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Finals > Sexual health > Flashcards

Sexual health Flashcards

1
Q

How long is contraception required for after the menopause?

A
  • After last period, contraception required for 2 years in women under 50 and 1 year in women over 50
  • HRT not prevent pregnancy
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2
Q

How soon after childbirth does fertility return

A

Fertility returns after 21 days after giving birth

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3
Q

How effective is lactational amenorrhoea as contraception

A

98% effective as contraception up to 6m after birth
o Must be fully breastfeeding and amenorrhoeic

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4
Q

Contraception options in breast cancer

A

o Avoid hormonal contraception
o Choose copper coil or barrier methods

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5
Q

Contraception offers in cervical or endometrial cancer

A

Avoid mirena coil

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6
Q

Contraception options in Wilson’s disease

A

Avoid copper coil

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7
Q

Advantages of barrier methods

A
  • Physical barrier to semen entering uterus and causing pregnancy
  • Only method that protects against STIs
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8
Q

Examples of barrier methods

A

Condoms
Diaphragms
Dental dams

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9
Q

Contraindications to COCP

A

o Uncontrolled hypertension
o Migraine with aura
o History of VTE
o Aged >35, smoking >15 cigarettes per day
o Major surgery with prolonged immobility
o Vascular disease or stroke
o IHD, cardiomyopathy or AF
o Liver cirrhosis and liver tumours
o SLE and antiphospholipid syndrome
o BMI >35 (high risk which outweighs benefits)

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10
Q

Mechanism of COCP

A

o Preventing ovulation
o Progesterone thickens cervical mucus
o Progesterone inhibits proliferation of endometrium, reducing chance of successful implantation

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11
Q

Breastfeeding and COCP

A

Avoided in breastfeeding until at least 6 wks

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12
Q

Types of COCP

A

o Monophasic = same amount of hormone in each pill
 1st line = levonorgestel or norethisterone
 1st line for premenstrual syndrome = drospirenone
 Treatment of acne and hirsutism = dianette, co-cyprindiol
o Multiphasic = varying amounts of hormone to match normal cyclical hormonal changes more closely

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13
Q

Regimes for COCP

A

o 21 days on 7 days off
o 63 days on and 7 days off
o Continuous use without pill-free period

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14
Q

Side effects and risks of COCP

A

o Unscheduled bleeding (common in first 3m)
o Breast pain and tenderness
o Mood changes and depression
o Headaches
o Hypertension
o VTE
o Small increased risk of breast and cervical cancer, return to normal 10 years after stopping
o Small increased risk of MI and stroke

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15
Q

Benefits of COCP

A

o Effective contraception
o Rapid return of fertility after stopping
o Improvement in premenstrual Sx, menorrhagia and dysmenorrhoea
o Reduced risk of endometrial, ovarian and colon cancer
o Reduced risk of benign ovarian cysts

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16
Q

Starting the COCP

A

o Start within first 5 days on menstrual cycle
o If starting after 5 days, requires extra contraception for 7 days (condoms)
o Ensure pregnancy status negative

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17
Q

Reduces effectiveness of COCP

A

o Vomiting
o Diarrhoea
o Certain medications (rifampicin)

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18
Q

Surgery and COCP

A

Stop combine pill 4 wks before major operation

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19
Q

POP and breastfeeding

A

Safe in breastfeeding and started anytime after birth

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20
Q

Types of POP

A

o Traditional POP = norgeston or noriday
o Desogestrel-only pill

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21
Q

Contraindications to POP

A

Active breast cancer

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22
Q

Regime for POP

A

o Taken continuously
o Traditional POP cannot be delayed by >3hrs
o Desogestrel only pill taken up to 12hrs late and still be effective

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23
Q

Mechanism of POP

A

o Thickening cervical mucus
o Altering endometrium and making it less accepting of implantation
o Reducing ciliary action in fallopian tubes
o Desogestrel = Inhibiting ovulation

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24
Q

Starting POP

A

o Up to day 5 of menstrual cycle for immediate protection
o Additional contraception required for 48 hrs
o Take pregnancy test 3wks after last unprotected intercourse

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25
Q

Side effects and risks of POP

A

o Unscheduled bleeding
o Irregular, prolonged or troublesome bleeding (40%)
o Breast tenderness
o Headaches
o Acne
o Ovarian cysts
o Ectopic pregnancy
o Minimal increased risk of breast cancer, return to normal 10 years after stopping

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26
Q

Reduces effectiveness of POP

A

Diarrhoea and vomiting

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27
Q

Types of progesterone-only injection

A

o Depo-Provera (IM)
o Sayana Press (SC)

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28
Q

Regime of POI (depot)

A

Given at 12-13 wk intervals

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29
Q

Benefits of POI (depot)

A

o Improves dysmenorrhoea
o Improves endometriosis-related symptoms
o Reduces risk of ovarian and endometrial cancer
o Reduces severity of sickle cell crisis

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30
Q

Side effects of POI (depot)

A

o Can take 12m for fertility to return after stopping
o Should be stopped before 50 years due to risk of osteoporosis
o Concerns of reduced bone mineral density in <20s
o Irregular bleeding (can be heavier and last longer)
o Weight gain
o Acne
o Reduced libido
o Mood changes
o Headaches
o Flushes
o Hair loss
o Skin reactions at injection sites
o Small increased risk of breast and cervical cancer

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31
Q

Contraindications to POI (depot)

A

o Active breast cancer
o IHD and stroke
o Unexplained vaginal bleeding
o Severe liver cirrhosis
o Liver cancer

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32
Q

Mechanism of POI (depot)

A

o Inhibit ovulation = inhibit FSH secretion by pituitary gland, preventing development of follicles in ovaries
o Thickening cervical mucus
o Altering endometrium and making it less accepting of implantation

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33
Q

Starting POI

A

o Up to day 5 requires no additional protection
o After day 5 requires 7 days of extra contraception before becomes reliably effective

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34
Q

Implant and breastfeeding

A

Safe in breastfeeding and started any time after birth

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35
Q

Mechanism of the implant

A

o Slowly releases progestogen into blood
o Lasts for 3 years
o Inhibiting ovulation
o Thickening cervical mucus
o Altering endometrium and making it less accepting of implantation

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36
Q

Benefits of the implant

A

o Good choice off long-acting reversible contraception in <20s
o Effective and reliable contraception
o Improve dysmenorrhoea
o Make periods lighter or stop all together
o No need to remember to take pills
o No weight gain
o No effect on bone mineral density
o No increase in thrombosis risk
o No restrictions for use in obese patients

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37
Q

Drawbacks of the implant

A

o Requires minor operation with local anaesthetic
o Worsening of acne
o No protection against STIs
o Cause problematic bleeding
o Implants can be bent or fractured
o Implants can become impalpable or deeply implanted (rare)

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38
Q

Contraindication of implant

A

o Licensed for ages 18-40
o Active breast cancer

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39
Q

Insertion and removal of implant

A

o Insert up to day 5 provides immediate protection
o Insertion after day 5 requires 7 days of extra contraception

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40
Q

Bleeding pattern of implant

A

o 1/3 infrequent bleeding
o 1/4 frequent or prolonged bleeding
o 1/5 have no bleeding
o Rest have normal regular bleeds
o Add COCP if problematic bleedings for 3m

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41
Q

Licenced use for mirena

A
  • Licensed for 5 yrs contraception, 4yrs HRT
    o Also used for menorrhagia
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42
Q

Postpartum and mirena

A

Inserted within 48hrs of birth or >4wks

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43
Q

Mechanism of mirena

A

o Contains progestogen that is slowly released into uterus
o Thickening cervical mucus
o Altering endometrium and making it less accepting of implantation
o Inhibits ovulation in small number of women

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44
Q

Benefits of mirena

A

o Fertility returns immediately after removal
o Can make periods lighter or stop
o May improve dysmenorrhoea or pelvic pain related to endometriosis
o No effect on bone mineral density
o No increase in thrombosis risk
o No restrictions for use in obese patients

45
Q

Drawbacks of mirena

A

o Procedure required
o Cause spotting or irregular bleeding
o Sometimes pelvic pain
o Not protect against STIs
o Increase risk of ectopic pregnancies
o Increase incidence of ovarian cysts
o Systemic absorption  Acne, headaches, breast tenderness
o 5% fall out

46
Q

Contraindications of mirena

A

o PID or infection
o Immunosuppression
o Pregnancy
o Unexplained bleeding
o Pelvic cancer
o Uterine cavity distortion (fibroids)

47
Q

Insertion of mirena

A

o Screen for chlamydia and gonorrhoea if at increased risk (under 25)
o BP and HR recorded before and after
o Inserted up to day 7 without additional contraception
o NSAIDs help with discomfort
o Woman seen 3-6 wks after insertion to check threads

48
Q

Risk with insertion of mirena

A

o Bleeding
o Pain on insertion
o Vasovagal reactions (Dizziness, bradycardia, arrhythmias)
o Uterine perforation (1 in 1000, higher in breastfeeding women)
o PID (in first 20 days)
o Expulsion rate is highest in first 3m

49
Q

Removal of mirena

A

Abstain from sex or use condoms for 7 days

50
Q

Causes of non-visible mirena threads

A

o Expulsion
o Pregnancy
o Uterine perforation
o Ix: US  abdominal and pelvic XR  hysteroscopy or laparoscopic surgery

51
Q

Licencing of copper coil

A
  • Licensed for 5-10 yrs
  • Can be used as emergency contraception (inserted up to 5 days after episode of unprotected intercourse)
  • Inserted within 48 hrs of birth or >4wks
52
Q

Mechanism of copper coil

A

o Contains copper and creates hostile environment for pregnancy
o Alters endometrium and makes it less accepting of implantation

53
Q

Benefits of copper coil

A

o Fertility returns immediately after removal
o Reliable contraception
o Inserted at any time of menstrual cycle and effective immediately
o No hormones = safe for women at risk of VTE or history of hormone-related cancers
o Reduce risk of endometrial and cervical cancer

54
Q

Drawbacks to copper coil

A

o Procedure required to insert and remove
o Cause heavy or intermenstrual bleedings
o Sometimes pelvic pain
o Not protect against STIs
o Increased risk of ectopic pregnancy
o 5% fall out

54
Q

Uses of emergency contraception

A
  • Used after episode of unprotected sexual intercourse
    o Includes damaged condoms or multiple missed pills
54
Q

Options for emergency contraception

A

o Levonorgestrel (within 72hrs)
 Prevents or delays ovulation
 COCP or POP can be started immediately after taking
 Extra contraception required for first 7 days of combined pill or first 2 days of POP

o Ulipristal (within 120 hrs)
 Selective progesterone receptor modulator
 Delays ovulation
 More effective than levonorgestrel
 Wait 5 days before starting COCP or POP
 Extra contraception required for first 7 days

o Copper coil (within 5 days) = most effective

55
Q

Effectiveness of oral emergency contraception

A

o Reduced by BMI, enzyme-inducing drugs or malabsorption
o Earlier taken = more effective
o Unlikely to be effective after ovulation has occurred

56
Q

Considerations of emergency contraception

A

o Confidentiality
o STIs
o Future contraception plans
o Safeguarding, rape and abuse

57
Q

Side effects of levonorgestrel

A

 Nausea and vomiting (within 3 hrs, repeated dose needed)
 Spotting and changes to next menstrual period
 Diarrhoea
 Breast tenderness
 Dizziness
 Depressed mood

58
Q

Side effects of ulipristal

A

 Nausea and vomiting
 Spotting and changes to next menstrual period
 Abdo or pelvic pain
 Back pain
 Mood changes
 Headache
 Dizziness
 Breast tenderness

59
Q

Contraindications to ulipristal

A

 Breastfeeding avoided for 1 wk (milk expressed and discarded)
 Avoided with severe asthma

60
Q

Female sterilisation

A

tubal occlusion
o Laparoscopy under general anaesthesia = elective or during c-section
o Occlusion of tubes using Filshie clips, tubes tied and cut or tubes removed altogether
o Prevents ovum travelling from ovary to uterus
o 99% effective
o Alternative contraception required until next menstrual period

61
Q

Male sterilisation

A

vasectomy
o Cutting vas deferens
o Prevents sperm travelling from testes to join ejaculated fluid
o >99% effective
o Local anaesthetic and quick (15-20mins)
o Alternative contraception required for 2m post procedure
o Testing semen (12wks later) to confirm absence of sperm necessary before relied upon for contraception

62
Q

Causes of bacterial vaginosis

A
  • Gardnerella vaginalis
  • Mycoplasma hominis
  • Prevotella species
63
Q

Risk factors for bacterial vaginosis

A
  • Multiple sexual partners (not an STI)
  • Excessive vaginal cleaning
  • Recent Abx
  • Smoking
  • Copper coil
64
Q

Protective factors for bacterial vaginosis

A
  • COCP
  • Condoms
65
Q

Presentation of bacterial vaginosis

A
  • Fishy-smelling watery grey or white vaginal discharge
  • Half are asymptomatic
  • No itching, irritation or pain
66
Q

Investigations for bacterial vaginosis

A
  • Speculum = confirm typical discharge
  • High vaginal swab (charcoal)
    o Clue cells = epithelial cells from cervix with bacteria stuck inside them
  • Swabs for chlamydia and gonorrhoea
67
Q

Management of bacterial vaginosis

A
  • Asymptomatic = no treatment, resolve itself
  • Metronidazole = 1st line
  • Clindamycin = alternative
  • Lifestyle advice
68
Q

Complications of bacterial vaginosis

A
  • STIs = chlamydia, gonorrhoea, HIV
  • Pregnancy complications
    o Miscarriage
    o Preterm delivery
    o Premature rupture of membranes
    o Chorioamnionitis
    o Low birth weight
    o Postpartum endometritis
69
Q

Cause of thrush

A

Candida albicans

70
Q

Risk factors for thrush

A
  • Increased oestrogen (pregnancy)
  • Poorly controlled diabetes
  • Immunosuppression (corticosteroids)
  • Broad-spectrum Abx
71
Q

Presentation of thrush

A
  • Thick, white discharge that doesn’t typically smell (‘cottage cheese’)
  • Vulval and vaginal itching, irritation or discomfort
  • Erythema
  • Fissures
  • Oedema
  • Pain during sex
  • Dysuria
  • Excoriation
  • Satellite lesions
72
Q

Investigations for thrush

A
  • Clinical diagnosis
  • Testing vaginal pH (<4.5)
  • Charcoal swab with microscopy
73
Q

Management of thrush

A
  • 1st line = Oral antifungal tablets (fluconazole 150mg single dose)
    o Contraindicated in pregnancy
  • 2nd line = Antifungal pessary (clotrimazole)
  • Antifungal cream (clotrimazole) inserted into vagina with applicator
  • Canesten duo = over the counter
74
Q

Management of recurrent infection of thrush

A

> 4 per year
o Check compliance
o Confirm diagnosis with high vaginal swab
o Rule out diabetes with blood glucose test
o Exclude lichen sclerosus
o Induction and maintenance regime >6m with oral or vaginal antifungal (fluconazole) medications = every 3 days for 3 doses and then weekly for 6m

75
Q

Contraceptive advice for thrush

A

o Antifungal creams and pessaries damage latex condoms and prevent spermicides from working
o Alternative contraception required for at least 5 days after use

76
Q

Risk factors for chlamydia

A
  • Age <25
  • Sexual partner +ve for chlamydia
  • Recent change in sexual partner
  • Co-infection with another STI
  • Non-barrier contraception or lack of consistent use of barrier contraception
77
Q

Cause of chlamydia

A

Chlamydia trachomatis (gram neg bacterium)

78
Q

Presentation of chlamydia

A
  • Asymptomatic (50% men, 70% women)
  • Women
    o Pain  Dysuria, deep dyspareunia, lower abdo pain, pelvic tenderness
    o Abnormal vaginal discharge (mucopurulent)
    o Intermenstrual or postcoital bleeding
    o Cervicitis and cervical excitation
  • Men
    o Dysuria
    o Testicular pain
    o Epididymal tenderness
    o Mucopurulent discharge
79
Q

Investigations for chlamydia

A
  • NAAT
    o F = vulvo-vaginal swab
    o M = first catch urine sample
80
Q

Management of chlamydia

A
  • Doxycycline 100mg twice daily for 7 days
  • Alternative: Azithromycin 1g single dose
  • In pregnancy use azithromycin, erythromycin or amoxicillin
  • Avoid sexual intercourse and oral sex until completing treatment
  • If aged <25, repeat testing is recommended 3 months after treatment
81
Q

Contact tracing for chlamydia

A

o Symptomatic Men  all contact since and 4 weeks prior to onset of symptoms
o Women and asymptomatic men  all partners from last 6 months

82
Q

Complications for chlamydia

A
  • Chlamydial conjunctivitis
  • Salpingitis/endometritis
  • PID
  • Ectopic pregnancy
  • Infertility
  • Epididymitis/epididymo-orchitis
  • Sexually acquired reactive arthritis
  • If pregnant = premature delivery, miscarriage, stillbirth
83
Q

Cause of genital herpes

A

Herpes simplex virus 2

84
Q

Presentation of genital herpes

A
  • May be asymptomatic
  • May develop symptoms mnths or yrs after initial infection when latent virus reactivated
  • Ulcers or blistering lesions affecting genital area
  • Neuropathic type pain (tingling, burning, shooting)
  • Flu-like symptoms (fatigue, headaches)
  • Dysuria
  • Inguinal lymphadenopathy
  • Symptoms last 3 wks and appear within 2 wks of infection
  • Recurrent episodes usually milder and resolve more quickly
  • Sexual contacts including those with cold sores
85
Q

Investigations for genital herpes

A

Viral PCR from lesion

86
Q

Management of genital herpes

A
  • Aciclovir
  • Manage symptoms
    o Paracetamol
    o Topical lidocaine 2% gel (instillagel)
    o Cleaning with warm salt water
    o Topical Vaseline
    o Additional oral fluids
    o Wear loose clothing
    o Avoid intercourse with symptoms
87
Q

Complications of genital herpes

A

Neonatal herpes simplex infection contacted during labour and delivery

88
Q

Risk factors for gonorrhoea

A
  • Age <25
  • Men who have sex with men
  • High density urban areas
  • Previous gonorrhoea infection
  • Multiple sexual partners
89
Q

Cause of gonorrhoea

A

Neisseria gonorrhoeae (gram-neg bacterium)

90
Q

Presentation of gonorrhoea

A
  • Female
    o Altered/increased vaginal discharge (thin, watery, green/yellow)
    o Dysuria
    o Dyspareunia
    o Lower abdominal pain
    o Rare – intermenstrual/post-coital bleeding
  • Male
    o Mucopurulent/purulent urethral discharge
    o Dysuria
    o Epididymal tenderness
    o Anal pain/discomfort
91
Q

Investigations for gonorrhoea

A

NAAT + microscopy and culture

92
Q

Management of gonorrhoea

A
  • Single dose IM ceftriaxone 1g
  • Alternative: oral cefixime + oral azithromycin
  • Contact tracing of sexual partners
  • Future safe sex advice – abstain from sex until both partners treated
93
Q

Complications of gonorrhoea

A
  • PID  chronic pain, infertility, ectopics
  • Epididymo-orchitis
  • Prostatitis
  • Disseminated gonococcal infection  joint pain and skin lesions
  • Urethral stricture
94
Q

Risk factors for HIV

A
  • Unprotected sexual contact – vaginal, anal, oral
  • Sharing of injecting equipment
  • Medical procedures – blood products, skin grafts, organ donation, artificial insemination
  • MSM
  • IVDU
  • High prevalence areas
  • Unprotected sex with someone who lived or travelled in Africa
95
Q

Presentation of HIV

A
  • 2-6 wks after exposure:
    o Fever
    o Muscle aches
    o Malaise
    o Lymphadenopathy
    o Maculopapular rash
    o Pharyngitis
  • Next months-years = latent, asymptomatic
  • Symptomatic latent
    o Weight loss
    o High temp
    o Diarrhoea
    o Frequent minor opportunistic infections
96
Q

Investigations for HIV

A
  • Fourth-generation test = HIV antibodies and p24 antigen
  • Contact tracing
97
Q

Management of HIV

A
  • Highly active antiretroviral therapy (for life)
98
Q

Cause of syphilis

A

Treponema pallidum

99
Q

Transmission of syphilis

A
  • Oral, vaginal or anal sex (involving direct contact with infected area)
  • Vertical transmission (mother to baby)
  • IVDU
  • Blood transfusion and other transplants
100
Q

Presentation of syphilis

A
  • Primary (Sx resolve over 3-8wks)
    o Painless genital ulcer (chancre)
    o Local non-tender lymphadenopathy
    o Often not seen in women (lesion may be on cervix)
  • Secondary (Symptoms resolve 3-12 wks)
    o Maculopapular rash on trunk, palms and soles
    o Condylomata lata  Grey wart-like lesions around genitals and anus
    o Low-grade fever, Lymphadenopathy
    o Alopecia
    o Buccal ‘snail track’ ulcers
  • Tertiary (many years after initial infection)
    o Gummatous lesions (affecting skin, organs, bones)
    o Ascending Aortic aneurysms
  • Neurosyphilis
    o Headache
    o Altered behaviour
    o Dementia
    o Tabes dorsalis
    o Ocular syphilis
    o Paralysis
    o Sensory impairment
    o Argyll-Robertson pupil (constricted pupil that accommodates when focusing on near object but not react to light)
101
Q

Investigations of syphilis

A
  • Antibody testing (screening)
  • Samples from sights of infection
    o Dark field microscopy
    o PCR
102
Q

Management of syphilis

A
  • Single deep IM benzathine benzylpenicillin
  • Alternatives = Ceftrixone, Amoxicillin, Doxycycline
  • Advise to avoid sexual activity until treated
  • Contact tracing
103
Q

Causes of trichomoniasis

A

Trichomonas vaginalis (flagellated protozoa)

104
Q

Presentation of trichomoniasis

A
  • 50% cases asymptomatic
  • Vaginal discharge (frothy, yellow-green, fishy smell)
  • Itching
  • Dysuria
  • Dyspareunia
  • Balanitis (inflammation of glans penis)
  • Strawberry cervix
  • Raised vaginal pH
105
Q

Investigations of trichomoniasis

A
  • Women = high vaginal charcoal swab with microscopy
  • Men = urethral swab or first-catch urine
106
Q

Management of trichomoniasis

A

Metronidazole

107
Q

Complications of trichomoniasis

A
  • Contracting HIV (damaging vaginal mucosa)
  • Bacterial vaginosis
  • Cervical cancer
  • PID
  • Pregnancy-related complications = pre-term delivery

Finals (23 decks)

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