last missed pill, and continue taking pills as normal from there.
Barrier contraception for 7 days.

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3
Q

Multiple missed COCP week 2. What do you advise?

A

Take most recent missed pill. Continue as normal.

Barrier contraception for 7 days.

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4
Q

How long post-partum must a woman be for COCP to be prescribed if she is BF?

A

6 weeks

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5
Q

At what stage post partum is it possible to insert an IUD?

A

<48 hours

>4 weeks

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6
Q

What method of contraception is suitable for a woman who is 3 weeks post partum and is breast feeding?

A

Progesterone only pill

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7
Q

Important factors to ask about in history taking when deciding on contraception

A 
PMHx
Migraine with aura
BMI >35
Breast cancer
Liver disease
VTE
Vascular disease
Congenital heart disease
Breast feeding
HTN (>140-160 contraindicated)

FHx
VTE

SOCIAL

  • Smoking (COCP contraindicated >35)
  • Drinking
  • Lifestyle e.g. occupation, what works best
  • Concerns e.g. weight gain, acne

OTHER

  • PID/possible STI
  • Possibility of pregnancy
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8
Q

Mechanism of action of combined contraception

How long do they start working?

A

Prevent ovulation by suppressing LH and FSH to prevent oestrogen release. (+ thickens cervical mucus).

1st 5 days of period = immediately
Otherwise = takes 7 days

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9
Q

Missed pill rules for COCP

A

Miss 1 = doesn’t really matter (unless 1st in pack)

Miss 2 or more:

1st week = DANGER WEEK: high risk. Emergency contraception, condoms for 7 days.

2nd week = medium risk. condoms for 7 days.

3rd week = medium risk. Condoms for 7 days + miss pill free break.

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10
Q

Mechanism of action of progestogen only contraception

A

Inhibits ovulation + thickens cervical mucus + prevents endometrial proliferation

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11
Q

Missed pill rules for progesterone only pill

A

Missed = >24 hours

Any missed pill - use condoms for 48 hours

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12
Q

SEs specific to depot injection

A

Reduced bone mineral density
Weight gain
Delayed return to fertility (6-9 months)

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13
Q

Which contraceptive method is associated with a delayed return to fertility?

A

Depot injection

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14
Q

Mechanism of action of IUS coil

A

Prevents endometrial proliferation

Thickens cervical mucus

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15
Q

Mechanism of action of IUD coil

A

Spermicide

Prevents implantation

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16
Q

Coil counselling: E and 6Ps

A

Expulsion rate (5%)
Pregnancy
Perforation
PID (swabs/sexual history)
Periods (IUD = heavier, IUS = lighter/stop)
Progestrogenic SEs (rare - acne, mood etc)
Procedure (explain and consent form)

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17
Q

How many days after miscarriage can you become pregnant?

A

5

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18
Q

How to work out ovulation date?

A

Ovulation = 14 days before period (luteal phase is fixed)

Work out normal cycle length and LMP

19
Q

How long after ovulation can implantation take place?

A

5 days

20
Q

Mechanism of action of EllaOne (ulipristal)

A

Selective progesterone receptor modulator (SPERM)

Works on progesterone receptors - can’t be used within 5 days of other hormonal contraception: receptors already involved so it will be less effective.
Won’t disrupt existing pregnancy

21
Q

When can Ulipristal be used?

A

120 hours after sex (5 days)

Will only work before ovulation

22
Q

MOA of levonelle (levonorgestrel) and when can it be used?

A

Delays/inhibits ovulation
Will only work before ovulation
72 hours (3 days) after sex

Won’t disrupt existing pregnancy

23
Q

Contraceptives affected by other enzyme inducer medications

A

Combined pill
Progesterone only pill
Implant
Oral emergency contraception

24
Q

What are the Fraser guidelines for giving contraception to U16?

A

UnProtected Sex Is Silly

Understand?
Parents - can they be persuaded to tell them?
Sex continues with/without contraceptive treatment?
Interest - best interest to give
Suffer - they would suffer without it

25
Q

When should you restart contraception after taking EllaOne/Levonelle?

A 
EllaOne = COCP 5 days, POP 7 days (condoms 12 days)
Levonelle = immediately (condoms 7 days)
26
Q

Screening for HIV risk

A 
IVDU
MSM
Abroad
Paid for sex 
Contact with HIV
27
Q

How to diagnose HIV

A

P24 antigen will be present 2-4 weeks after infection.
HIV antibody will be present 4-8 weeks after infection (100% effective after 12 weeks)

Serology –> ELISA test: more accurate. Tests for ANTIGEN (18 - 45 days (2-6 week) window)

Point of care test –> instant results - shows ANTIGEN (from 2-4 weeks - 99% will be positive at 12 weeks after infection).

If <4 weeks still do the test, but get them back for another.
If high risk advise tests 3-6 monthly.

28
Q

How to prevent HIV transmission.

A

Condoms
PrEP - pre-exposure prophylaxis. Give before, during and after sex with HIV+ve partner. Daily or just when needed. Very effective, test regularly.

PEP - post-exposure prophylaxis. Taken within 72 hours (ideally 24), for 28 days.

29
Q

HIV treatment plan

What about in pregnancy?

A

HAART (highly active antiretroviral therapy) - reduces viral load to undetectable level, which means minimal transmission risk.
Lots of drug interactions! Take care - liverpool drug interaction checker.

When used in pregnancy = reduces transmission risk to <1%.

30
Q

Hep B Serology results and what do they mean?

A 
HbeAg = highly infective 
HbsAg = current
HbcAb = current / cleared
HbsAb = cleared/ vaccinated (safe)
31
Q

What cells move to the ectocervix in an ectropion?

A

Columnar epithelial cells

32
Q

Treatment for chlamydia

A

doxycycline 7 day 100mg TDS

33
Q

Treatment for BV

A

Metronidazole 5-7 days

34
Q

What will be seen under the microscope if BV is present?

A

Clue cells

35
Q

Candida treatment

A

Clotrimazole pessary + fluconazole PO

pregnancy = JUST pessary

36
Q

Trichomonas treatment

A

Metronidazole PO 2g STAT dose
+
Metronidazole 5/7

37
Q

Gonorrhoea treatment

A

Ceftriazone 1g IM single dose

38
Q

Anogenital herpes treatment

A

Acyclovir

39
Q

syphillis treatment

A

Benzathine penicillin IM weekly for 3 weeks

40
Q

What will be seen on wet mount microscopy for TV?

A

Flagellated unicellular organisms

41
Q

UK MEC4 criteria for CI of COCP

A 
Age >35 and smoking >15 a day
Migraine with aura
Personal history of VTE
Personal history of stroke/MI
Antiphospholipid syndrome
Breastfeeding at <6 weeks PP
Uncontrolled hypertension
Current breast cancer
Major surgery with prolonged immobilisation
42
Q

How long after taking leveonelle does one need to wait to restart regular contraception?

A

immediately

43
Q

How long after taking ellaone does one need to wait to restart regular contraception?

A 
COCP = 5 days
POP = 7 days
44
Q

Management of lichen sclerosis

A

Topical steroids and emollients

GOSH (3 decks)

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