Sexual Health Flashcards
KFP
3 emergency contraceptives and timeframe they can be used
Levonorgestrel emergency contraceptive pill - 3-4 days
Ulipristal acetate emergency contraceptive pill - 5 days
Copper IUD - 5 days
Gonorrhoea treatment + differences
Genital + anorectal -> Ceftriaxone 500mg IM + azithromycin 1g PO
Pharyngeal -> cef IM 500mg + 2g oral azith - ie higher oral azith dose
Conjuctivitis -> cef 1g IM + 1g oral azith -> ie higher IM ceftriaxone dose
Management steps with STI diagnosis (excluding HIV) (9)
- Pharmacological treatment
- Advise no sex for 7 days after treatment commenced OR course complete and Asx (whichever is later)
- No sex with partners from previous X months (dependent on infection)
- Contact tracing - advise patient, can utilise anonymnous tools
- Notify state/territory
- Organise test of cure if relevant
- Test of re-infection and other STIs at 3months
- Consider testing for other STIs if not already done so
- Consider PrEP for any high risk
Contact tracing requirements for STI
Gonorrhoea - 2months
Chlamydia - 6 months
Syphilis - 3/6/12mo for primary/secondary/early latent (or from last negative test)
HIV - start with recent partners, or needle sharing partners - outer limit is last known neg test, or onset of risk behaviours
Chlamydia treatment
Oral doxycycline, 100mg BD for 7 days
For symptomatic anorectal cases - 100mg BD for 21 days
2nd line - 1g oral azithromycin stat (rpt dose 12-24 hrs in anorectal)
- this is often used first in hetero patients
- 1st line for chlamydia conjuctivitis
Painless ulcer + inguinal lymphadenopathy
Primary syphilis
- chancre (painless ulcer)
- non tender rubbery enlarged inguinal lymph nodes
- highly infectious
- incubation 3-90 days (av3wk)
Flu like symptoms + trunk rash + wart like growth near anus
Secondary syphilis
- >6wks post infection
- generalised systemic symptoms
- rash common
- condylomata lata (wart-like growths, often anorectal area)
- alopecia
- mucous patches
Positive syphilis serology, Asymptomatic, no previous treatment. Unclear when had initial infection
Latent syphilis
- need to treat as late latent given unclear when infection acquired
- if <2yrs then can dx early latent syphilis (single dose Rx as with other early infectious stages)
- if unclear -> Rx as late -> 3x weekly doses
Positive syphilis serology on pregnancy work-up, asymptomatic. On history clearly >2yrs from initial infection. Is treatment needed
Late latent syphilis. Although no longer infectious through sex, CAN be transmitted VERTICALLY.
Need to discuss with ID + Obs/Gyn
Management of syphilis
BENZATHINE PENICILLIN (not benpen)
Early infectious (primary, secondary, early latent) - Benzathine penicillin 2.4MU IM stat (given as 2 injections
Late latent - Benzathine penicillin 2.4MU IM weekly for 3 weeks
Flu like illness after being given Benzathine penicilin for syphilis
Jarisch-Herxheimer reaction
- need to make pt aware of this pre treatment
- can occur 6-12hrs after treatment
- will only last few hours, managed with rest and analgesia
Present as sexual contact 2 months ago with patient with secondary syphilis - ?any treatment or testing needed
Treat presumptively (any contact with primary or secondary within 3 months)
Testing
Follow-up
Management steps for new HIV diagnosis
- Discuss HIV - with ART can acheive undetectable viral load (=untransmissable)
- Discuss support available
- Discuss need for contact tracing
- consider PEP for those within 72hrs - Consider comprehensive STI testing
- Notifiable condition
On COCP - when is emergency contraception needed (3)
- Missed >1 pill in first 7 days of new pack AND sex in last 5/7
- Started new pack >24hrs late AND sex in last 5/7
- Unprotected sex in the 7 days AFTER missing more than 1 pill
Missed COCP >24hs late (ie >48hrs from last pill) - what to do next (5)
Take as soon as remember (may take 2 pills together)
Otherwise take pills as normal
Skip break/non hormonal pills if occurring with 7 days
Additional contraception for 7 days
May need emergency contraception if in first week of new pack
26yo, painful lesions on groin. MSM, multiple partners. First noticed painless lump on penis. 3wks later painful lumps in groin, some ruptured to form ulcers.
?Dx + Rx
Lymphogranuloma venereum (LGV)
- initial painless lumps (resolve quickly unlike chancre of syphilis)
- Develop pain lymph nodes (rather than non-tender rubbery nodes)
- Lumps can rupture
Rx - Oral doxycyline 100mg BD for 21 days
Non pharma management of genital herpes infection (5)
- Avoidance of sexual activity until symptoms resolve (OR condoms when Asx)
- Urinate in shower (if dysuria)
- Apply water-proof dressing to lesions
- Provide information on HSV to reduce stigma
- Offer routine STI screening
