Sexual health

Question 1

Which fungus most commonly causes thrush?

Answer 1

Candida albicans

Question 2

What are the typical symptoms of thrush?

Answer 2

Erythema
Non-offensive discharge
Itching

Question 3

What is the discharge typically like in thrush?

Answer 3

White curd-like discharge
Non-offensive smelling

Question 4

If the vaginal discharge has an offensive smell, is BV or thrush more likely?

Answer 4

Most likely to be BV

Question 5

Name 3 risk factors for thrush.

Answer 5

Antibiotic use
Steroids
Diabetes mellitus

Question 6

What is the appearance of thrush on the genitalia?

Answer 6

Erythema
Satellite lesions: red pustular lesions with superficial white/creamy plaques that can be scraped off
White, curd like discharge

Question 7

What is the first line medical treatment of thrush?

Answer 7

Topical fluconazole/canestan

Question 8

What is the treatment for recurrent thrush where topical antifungals does not work?

Answer 8

Oral fluconazole

Question 9

What are the symptoms of BV?

Answer 9

Fishy smelling grey/white discharge. Not associated with soreness or itching
Can be asymptomatic

Question 10

What are the most common causes of BV?

Answer 10

Over use of vaginal products such as douches and vaginal washes.

Question 11

What is the pH of the vagina in BV?

Answer 11

Over 4.5

Question 12

What is the management of BV?

Answer 12

Oral metronidazole for 5-7 days

Question 13

What are the most common symptoms of chlamydia?

Answer 13

Vaginal discharge
Post coital/intermenstrual bleeding
Pelvic pain
Deep dyspareunia
Dysuria

Question 14

What investigations are carried out in suspected chlamydia?

Answer 14

In women: vulvo-vaginal or endocervical swab.
In men: first catch urine sample or urethral swab

Question 15

Treatment for chlamydia?

Answer 15

Doxycycline BD for 7 days

Question 16

What are the symptoms of gonorrhoea?

Answer 16

Thin watery, yellow/green discharge
Dysuria
Dyspareunia
Lower abdo pain

Question 17

What signs are seen on bi manual in someone with gonorrhoea?

Answer 17

Cervical bleeding
Pelvic tenderness
Mucopurulent endocervical discharge

Question 18

What is the treatment for gonorrhoea?

Answer 18

1g Ceftriaxone
Follow up testing

Question 19

What organism is syphilis caused by?

Answer 19

Treponema pallidum

Question 20

What are the signs or primary syphilis?

Answer 20

Infectious hard ulcer under the skin (chancre)

Question 21

What is the incubation period after exposure for primary syphilis?

Answer 21

2-3 weeks

Question 22

When does secondary syphilis develop after exposure?

Answer 22

3 months post infection

Question 23

What are the symptoms of secondary syphilis?

Answer 23

Skin rash on hands and soles of feet.
Fever
Malaise
Arthralgia
Weight loss
Headaches

Question 24

What are the investigations for syphilis?

Answer 24

Dark ground microscopy of chancre fluid
PCR testing of active lesion
Serology

Question 25

What is the management of early syphilis?

Answer 25

1 IM dose benzathine penicillin

Question 26

What is the management of late syphilis?

Answer 26

3 doses IM Benzathine penicillin at weekly intervals

Question 27

What areas does trichomonas affect in both men and women?

Answer 27

In women it affects: urethra, vagina and paraurethral glands In men it affects: Urethra and under foreskin

Question 28

What type of organism is trichomonas?

Answer 28

A flagellated protozoan, which divides via binary fission.

Question 29

What is the appearance of the cervix in trichomonas infection?

Answer 29

Strawberry cervix

Question 30

What are the symptoms of trichomonas infection?

Answer 30

Offensive vaginal odour Thick, frothy discharge Itchiness of vulva

Question 31

Treatment of trichomoniasis?

Answer 31

2g of metronidazole orally in a single dose or Metronidazole 400-500mg twice daily for 5-7days

Question 32

Which virus transmits genital herpes?

Answer 32

Herpes simplex virus

Question 33

What are the symptoms of genital herpes?

Answer 33

Burning and itching around the genitals Painful red blisters around genitals

Question 34

What is the treatment for genital herpes?

Answer 34

Aciclovir

Question 35

How can HIV be transmitted?

Answer 35

Unprotected sex Reusing needles Medical procedures Vertical transmission from mother to baby

Question 36

What is levonorgestrel?

Answer 36

An emergency contraception. It is a progesterone.

Question 37

When should levonorgestrel be taken to be effective as an emergency contraceptive?

Answer 37

Within 72 hours of UPSI

Question 38

If vomiting occurs within how many hours of taking levonogestrel must you take another dose?

Answer 38

Within 3 hours of taking you must take another dose as you are not protected.

Question 39

When can hormonal contraception be used after taking levonogestrel?

Answer 39

It can be stated immediately

Question 40

What is the mode of action of levonorgestrel?

Answer 40

It stops ovulation and inhibits implantation

Question 41

What is the mechanism of action of ulipristal?

Answer 41

It inhibits ovulation

Question 42

Within how long of UPSI can ulipristal be taken?

Answer 42

120 hours

Question 43

When should hormonal contraception be started or restarted after using ulipristal?

Answer 43

5 days after ulipristal as it can reduce the effectiveness of the contraception

Question 44

Which patients should you not give ulipristal to?

Answer 44

Those with severe asthma

Question 45

When can a copper IUD be used for UPSI?

Answer 45

Within 5 days of UPSi

Question 46

What is the mechanism of action of a Copper IUD in emergency contraception?

Answer 46

It prevents implantation and may inhibit fertilisation

Question 47

How long should the copper IUD be left in for if used for emergency contraception?

Answer 47

Until at least the next period.

Question 48

Name 9 absolute contraindications for the COCP.

Answer 48

Over 35 years old and smoking more than 15 a day Migraine with aura History of VTE History of stroke of IHD Breast feeding or < 6weeks post-partum Uncontrolled hypertension Current breast cancer Major surgery with prolonged immobilisation Positive antiphospholipid antibodies (SLE)

Question 49

Name 7 UKMEC 3 criteria for COCP.

Answer 49

Over 35 smoking less than 15 a day BMI over 35 FHx of VTE in relatives under 45 Controlled hypertension Immobility Carrier of BRCA1 or 2 Current gall bladder disease

Question 50

Why is the COCP contraindicated in migraine with aura?

Answer 50

Increases risk of stroke