Sexual Health Flashcards
Multiple missed COCP pill week 3. No sexual intercourse. What do you advise?
Take the last missed pill, finish the pack and start a new pack immediately.
Use barrier contraception for 7 days.
Multiple missed pills, COCP week 1. What do you advise?
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.
Multiple missed COCP week 2. What do you advise?
Take most recent missed pill. Continue as normal.
Barrier contraception for 7 days.
How long post-partum must a woman be for COCP to be prescribed if she is BF?
6 weeks
At what stage post partum is it possible to insert an IUD?
<48 hours
>4 weeks
What method of contraception is suitable for a woman who is 3 weeks post partum and is breast feeding?
Progesterone only pill
Important factors to ask about in history taking when deciding on contraception
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
Mechanism of action of combined contraception
How long do they start working?
Prevent ovulation by suppressing LH and FSH to prevent oestrogen release. (+ thickens cervical mucus).
1st 5 days of period = immediately
Otherwise = takes 7 days
Missed pill rules for COCP
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.
Mechanism of action of progestogen only contraception
Inhibits ovulation + thickens cervical mucus + prevents endometrial proliferation
Missed pill rules for progesterone only pill
Missed = >24 hours
Any missed pill - use condoms for 48 hours
SEs specific to depot injection
Reduced bone mineral density
Weight gain
Delayed return to fertility (6-9 months)
Which contraceptive method is associated with a delayed return to fertility?
Depot injection
Mechanism of action of IUS coil
Prevents endometrial proliferation
Thickens cervical mucus
Mechanism of action of IUD coil
Spermicide
Prevents implantation
Coil counselling: E and 6Ps
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)
How many days after miscarriage can you become pregnant?
5
How to work out ovulation date?
Ovulation = 14 days before period (luteal phase is fixed)
Work out normal cycle length and LMP
How long after ovulation can implantation take place?
5 days
Mechanism of action of EllaOne (ulipristal)
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
When can Ulipristal be used?
120 hours after sex (5 days)
Will only work before ovulation
MOA of levonelle (levonorgestrel) and when can it be used?
Delays/inhibits ovulation
Will only work before ovulation
72 hours (3 days) after sex
Won’t disrupt existing pregnancy
Contraceptives affected by other enzyme inducer medications
Combined pill
Progesterone only pill
Implant
Oral emergency contraception
What are the Fraser guidelines for giving contraception to U16?
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
When should you restart contraception after taking EllaOne/Levonelle?
EllaOne = COCP 5 days, POP 7 days (condoms 12 days) Levonelle = immediately (condoms 7 days)
Screening for HIV risk
IVDU MSM Abroad Paid for sex Contact with HIV
How to diagnose HIV
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.
How to prevent HIV transmission.
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.
HIV treatment plan
What about in pregnancy?
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%.
Hep B Serology results and what do they mean?
HbeAg = highly infective HbsAg = current HbcAb = current / cleared HbsAb = cleared/ vaccinated (safe)
What cells move to the ectocervix in an ectropion?
Columnar epithelial cells
Treatment for chlamydia
doxycycline 7 day 100mg TDS
Treatment for BV
Metronidazole 5-7 days
What will be seen under the microscope if BV is present?
Clue cells
Candida treatment
Clotrimazole pessary + fluconazole PO
pregnancy = JUST pessary
Trichomonas treatment
Metronidazole PO 2g STAT dose
+
Metronidazole 5/7
Gonorrhoea treatment
Ceftriazone 1g IM single dose
Anogenital herpes treatment
Acyclovir
syphillis treatment
Benzathine penicillin IM weekly for 3 weeks
What will be seen on wet mount microscopy for TV?
Flagellated unicellular organisms
UK MEC4 criteria for CI of COCP
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
How long after taking leveonelle does one need to wait to restart regular contraception?
immediately
How long after taking ellaone does one need to wait to restart regular contraception?
COCP = 5 days POP = 7 days
Management of lichen sclerosis
Topical steroids and emollients
