Sexual Health Flashcards
1
Q
What is the causative organism in gonorrhoea?
A
- Neisseria gonorrhoea
(Gram -ve intracellular diplococcus)
2
Q
What is the incubation period for gonorrhoea?
A
- 2-7 days
3
Q
Give 8 symptoms of gonorrhoea
A
- Penile/vaginal discharge
- Dysuria
- Pelvic pain
- IM bleeding
- Conjunctivitis
- Deep dysparaeunia
- Proctitis
- Bartholin’s cyst (tender mass in labial fold)
4
Q
Give 7 complications of gonorrhoea
A
- PID
- Epididymo-orchitis
- Tubo-ovarian cyst
- Ectopic pregnancy
- Infertility
- Disseminated gonococcal infection (presenting as rash)
- Septic arthritis
5
Q
Give 1 diagnostic test for gonorrhoea
A
- NAAT - first catch urine sample in men, vaginal swab in women
6
Q
Give the management of gonorrhoea
A
- Ceftriaxone (IM stat)
- Azithromycin (PO stat) - accounts for increasing resistance
7
Q
What impact does gonorrhoea have on pregnancy?
A
- Causes opthalmia neonatorum (occurring earlier than chlamydial conjunctivitis) and so requires management in the pregnant mother
8
Q
Is partner notification required for gonorrhoea?
A
- Yes
9
Q
Give the causative organism for chlamydia
A
- Chlamydia trachomatis (Gram -ve bacterium)
10
Q
Give 8 symptoms of chlamydia
A
- Penile/vaginal discharge
- Dysuria
- Conjunctivitis
- Pelvic pain
- Dysparaeunia
- IM bleeding
- Proctitis
- Post-coital bleeding
11
Q
Give 7 complications of chlamydia
A
- PID
- Epididymo-orchitis
- Tubo-ovarian cyst
- Infertility
5.Ectopic pregnancy - Sexually-acquired reactive arthritis (arthritis, rash, urethritis, uveitis)
- Peri-hepatitis
12
Q
Give 1 investigation for chlamydia
A
- NAAT - first pass urine sample in men, vaginal swab in women
13
Q
Give the management of chlamydia
A
- Doxycycline PO
14
Q
Give the impact of chlamydia infection in pregnancy
A
- Causes neonatal conjunctivits (2-4 weeks after birth - presents later than opthalmia neonatorum)
- Causes neonatal pneumonitis (managed with erythromycin PO)
- Treat the mother with azithromycin (doxycycline is contra-indicated in pregnancy)
15
Q
Is partner notification required for chlamydia?
A
- Yes
16
Q
Give the causative organism for lymphogranuloma venereum
A
- Chlamydia trachomatis serovar L1-3 (more infective subtype)
17
Q
Give the presentation of lymphogranuloma venereum
A
- Proctitis
- Tenesmus
- Fever
- Inguinal lymphadenopathy
18
Q
Give 1 complication of lymphogranuloma venereum
A
- Fistulae formation
19
Q
Give the management for lymphogranuloma venereum
A
- Doxycycline PO (prolonged course)
20
Q
Give the causative organism of syphilis
A
- Treponema pallidum (spirochete bacterium)
21
Q
Give the 5 stages of syphilis
A
- Primary syphilis
- Secondary syphilis
- Early-latent syphilis
- Late-latent syphilis
- Tertiary syphilis
22
Q
Give the presentation of primary syphilis
A
- Chancre formation (single painless ulcer on genitals)
23
Q
Give the presentation of secondary syphilis
A
- Widespread non-pruritic maculopapular rash involving the palms of the hands and the soles of the feet
- Alopecia
- Oral snail-track lesions
- Pyrexia, fatigue, malaise
24
Q
Give the presentation of early-latent syphilis
A
- Asymptomatic infection with positive serology within 2 years of diagnosis
25
Give the presentation of late-latent syphilis
1. Asymptomatic infection with positive serology greater than 2 years after diagnosis
26
Give the presentation of tertiary syphilis
1. Untreated syphilis may develop to: neurosyphilis (paresis, strokes) or cardiovascular syphilis (aortitis, aneurysm)
27
Give 3 investigations for syphilis
1. Dark ground microscopy of chancre fluid
2. PCR from chancre
3. Serology (including VDRL - becomes raised in secondary syphilis)
28
Give the management of syphilis
1. IM pencillin STAT (benzathene penicillin) - azithromycin as 2nd line
29
Give 1 side effect of syphilis management
1. Jarisch-Herxheimer Reaction - acute inflammatory response to toxins released during spirochete cell lysis causing fever, myalgia and headache. Presents with sepsis-like picture
30
Give the impact of syphilis in pregnancy
1. May cause stillbirth and miscarriage
2. May cause congenital syphilis - presenting with deformed bone, rash, meningitis and anaemia
31
Give 1 complication of syphilis management
1. Jarisch-Herxheimer reaction - antibiotic management of syphilis causes endotoxin release, presenting with a sepsis-like picture. Can be prevented with steroids
32
Give the causative organism of trichomoniasis
Trichomonas vaginalis (flagellated protozoan)
33
Give the presentation of trichomoniasis
1. Vaginal discharge
2. Vulval itch
3. Dysparaeunia
4. Dysuria
5. Balanitis and urethral discharge (men)
34
Give the management of trichomoniasis
1. Metronidazole (PO single dose)
35
Give the diagnostic investigation of choice for trichomoniasis
1. NAAT of urine sample of swab of vaginal discharge
36
Is partner notification required for trichomoniasis?
Yes
37
Give 3 complications of trichomoniasis
1. PID (increases risk of infertility)
2. Prostatitis
3. Increased risk of premature rupture of membranes and premature birth
38
Give the causative organism of genital herpes
1. Herpes zoster virus 1 and 2 (DS DNA virus)
39
Give the presentation of genital herpes
1. Either primary infection or recurrence
2. Blisters which progress to painful ulcers
3. Dysuria
4. Pyrexia
40
Give the investigations for genital herpes
1. HSV PCR - swab from lesions (burst an ulcer nd swab the base)
41
Give 1 complication of genital herpes
1. Encephalitis
42
Give the management of genital herpes
1. Aciclovir (for primary, recurrence and as prophylaxis)
2. Pain relief, topical vaseline, salt water baths
43
Give the presentation of neonatal herpes
1. Vesicular rash
2. Encephalitis (seizures, bulging fontanelle, irritability)
3. Respiratory failure
4. Hepatic failure
5. Disseminated intravascular coagulation
6. Death
44
Give the management of neonatal herpes
1. Aciclovir
45
Give the causative organism of genital warts
Human papillomavirus 6 and 11 (DS DNA virus)
46
Give the symptoms of genital warts
1. Vulval, vaginal, anal or penile warts
47
Give the management of genital warts
1. May resolve spontaneously
2. Topical podophyllin paint (avoid in pregnancy)
3. Cryotherapy
4. Surgical removal (likely to scar)
48
Give 2 preventative measures for genital warts
1. Behavioural
2. Quadrivelant HPV vaccine
49
Give the pathophysiology of HIV
1. SS RNA virus
2. Incorporates into host cell DNA using reverse transcriptase and integrase enzymes
3. Viral proteins are assembled by proteases, which are released from the cell via budding - killing the cell
4. New virions affect further cells - any with a CD4 receptor (incl. CD4+ T-cells, macrophages, monocytes)
5. CD4+ T-cells are gradually destroyed, resulting in reduced immunity
50
Give the presentation of HIV seroconversion illness
1. 2-6 weeks following exposure
2. Fever, malaise, myalgia
3. Maculopapular rash
4. Widespread lymphadenopathy
51
Give the presentation of AIDS
1. Marked immunodeficiency with reduced CD4+ T-cell count
2. Clinical syndrome of disease in the presence of HIV:
a) Respiratory/oesophageal candida
b) Chronic HSV
c) Disseminated TB
d) Toxoplasmosis of the brain
e) Recurrent salmonella
f) Lymphoma of the brain
52
Give the investigations for HIV
1. Antigen-antibody test - positive 2-6 weeks following exposure
2. Western blot test
3. CD4+ T-cell count - measures immune function
4. HIV RNA - 'viral load' to monitor treatment progress
53
Give the management of HIV
1. Anti-retroviral therapy - aims to reduce virl load to below detectable levels
2. 2x nucleotide analogue reverse transcriptase inhibitors (NRTIs), PLUS 1x protease inhibitor OR 1x non-NRTI
54
Give 2 examples of NRTIs
1. Tenefovir
2. Zidovudine
55
Give 3 side effects of NRTIs
1. GI distrubance
2. Anaemia
3. Neuropathy
56
Give 1 example of a protease inhibitor
1. Indinavir
57
Give 1 example of a non-NRTI
1. Nevirapine
58
Describe post-exposure prophylaxis
1. Effective if taken within 72 hours of exposure
2. Truvada (tenefovir plus emtracitabine) PLUS raltegravir
59
Describe pre-exposure prophylaxis
1. Truvada (tenefovir plus emtracitabine)
2. Can be taken daily or event-driven (2 tablets 2-24 hours prior to sex PLUS 1 tablet every 24 hours for at least 2 doses after sex)
60
Give the management of HIV in pregnancy
1. Mother should take nevirapine (non-NRTI)
2. Elective caesarean at 38 weeks
3. Abstain from breast feeding
4. May vertically transmit HIV to foetus
61
Give the transmission route for Hepatitis A
1. Faeco-oral
2. Rarely transmitted via sex
62
Give the presentation of Hepatitis A
1. Often asymptomatic
2. Jaundice, malaise, abdominal pain, fever
63
Give the investigations for Hepatitis A
1. Abnormal LFTs
2. Anti-HAV antibodies
64
Give the management of Hepatitis A
1. Usually self-limiting, lasting around 6 weeks
2. No unprotected sex for 7 days following onset of jaundice
3. Not associated with chronic hepatic disease
4. Hepatitis A vaccine as prophylaxis
65
Give the infection route for Hepatitis B
1. Sexually
2. Blood-borne
66
Give the pathophysiology of Hepatitis B
1. Hepatocytes become infected with Hep. B and present HBsAg
2. T-cells induce apoptosis in these cells
67
Give the incubation period for Hepatitis B
1-4 months
68
Give the presentation of Hepatitis B
1. Fever, malaise, fatigue, joint pain
2. Jaundice, pale stool, dark urine
3. Chronic hepatitis B may cause liver cirrhosis or cancer
69
Give the investigations for Hepatitis B
1. Deranged LFTs
2. Positive hepatitis B serology
70
Give the pathophysiology of Hepatitis B
1. Hepatocytes become infected with Hep. B and present HBsAg
2. T-cells induce apoptosis in these cells
71
Describe serology positive for acute/chronic Hepatitis B infection
1. + HBsAg
2. + Anti-HBc
3. - Anti-HBs
Acute = < 6 months
Chronic = > 6 months
72
Describe the serology positive for immunity following Hepatitis B vaccination
1. - HBsAg
2. - Anti-HBc
3. + Anti-HBs
73
Give the serology positive for immunity following previous Hepatitis B infection
1. - HBsAg
2. + Anti-HBc
3. + Anti-HBs
74
Give the complications of Hepatitis B infection
1. Acute liver failure
2. Chronic hepatitis B
3. Cirrhosis
4. Hepatocellular carcinoma
75
Give the management of Hepatitis B
1. Symptomatic management during acute infection
2. Anti-viral therapy in chronic infection (e.g. interferon)
3. Alcohol abstinence
4. Vaccination of sexual partners
5. HBIg if exposed
76
Give the management of Hepatitis B in pregnancy
1. HBIg to baby within 24 hours of birth
2. Full course of vaccination for baby
77
Give the transmission route for Hepatitis C
1. Blood-borne
2. Sex (rare)
Most commonly transmitted in IVDU
78
Describe the epidemiology of Hepatitis C
1. Rare in the UK
2. 19% of population affected in Egypt
79
Give the presentation of Hepatitis C
1. Often asymptomatic
2. Jaundice, malaise, abdo pain, nausea, fever
3. Most cases are discovered on routine LFT
80
Give the investigations for Hepatitis C
1. Raised ALT, bilirubin
2. Decreased INR
3. Anti-HCV and HCV PCR
4. Liver USS - assess for cirrhosis and hepatocellular carcinoma
81
Give the management of Hepatitis C
1. Antiviral therapy e.g. sofosbuvir + ledipasvir
2. Transmission counselling
82
Give the impact of Hepatitis C in pregnancy
1. C-section doesn't reduce risk of transmission
2. Test babies at age 18 months
3. Breastfeeding is safe - unless nipples cracked or bleeding
83
Give the most common causative organism of candida
1. Candida albicans - CAN NOT BE SEXUALLY TRANSMITTED
84
Give the presentation of candida
1. Vaginal discharge - characteristically white (cottage cheese)
2. Vulvitis
3. Balanitis
85
Give the investigations for diagnosis of candida
1. Clinical
2. Swab - false positives often seen
86
Give the management of candida
1. Clotrimazole - pessary/cream
2. Fluconazole
87
Give the presentation of bacterial vaginosis
1. Smelly (fishy) white discharge - comprising waste products of colonising bacteria
2. Vaginal itch
88
Give the investigations for bacterial vaginosis
1. Whiff test - add KOH, if a strong fish smell present then positive for BV
2. pH > 4.5
3. Culture - determines causative organism
89
Give the management of bacterial vaginosis
1. Metronidazole
2. Clindamycin
90
Give the risks of bacterial vaginosis during pregnancy
1. Pre-term labour
2. Intra-amniotic infection
91
Give the presentation of mycoplasma genitalum
1. Males - urethral discharge, dysuria, epididymitis
2. Females - dysuria, PC bleeding, PID
Tiny self-replicating bacteria which are usually asymptomatic. Mainly indicated in the absence of chlamydia/gonorrhoea.
92
Give the investigations for mycoplasma genitalum
1. NAAT
93
Give the management of mycoplasma genitalum
1. In urethritis - doxycycline + azithromycin
2. In PID/epididymo-orchitis - moxifloxacin
94
Give 1 example of a combined oral contraceptive pill and the drugs which it contains
1. Microgynon (ethinylestradiol and leveonorgestrel)
95
Give 3 benefits of the COCP
1. Reversible
2. Can reduce risk of dysmenorrhoea and menorrhagia, endometrial and ovarian cancers, PID and fibroids/ovarian cysts
3. Effective treatment for acne and endometriosis
96
Describe the course of COCP
21 day course with a 7 day pill-free (or placebo) break
Still protected during this time
97
Give the mechanism of action of the COCP
Prevents ovulation, thins the uterine wall and thickens cervical mucus to prevent passage of sperm into the uterus.
98
Give the side effects of the COCP
1. Breast tenderness
2. Breakthrough bleeding
3. Headache
4. Mood changes
5. Nausea
6. Thromboembolic events
99
Give the contraindications for COCP use
1. Migraine with aura or of great severity
2. Previous DVT/PE/stroke
3. Age >50
4. Smoker and age >35
5. Heart disease or BP > 160/95
6. BMI >35
100
Describe the management of missed COCP doses
1. Pill can be taken within 24 hours of normal time, so take missed tablet ASAP even if taking 2 pills at once
2. If 2 pills are missed then significant risk of pregnancy - give emergency contraception if has had sex. Take rest of pack as normal but use additional contraception for 7 days.
3. If this 7 days includes part of the pill-free break then commence new pack immediately - do not have pill-free break!
4. If vomiting within 2 hours of taking pill, take another dose
5. Do not take missed pills if >2 missed
101
Give 3 drug interactions for the COCP
1. Rifampicin
2. St. John's wort
3. Carbamazepine
Stop taking COCP and use alternative protection of on antibiotics or if within 4 weeks of surgery (due to clotting risk)
102
Describe how the COCP should be commenced
1. Start on day 1 of cycle
2. If started on any other day of cycle then use additional contraception for 7 days
Can be started 3 weeks after birth IF not breast feeding (additional contraception should also be used for 7 days)
103
Describe how the POP should be switched to the COCP
Start POP on day 1 of cycle, or if the patient is amenorrhoeic then start on any day of cycle
104
Give 1 indication for progestogen only contraceptive use
COCP contra-indicated (e.g. breastfeeding, older women, CV risk, DM, >35 years and smoke)
105
Give 2 examples of the POP
1. Mini-pill
2. Cerazette
106
Describe the mechanism of action for the POP
1. Thickens cervical mucus to prevent passage of sperm
2. Thins uterine lining
3. In high doses may prevent ovulation
107
When is fertility restored after ceasing POP use?
Immediately
108
Give 3 risks of the POP
1. Ovarian cysts
2. Ectopic pregnancy
3. Breast tenderness
109
When should the POP be commenced?
1. Day 1 of cycle
2. If taken within 5 days of the start of the cycle then protection is immediate
3. Otherwise use additional contraception for 2 days (also if patient has a short menstrual cycle)
Can be commenced immediately after pregnancy
110
What advice should be given if a dose of POP is missed?
1. Dose must be taken within a 3 hour window (window for cerazette is 12 hours)
2. Take missed pill ASAP
3. If outside window then use condoms for 2 days
4. Emergency contraception if sex has occurred during this time
5. If vomiting after taking the POP, use condoms for 2 days
111
Give the mechanism of action for the Mirena IUD
Releases levonorgestrel directly into the uterine cavity, thickening cervical mucus and preventing proliferation of the endometrium
112
Give 2 indications for insertion of the Mirena IUD
1. Contraception
2. Menorrhagia (may take 6 months to take effect)
113
How long does the Mirena IUD last?
5 years
114
Give 4 advantages of the Mirena IUD over the copper IUD
1. Reduced risk of PID
2. Reduced blood loss
3. Reduced risk of dysmenorrhoea
4. Reduced risk of ectopic pregnancy
115
Give 1 advantage of the Mirena IUD over the POP
1. Very few systemic effects
116
Give 3 risks of the Mirena IUD
1. Increased risk of ectopic pregnancy
2. Avoid for 5 years after breast cancer
3. Perforation and expulsion
117
Give 4 side effects of the Mirena IUD
1. Altered menstrual bleeding
2. Breast pain
3. Mood changes
4. Ovarian cysts
118
How long does the copper IUD last?
Either 5 or 10 years
119
Give the mechanism of action for the copper IUD
Encourages a mild inflammatory state to prevent implantation.
Copper is toxic to sperm
120
Give 2 contraindications to IUD insertion
1. Infection - conduct STI test prior to insertion
2. Pregnancy - conduct pregnancy test prior to insertion
121
Give 1 side effect of copper coil insertion
1. Heavy bleeding - manage with TXA (antifibrinolytic)
122
When can the copper coil be inserted?
Any time in cycle, and is immediately effective.
Fertility returns quickly after removal.
Tampons can be used alongside the IUD.
123
Give the mechanism of action for the morning after pill
1. Levonorgestrel - high dose (1.5mg)
2. Prevents ovulation, fertilisation and implantation
DOES NOT CAUSE ABORTION
124
When is the morning after pill effective?
Up to 72 hours following unprotected sex
125
Give the benefits of the copper IUD as emergency contraception
1. Can prevent pregnancy up to 5 days after unprotected sex
2. Provides continued contraception for 5-10 years
3. The most effective method of emergency contraception
126
Give 2 examples of hormonal implant contraception
1. Implanon
2. Nexplanon
Levonorgestrel implants
127
Where is the hormonal implant placed?
Subcutaneously in medial aspect of non-dominant upper arm
128
How long does the hormonal implant provide effective contraception for?
3 years (2 years in obese women)
129
Give the mechanism of action for the hormonal implant
Slowly releases levonorgestrel, which acts to thicken cervical mucus, prevent ovulation and prevent endometrial proliferation.
130
Give the side effects of the hormonal implant
1. Irregular bleeding patterns
2. Acne
3. Breast tenderness
4. Mood swings
131
Give the benefits of the hormonal implant
1. Set it and forget it
2. Less likely to have periods than on POP
3. No interaction with Abx
4. Reduced risk of cysts and ectopic pregnancy
132
Give 2 examples of hormonal contraceptive injection
1. Depo-provera (administered every 12 weeks)
2. Novisterat (administered every 8 weeks)
133
Give the mechanism of action of hormonal contraceptive injection
1. Slowly releases progesterone into the body
2. Thins the endometrium, thickens cervical mucus and prevents ovulation
134
Give 3 advantages of the hormonal contraceptive injection
1. No oestrogen content - can be used in breastfeeding and epilepsy
2. Reduced risk of PID
3. May stop periods
135
Give the cautions to hormonal contraceptive injection use
1. Risk of reduction in bone density - don't usually prescribe in <18 and >45. Avoid injection if other RF for osteoporosis - e.g. low oestrogen, smoker, long-term steroid use
136
Give the side effects of hormonal contraceptive injection use
1. Heavy menstruation - settles down eventually
2. Mood swings
3. Weight gain
137
How is the hormonal contraceptive injection administered?
IM injection into arm or gluteals
138
When should the hormonal contraceptive injection be administered?
Commence within 5 days of start of cycle. If started outside this period, use 7 days of additional contraception.
139
When can the hormonal contraceptive injection be commenced following pregnancy?
1. Re-start 6 weeks after birth
2. Can start from 21 days if required - will also need additional methods of contraception
140
When can the COCP be re-started after pregnancy?
3 weeks - due to risk of VTE
141
When can hormonal contraception (COCP and POP) be re-started after levonorgestrel emergency contraceptive use?
Immediately
142
Which contraceptive methods are not affected by enzyme-inducing drugs (e.g. carbamazepine, rifampicin)?
1. Copper IUD
2. Depo-provera
3. Mirena IUS
Copper IUD is usually 1st choice as non-hormonal
143
Which contraceptive methods have immediate effect?
Copper IUD
144
Which contraceptive methods become effective after 2 days?
POP
145
Which contraceptive methods become effective after 7 days?
COCP, injection, implant, Mirena IUS
146
Give the effect of gastric sleeve surgery on contraceptive use
Can never have oral contraceptive or oral emergency contraceptive due to decreased efficacy
147
Which emergency contraceptive should be used in PID?
Hormonal - levonorgestrel (within 72 hours) or ulipristal acetate (72-120 hours)
148
What is the most likely effect of the Mirena IUS on bleeding?
Initially irregular bleeding followed by light menses or amenorrhoea
149
When is the copper IUD indicated as emergency contraceptive?
The copper intrauterine device can be used as emergency contraception if it is inserted within 5 days of UPSI, or up to 5 days after the likely ovulation date.
150
Which contraceptive method is contra-indicated in wheelchair users?
COCP - oestrogen results in increased risk of VTE
151
How long should you wait before restarting hormonal contraceptive following ulipristal acetate emergency contraception?
After taking ulipristal acetate women should wait 5 days before starting regular hormonal contraception
152
Give 1 contraindication to ulipristal acetate use
Ulipristal should be used with caution in patients with severe asthma
153
Give 1 contraindication to injectable hormonal contraceptive
Current breast cancer is a contraindication for injectable progesterone contraceptives
154
Give 1 contraindication to injectable hormonal contraceptive
Current breast cancer is a contraindication for injectable progesterone contraceptives
155
Following pregnancy, when may an IUD/IUS be inserted?
The intrauterine device or intrauterine system can be inserted within 48 hours of childbirth or after 4 weeks
156
Which cancers does the COCP increase the risk of?
increased risk of breast and cervical cancer
157
Which cancers is the COCP protective against?
protective against ovarian and endometrial cancer
158
What impact do antibiotics have on the POP?
Progestogen only pill + antibiotics - no need for extra precautions
159
When switching from the POP to COCP, how many days of barrier protection are needed?
When switching from a traditional POP to COCP (with correct prior use) 7 days of barrier contraception is needed
