Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AKT - Lizzie Bain > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

How many hours after exposure to HIV is post-exposure prophylaxis (PEP) considered to be effective?

A
  • most effective when initiated ASAP
  • can be offered up to 72hrs post exposure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which routine imms are recommended in pts with HIV? Which are contraindicated?

A

* pneumococcal (single dose)
* annual inactivated influenza
* Covid-19
* HepB testing and immunisation
* HepA inactivated immunisation for MSM, travel, IVDU
* HPV (3 doses) - up to age 40 (heterosexual men up to age 26)
* Pertussis - pregnant women
* MMR attenuated - all non-immune (CD4 >200)
* Varicella (chickenpox) attenuated - all non-immune (CD4>200, non pregnant)
* Herpes zoster (shingles, Shingrix) attenuated - age >65 (CD4 >200)
* meningococcus - age <25**

LIVE vaccines should NOT be given:
* live influenza vaccine
* live smallpox vaccine
* BCG (for TB)
* live typhoid vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the eligibility criteria for the HPV vaccine?

A

**All 12- and 13-year-olds (girls AND boys) **in school Year 8 are offered the human papillomavirus (HPV) vaccine.
* normally given in school
* information given to parents and available on the NHS website make it clear that the child may receive the vaccine against parental wishes
* since September 2023 one dose is now given instead of two. This change followed evidence from large studies that one dose provided equivalent protection

Other groups
* eligible GBMSM (gay/bisexual men who have sex with men) under the age of 25 also receive 1-dose, offered through sexual health clinics
* eligible GBMSM aged 25 to 45 years receive a 2-dose schedule, offered through sexual health clinics
* eligible individuals who are immunosuppressed or those known to be HIV-positive receive a 3-dose schedule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Everyone requesting oral contraception should be offered a LARC, what does this include? Why is this?

A
  • Progesterone only implant
  • IUCD - copper coil
  • LNG-IUS

COCP has a failure rate of 8 in 100 women per year
All forms of LARC have a failure rate of <1 in 100 women per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

POPs have very few contraindications- what are they?

A

All women of reproductive age are eligible except:
* acute porphyria
* active breast cancer

If past breast cancer- risks usually outweigh benefits - discuss with oncologist.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the ‘traditional’ POPs and how do they work?

A
  • levonorgestrel (Norgeston), and norethisterone (Noriday)
  • do not reliably prevent ovulation
  • rely on changes in cervical mucus
  • 3hr window for missed pills

All POPs must be taken every day
Cause irregular bleeding in 4 in 10 women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the Desogestrel POPs and how do they work?

A
  • Cerazete and Cerelle (Hana and Lovima OTC)
  • prevent ovulation in 97% cycles
  • may improve dysmenorrhoea
  • 12 hr window for missed pills

All POPs must be taken every day
Cause irregular bleeding in 4 in 10 women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do COCPs work?

A
  • primarily by inhibiting ovulation. Also effects on cervical mucus and endometrium.
  • usually give a predictable bleed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When a woman wants oral contraception, in which situations should POP be offered in preference to COCP?

A
  • Age >50
  • BMI >35
  • Smoking >15/day over age 35
  • Breast feeding <6/52 after delivery
  • Impaired cardiac function/cardiac arrhythmias
  • Mirgaine with aura
  • Personal or strong FHx of VTE
  • Vascular disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the estimated risks of VTE per 10,000 women per year in general woman, pregnant woman, and COCPs?

A
  • Woman: 2
  • pregnant woman: 10-20
  • 2nd gen COCP (levonorgestrel) 5-7
  • 3rd gen COCP (Desogestrel) 9-12
  • 4th Gen COCP (drospirenone) 9-12
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the adverse effects (risks) of taking the COCP?

A

Increased risk of:
* VTE (increases with 3rd Gen COCP)
* Cardiovascular disease: MI and ischaemic stroke (risk greater with higher oestrogen doses). CVD risk is additive, so use with caution if one risk factor present, but avoid if multiple risk factors present.
* Breast cancer. Small increased risk decreases gradually after stopping, disappears by 10 years.
* Cervical cancer: small increased risk with use for 5+ years. Reduces after stopping and disappears by 10 years.

(Protective against endometrial and ovarian cancers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What advice should be given to women taking COCP where: **one pill ** has been missed?

A

Missed pill= more than 24hrs since should have taken it
* if you have missed one pill anywhere in the pack, or started a new pack one day later - you’re still protected against pregnancy
* take the last pill you missed now, even if this means taking two pills in one day.
* Carry on taking the rest of the pack as normal.
* Take your 7-day pill free break as normal
* You do not need to use extra contraception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What advice should be given to women taking COCP where: **two or more pills ** have been missed?

A

If you have missed two or more pills anywhere in the pack, or started a new pack 2 or more days late - your protection against pregnancy may be affected.
* take the last pill you missed now, even if this means taking two pills in one day
* leave any earlier missed pills
* carry on taking the rest of the pack as normal
* Use extra contraception - condoms, for next 7 days

  • if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
  • if pills are missed in week 2 (Days 8-14): there is no need for emergency contraception (as pills had been taken for 7 consecutive days prior to this)
  • if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What advice should be given for missed POP?

A

If action is needed:
* take the missed pill as soon as possible. If more than one pill has been missed just take one pill. Take the next pill at the usual time, which may mean taking two pills in one day
* continue with rest of pack
* extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours
* Emergency contraception is needed if there was UPSI from the time that the first pill was missed until correct pill taking had resumed for 48 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the UKMEC4 criteria for COCP?

A
  • more than 35 years old and smoking more than 15 cigarettes/day
  • migraine with aura
  • history of thromboembolic disease or thrombogenic mutation
  • history of stroke or ischaemic heart disease
  • breast feeding < 6 weeks post-partum
  • uncontrolled hypertension
  • current breast cancer
  • major surgery with prolonged immobilisation
  • positive antiphospholipid antibodies (e.g. in SLE)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the UKMEC3 criteria for COCP?

A
  • more than 35 years old and smoking less than 15 cigarettes/day
  • BMI > 35
  • family history of thromboembolic disease in first degree relatives < 45 years
  • controlled hypertension
  • immobility e.g. wheel chair use
  • carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
  • current gallbladder disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the UKMEC 3 criteria for insertion of an IUD?

A
  • HIV with CD4 <200
  • Distorted urterine cavity
  • Long QT syndrome
  • Complicated organ transplant
  • 2 days-4 weeks post partum
  • cervical cancer after surgery to remove cervix
  • current asymptomatic chlamydia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the UKMEC 4 criteria for insertion of an IUD?

A
  • postpartum or post-TOP sepsis
  • endometrial cancer
  • cervical cancer awaiting treatment
  • current PID
  • current symptomatic chalmydia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the UKMEC3 criteria for a depot?

A
  • multiple risk factors for CVD or known vascular disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the UKMEC3 criteria for all LARC except the Cu-IUD?

A
  • past breast cancer
  • decompensated cirrhosis, hepatocellular adenoma or cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the UKMEC4 criteria for all LARC, and all short term contraceptives except the Cu-IUD??

A

Current breast cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the UKMEC3 criterion for all LARC?

A
  • unexplained vaginal bleeding.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which LARC method cannot be relied on in patients taking enzyme inducing drugs? e.g. AEDs

A

The progesterone only implant.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the failure rate of the implant? How long is it licenced for before it must be replaced?

A

0.05%

It has the lowest failure rate of any method.
Licensed for 3 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How does the implant work?

A
  • prevents ovulation
  • fertility is rapidly restored on removal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the commonest adverse effect of the implant?

A
  • irregular bleeding.
  • unfavourable bleeding has a 50% chance of improving over time.
  • can cause: amenorrhoea/infrequent bleeding, normal bleeding, frequent bleeding, prolonged bleeding.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the possible adverse effects of the implant?

A
  • irregular bleeding
  • headache
  • acne
  • depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the UKMEC3 criteria for implant?

A
  • ischaemic heart disease/stroke (for continuation, if initiation then UKMEC 2)
  • unexplained suspicious vaginal bleeding
  • past breast cancer
  • severe liver cirrhosis, liver cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the UKMEC4 criterion for implant?

A

current breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does the depot injection work? How often should it be given?

A
  • suppresses ovulation
  • Secondary effects include cervical mucus thickening and endometrial thinning.
  • available SC or IM, given at 13 week intervals.
  • if they present a week late (14 weeks), can have repeat injection without extra contraceptive precautions.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the average delay in return to fertility with the depot?

A
  • 5.5 months
  • ranges from no delay to up to a year.
  • therefore if more than 14 weeks since last depot - must use barrier contraception to prevent pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the adverse effects of the depot (depo provera)?

A
  • only method where there is a proven association with weight gain
  • irregular bleeding - can be prolonged and heavy. Usually trends towards amenorrhoea over time. injection cannot be reversed once given.
  • increased risk of osteoporosis - causes small loss in BMD. If aged <18 - depot should only be used if it is the only acceptable option (not yet reached peak body mass). Evaluate risks and benefits every 2 years. If other lifestyle/medical risk factors for osteoporosis - consider other methods. Advise to switch to another method at age 50 (risk of osteoporosis in menopause).
  • diffuse alopecia
  • headache
  • mood change
  • decreased libido
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the UKMEC3 criteria for depot?

A
  • Multiple risk factors for cardiovascular
    disease
  • past breast cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the UKMEC4 criteria for depot?

A
  • current breast cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How long can the Cu-IUD be left in place?

A

5-10 years depending on the type
can be relied upon immediately following insertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How long can the different LNG-IUS be used for contraception once in place?

A

Jaydess - 3 years (13.5mg)
Kyleena - 5 years (19.5mg)
Mirena - 8 years (52mg) - increased by FSRH in Jan 2024.

Can be relied upon 7 days after insertion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How long can the Cu-IUD and LNG-IUS be left in place for contraception in women close to the menopause?

A
  • Cu-IUD (containing 300 mm2 or more of copper) inserted in a woman aged>=40 can be left in until menopause (no contraception needed after 55 years - so could be in place for 15 years)
  • 52mg LNG-IUS inserted in a woman aged >=45 can be left in place until menopause. However if this is being used as the progestogenic component of HRT - this can only be used fo 5 years.
  • no contraception is needed after the age of 55
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the adverse effects assoc with IUD fitting?

A
  • pain - can be reduced with paracervical block
  • perforation - rare<2/1000, often heals spontaneously. 6x more common if breastfeeding.
  • pelvic infection - 0.5% within 90 days. Screen for chlamydia if at risk of STI
  • expulsion - 5% - most common in first 3 months. Teach women to feel for threads.
39
Q

What are the risk Fx for STI that should prompt a chlamydia swab pror to IUD fitting?

A
  • sexually active aged <25
  • new sexual partner in last 3months
  • more than one sexual partner in the last year
  • regular sexual partner has other partners
  • history of STIs
  • alcohol or substance abuse issues.
40
Q

How can a Cu-IUD be used for emergency contraception?

A
  • can be inserted up to 5 days after unprotected sex
  • can be inserted up to 5 days after ovulation (where ovulation date is known). e.g. in a regular 28 day cycle, ovulation is day 14. So the Cu-IUD could be inserted up to day 19 to cover unprotected sex at any point in the cycle before then.
  • It is more effective than oral emercency contraception

Sperm can live for up to 7 days
Ovum can live for 12-24 hours.

41
Q

What are the adverse effects of Cu-IUD?

A
  • periods have the same regularity but are usually heavier, longer and more painful. Especially in first 3 months. It may decrease with time if they can persist.
  • the proportion of pregnancies that are ectopic is increased but the absolute number of ectopic pregnancies is reduced, compared to a woman not using contraception
42
Q

What are the adverse effects of LNG-IUS?

A
  • irregular bleeding for first 3-6 months. Usually settles with 1/3 becoming amenorrhoeic with Mirena.
  • the proportion of pregnancies that are ectopic is increased but the absolute number of ectopic pregnancies is reduced, compared to a woman not using contraception
  • hormonal side effects less common than with POP/COCP/implant. Usually ease after first few months if they occur. Mood swings, reduced libido, acne, breast discomfort.
43
Q

What are the risks to mother and baby, of a pregnancy aged over 40?

A
  • increased rates of PPH, placenta praevia, gestational diabetes, pregnancy induced HTN and C-section
  • Increased chance of miscarriage (50% for women >45)
  • increased risk of ectopic pregnancy, stillbirth and perinatatl mortality
  • increased risk of Down syndrome
44
Q

At what age should COCP be stopped for a safer alternative?

A
  • age 35 for smokers
  • age 50 in non-smokers
45
Q

When can FSH be used as a guide for stopping contraception?

A
  • women over 50 using progesterone only contraception who are amenorrhoeic. (POP, implant, LNG-IUS)
  • If FSH raised >30, women should be advised to continue contraception for a further year before discontinuing (or stop at age 55 years)
  • If the FSH level is in the premenopausal range then the contraceptive method should be continued and the FSH level checked again one year later

The menopause is usually a clinical diagnosis made retrospectively after one year of amenorrhoea in women over the age of 45. However contraceptive methods can cause amenorrhoea so it can be difficult to diagnose menopause in these cases.

46
Q

How should contraception be stopped for women aged >40? For:
* non-hormonal methods (IUD, condoms)
* COCP
* Depot
* Progesterone only methods (POP, implant, IUS)

A
47
Q

When should levonorgestrel (Levonelle) be taken for EC?

A

within 72 hours of UPSI

works by inhibiting ovulation - so not effective if woman has already ovulated. Cu-IUD can be inserted up to 5 days after ovulation - can inhibit fertilisation or implantation.

48
Q

What should be done if vomiting occurs after taking levonorgestrel?

A
  • if it occurs within 3 hours - repeat the dose
49
Q

When should the dose of Levonorgestrel be increased for EC?

A
  • double the dose for BMI >26 or weight over 70kg.
50
Q

When should EllaOne (Ulipristal) be taken as EC?

A
  • within 120 hours of UPSI (5 days)

works by inhibiting ovulation - so not effective if woman has already ovulated. Cu-IUD can be inserted up to 5 days after ovulation - can inhibit fertilisation or implantation.

51
Q

Which HPV types cause 90% of genital warts?

A

HPV 6 and 11

52
Q

Which HPV types cause cervical cancer?

A

HPV types 16 and 18

53
Q

When is ABX prophylaxis against PCP (pneumocystis pneumonia) recommended in HIV? Which ABX is given?

A
  • when CD4 count is <200
  • co-trimoxazole
54
Q

When is ABX prophylaxis against Mycobacterium avium recommended in HIV? Which ABX is given?

A
  • when CD4 count <50
  • azithromycin
55
Q

What are the clinical features of chlamydia in men and women?

A
  • asymptomatic in around 70% of women and 50% of men
  • women: cervicitis (discharge, bleeding - PCB or IMB), dysuria
  • men: urethritis: urethral discharge, dysuria
56
Q

What are the potential complications of chlamydia?

A
  • epididymitis
  • pelvic inflammatory disease
  • endometritis
  • increased incidence of ectopic pregnancies
  • infertility
  • reactive arthritis
  • perihepatitis (Fitz-Hugh-Curtis syndrome)
57
Q

How should chlamydia be investigated in men and women?

A
  • men: first void urine sample for NAAT
  • women: self vaginal swab for NAAT

Chlamydia testing should be carried out two weeks after a possible exposure

58
Q

How should confirmed chlamydia infection be treated?

A
  • Recommend they attend GUM clinic
  • Doxycycline 100mg BD 7 days 1st line
  • if allergy or pregnant/breastfeeding: azithromycin 1g stat then 500mg OD for 2 days (d/w midwife/obstetrician)
  • Avoid sex until 7 days after they and partner(s) started treatment.
59
Q

How should chlamydia be contact traced?

A
  • trained practice nurses or refer GUM
  • If the person is unwilling/unable to attend GUM clinic, advise them that (with their consent) their details can be provided to GUM solely for the purposes of partner notification.
  • for men with urethral symptoms: all contacts since, and in the four weeks prior to, the onset of symptoms
  • for women and asymptomatic men all partners from the last six months or the most recent sexual partner should be contacted
  • contacts of confirmed Chlamydia cases should be offered treatment prior to the results of their investigations being known (treat then test)
60
Q

What is the chlamydia screening programme in the uk?

A
  • National Chlamydia Screening Programme is open to all men and women aged 15-24 years
  • self test kits available by post, GP surgeries, sexual health clinics, schools.
61
Q

How common is chlamydia? What is it?

A

Chlamydia is the most prevalent sexually transmitted infection in the UK and is caused by Chlamydia trachomatis, an obligate intracellular pathogen.

Approximately 1 in 10 young women in the UK have Chlamydia.

62
Q

Which pathogen causes gonorrhoea?

A
  • Gonorrhoea is caused by the Gram-negative diplococcus Neisseria gonorrhoeae.
  • Acute infection can occur on any mucous membrane surface, typically genitourinary but also rectum and pharynx.
  • The incubation period of gonorrhoea is 2-5 days
63
Q

What are the clinical features of gonorrhoea in men and women?

A
  • men: 90% are symptomatic. urethral discharge, dysuria, prostatitis, urethral stricture. Rectal infection : usually asymptomatic. May be anal discharge, pain. Pharyngeal infection usually asymptomatic.
  • women: asymptomatic 50%, cervicitis: vaginal discharge, dysuria. PID.
64
Q

How is gonorrhoea tested for in men and women?

A
  • all with suspected gonorrhoea should be referred to GUM for confirmation of diagnosis. If unwilling/unable to attend - can test in primary care.
  • men: first pass urine sample for NAAT
  • women: vulvovaginal swab for NAAT
  • rectal and pharyngeal sampling: MSM, women who are contacts of gonorrhoea, if symptomatic.
  • If gonorrhoea diagnosed by NAAT - send MC&S (urethral, endocervical, vaginal, anorectal and pharyngeal) for susceptibility testing. Send MC&S at same time if clinically suspected gonorrhoea.
  • Ideally wait for culture before treating.
65
Q

How is gonorrhoea treated?

A
  • all should be referred to GUM clinic. If unwilling to attend - can treat in primary care.
  • if culture shows susceptible - ciprofloxacin 500mg PO single dose.
  • If sensitivities not known - ceftriaxone 1g IM single dose.
  • If needle phobic/refuse IM: oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose)
  • For people with penicillin allergy, ceftriaxone and cefixime are suitable unless there is a history of severe hypersensitivity (anaphylactic reaction) to any beta-lactam antibacterial.
  • For pregnant or breastfeeding women: ceftriaxone 1 g IM injection as a single dose.
  • abstain from sex until 7 days after they and partner(s) have completed treatment.
66
Q

When should a person have test of cure or be retested for chlamydia?

A

Test of cure >=3 weeks after treatment for - pregnant or confirmed rectal infection.

Re-test at 3-6 months if aged <25, or older at high risk of re-infection.

67
Q

How should gonorrohea be contact traced?

A
  • Ideally by GUM clinic.
  • For men with symptomatic urethral infection, all sexual partners within the preceding 2 weeks, or their most recent partner if this was longer than 2 weeks ago.
  • For all others (women, asymptomatic men, men with gonorrhoea at other sites) - all partners within the preceding 3 months.
68
Q

How should a person treated for gonorrhoea be followed up?

A
  • TOC for all
  • if still symptomatic - repeat MC&S >3 days after completing treatment
  • if asymptomatic- NAAT testing >2 weeks after completing treatment
69
Q

What are the potential complications of gonorrhoea in men and women?

A
  • Men: epididymo-orchitis, prostatitis, infertility, urethral stricture
  • Women: PID - infertility, ectopic pregnancy. Peritoneal spread - perihepatic abscesses (Fitz-hugh-curtis). Pregnancy comps - miscarriage, premature labour, PROM, gonococcal conjunctivitis.
  • Disseminated gonorrhoea: bacteraemia causing septic arthritis, polyarthralgia, tenosynovitis, petechial/pustular skin lesions, or rarely, endocarditis, or meningitis
70
Q

What are the 5 most common causes of ‘abnormal’ vaginal discharge?

A
  • excessive normal secretions
  • Bacterial vaginosis
  • candida albicans
  • cervicitis (chlamydial, gonococcal, herpetic)
  • trichomonas vaginalis

Rarer: cervical ectropion/polyp, Cu-IUD/IUS/foreign body, cervical cancer, endometrial cancer, fistula.

71
Q

What are the key features of candida, trichomonas vaginalis and BV discharge?

A
  • BV - no vulval soreness
  • Candidiasis - vulvitis- superficial dyspareunia, pruritis vulvae, non-offensive discharge
  • trichomonas - vulval itching, dysuria, low abdo discomfort.
72
Q

What is the treatment for Bacterial Vaginosis?

A
  • not sexually transmitted, no need to treat partner.
  • lifestyle: reduce smoking, vaginal douching, bubble baths, shampoos in the bath.
  • metronidazole 400mg BD for 5-7 days (same for pregnancy if symptomatic. If asymptomatic - d/w specialist. Repeat test in 1 month.)
  • no TOC if syx resolve.
73
Q

What are the complications of BV?

A
  • increased risk of pre-term delivery
  • risk of PID and endometritis after birth or TOP
  • infection after hysterectomy.
74
Q

What are the risk factors for vaginal candidiasis (thrush)?

A
  • DM
  • pregnancy
  • immunosuppression: chemo/radiotherapy, HIV
  • steroid treatment
  • broad spectrum ABX
75
Q

How should vaginal thrush be treated? How should it be managed in pregnant women?

A
  • swab not needed if clinical features of thrush. Consider examination - offer routinely if recurrent thrush/treatment failure, and do HV swab/self swab for MC&S.
  • lifestyle advice: emollient soap substitute, avoid irritants - shampoo, shower gels, wipes, pads, vaginal douching. Avoid tight clothing (use loose cotton underwear)
  • Fluconazole 150 mg oral capsule as a single dose first-line. If severe infection - repeat dose after 72hrs (dose on day 1 and day 4)
  • clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated.
  • if vulval symptoms - topical imidazole in addition to an oral or intravaginal antifungal. clotrimazole 1% or 2% cream applied 2–3 times a day. topical imidazole preparations (and pessaries) may damage latex condoms and diaphragms. Vulval emollient for dermatitis.
  • If pregnant - clotrimazole pessary 500 mg intravaginally at night for up to 7 consecutive nights first-line. Topical treatments can also be added as above.
76
Q

How is trichomonas vaginalis diagnosed in women and men?

A
  • STI caused by flagellated protozoan trichomonas vaginalis
  • Refer to GUM if suspected - if not possible, examine in GP - speculum
  • High vaginal swab/self swab for MC&S
  • men: urethral swab or first void urine for MC&S
77
Q

How is trichomonas managed? (including partners)

A
  • ideally by GUM clinic
  • for men and non pregnant/breastfeeding women: oral metronidazole 400–500 mg twice a day for 5–7 days, or metronidazole 2 g as a single oral dose. (if HIV use 500mg dose)
  • in breastfeeding/pregnant women: oral metronidazole 400–500 mg twice a day for 5–7 days. The high single dose is not recommended. If asymptomatic - contact GUM specialist.
  • Treat current partner(s) simultaneously, and also treat any partner(s) from within the 4-week period prior to presentation
  • Offer screening for other STIs
  • sexual abstinence for at least one week and until the person and partner(s) have completed treatment and follow up.
78
Q

What are the complications of trichomonas infection in women and men?

A
  • women:
  • preterm delivery
  • low birth weight
  • maternal post partum sepsis
  • increased risk cervical cancer
  • PID and infertility
  • Men:
  • acute and chronic prostatitis
  • increased risk prostate cancer
  • infertility.

Both: increased risk of HIV transmission - facilitates.

79
Q

What is PID? What causes it?

A
  • Pelvic inflammatory disease (PID) is a general term for infection of the upper genital tract, which typically affects sexually active young women. Infection spreads upwards from the vagina and endocervix
  • Leads to endometritis, salpingitis, Oophoritis, tubo-ovarian abscess, peritonitis.
  • STIs - chlamydia, gonorrhoea, mycoplasma genitalium.
  • Other infections (part of normal microbiome) - gardnerella vaginalis
  • Increased risk after insertion of IUD - in first 3 weeks. Hysteroscopy, IVF, TOP.
80
Q

What are the typical clinical features of PID?

A
  • fever, malaise, nausea/vomiting
  • acute pelvic pain - usually bilateral
  • deep dyspareunia
  • 2ry dysmenorrhoea
  • abnormal vaginal bleeding - IMB, PCB, HMB
  • abnormal vaginal discharge (purulent)

Exam (pelvic & speculum, and abdo): bilateral lower abdo tenderness.
Adnexal tenderness, cervical motion tenderness, uterine tenderness.
Abnormal cervical/vaginal mucopurulent discharge and/or friable cervix on speculum.

81
Q

How is PID investigated and managed? (including sexual partners)

A
  • pregnancy test - exclude ectopic
  • urgent hospital admission if unwell, adnexal mass (tubo-ovarian abscess) , or peritonitis.
  • otherwise - refer to GUM for STI screening, treatment, contact tracing, IUD removal if severe symptoms or not improving.
  • if unable to attend - send swabs for MC&S and NAAT then immediately treat with ABX. Negative swabs do not rule out PID. Consider bloods: FBC, CRP - if raised support Dx. HIV, hepatitis and syphilis serology for STI screen.
  • ABX: ceftriaxone 1 g as a single intramuscular (IM) dose, followed by oral doxycycline 100 mg twice daily plus oral metronidazole 400 mg twice daily for 14 days.
  • Review 72h - if not improving - consider admission, review swab results.
  • Abstain from sex until woman and any partners have completed ABX, symptom free and TOC.
  • offer partners - screening for chlamydia, gonorrhoea & start empirical ABX doxycycline 100mg BD 1 week.
82
Q

What is the most common virus type causing genital herpes in the UK? What is primary and recurrent infection?

A
  • HSV-1 = most common cause of oro-labial herpes simplex infection (causing ‘cold sores’ or gingivostomatitis), and is now most common cause of genital herpes in the UK
  • HSV-2 more likely to cause recurrent genital herpes
  • Primary infection = first time HSV-1 or HSV-2 is acquired. Asymptomatic in majority with HSV-2. The virus becomes latent in local sensory ganglia lifelong.
  • Recurrent genital herpes = reactivation of pre-existing HSV-1 or HSV-2. Can cause ulcers or be asymptomatic but with viral shedding from external genitalia, anorectum, cervix, urethra - onward transmission.
83
Q

What are the typical clinical features of genital herpes simplex?

A
  • multiple painful genital blisters which quickly burst to leave ulcers on the external genitalia. (4-7 days after exposure). Can affect vagina and cervix in women. Primary episode can last 3 weeks - more severe than recurrent episodes.
  • Inguinal lymphadenopathy
  • prodromal tingling/buring pain genitals/buttocks/lower back before recurrent episode. Then often unilateral ulcers.
  • dysuria, vaginal/urethral discharge
  • malaise, fever - first episode
84
Q

How is genital herpes managed? First and recurrent episodes? Pregnant?

A
  • refer GUM clinic
  • if unable to attend - viral swab from base of an ulcer. Screen for other STIs.
  • first episode: oral antiviral treatment should be started within 5 days of the start of a first episode, or while new lesions are forming. Aciclovir 400 mg TDS for 5 days, or valaciclovir 500 mg BD for 5 days first-line. If immunocompromised/HIV- aciclovir 400mg 5 times a day for 7-10 days - seek specialist advice. Review at 5-7 days. If pregnant - urgent referral to sexual health service & midwife/obstetrician.
  • recurrent episodes: self-care. Episodic oral antiviral - aciclovir 800mg TDS for 2/7. Suppressive treatment if >6 episodes/year. Pregnant - refer midwife/obstetrician.
  • Partners should attend GUM clinic.
85
Q

What self care methods should be advised for genital herpes?

A
  • saline bathing
  • OTC analgesia - paracetamol, ibuprofen
  • topical vaseline or lidocaine 5% gel before passing urine
  • increase fluid intake - produce dilute urine. Void in bath.
  • Loose clothing.
86
Q

What advice should be given to reduce risk of genital herpes transmission?

A
  • abstain from sex (and oral sex) if lesions or prodromal syx, until lesions cleared
  • transmission can occur when no syx (asymptomatic shedding)
  • male condoms can reduce risk but cannot completely prevent.
  • transmission can occur from an asymptomatic partner years into a monogamous relationship.
  • (HSV-1) infection may have spread from elsewhere on the body, such as the lips or fingers.
87
Q

What are the clinical features of genital warts in men and women?

A
  • women: often asymptomatic. Can lead to vaginal itching or discharge.Warts seen on vulva/ introitus. They enlarge during pregnancy.
  • men: often found on penis or perianally.
88
Q

How are genital warts managed?

A
  • refer to GUM clinic -best treated there.
  • if unable - manage in primary care.
  • screen for STIs. If no other STIs, no tracing needed.
  • speculum exam in women - refer if cervical warts.
  • Podophyllotoxin, imiquimod and sinecatechins are suitable for home treatment by patients. All have high failure rate.
  • Refer all pregnant women to GUM - topical Rx cannot be used.
  • Refer all children - consider safeguarding.
  • Refer elderly
  • Refer if haematuria/obstructed urine stream, immunosuppressed, intra-anal warts.
89
Q

How should pubic lice be managed?

A
  • if likely sexual transmission - refer GUM - for contact tracing over last 3 months and screening for STIs
  • consider sexual abuse in children - safeguarding
  • permethrin 5% cream or malathion aqueous soln.
  • Re-examine 1 week after Rx
90
Q

What are the clinical features of primary, secondary and tertiary syphilis?

A
  • primary: chancre (soliatary painless ulcer)
  • secondary (4-8 wks after): maculopapular rash, condylomata lata, alopecia. Oral lesions. Lymphadenopathy. Low grade fever, malaise.
  • tertiary (up to 20yrs later): gummas (granulomas), cardiac disease, neurological disease.

treponema pallidum

91
Q

How should suspected syphilis be managed in primary care?

A
  • refer GUM - expert diagnosis needed.
  • avoid all sexual contact until sucessful treatment confirmed
  • if pt refuses - d/w GUM for testing advice: swabs and serological tests: VDRL test, TPHA.
  • treatment in sexual health clinic : benzathine penicillin IM (also given in pregnancy - risk of miscarriage, stillbirth, congenital syphilis).
92
Q

What is Behcets disease?

differential (non sexually transmitted) in ulcers

A
  • complex multi-system disorder of unknown aetiology characteristically presenting with recurrent oral ulcers. Presumed to be autoimmune.
  • Plus: recurrent genital ulceration, uveitis, skin: erythema nodosum, pathergy. Arthritis: arthritis and arthralgias are common; a non-erosive arthritis occurs which most often affects the lower limbs, especially the knee. Vasculitis can occur.
93
Q

What is ‘Reiter’s syndrome’?

A
  • reactive arthritis, urogenital tract infection, and uveitis.
  • A clinical subtype of reactive arthritis - now called sexually acquired reactive arthritis.

Reactive arthritis can be post-enteric infection (campylobacter,salmonella, shigella) or post -STI (chlamydia, HIV).
Usually lower extremity oligoarthritis.

94
Q

How is the earliest likely ovulation date calculated?

A

= date of 1st day of LMP + (length of shortest cycle in days -14).

Cycles must be regular and LMP accurate.

AKT - Lizzie Bain (55 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions