sexual health

Question 1

What are the most common types of HPV? which types are linked to cervical cancer?

Answer 1

Most common: Types 6 and 11 are responsible for 90% of genital warts cases

Link to cancer: 16,18 & 33 predisposes to cervical cancer.

Question 2

How often are women with HIV meant to have smears?

Answer 2

Annually

Question 3

What is chancroid?

Answer 3

Tropical disease (Haemophilus ducrey)
Chancroid presents as a deep, painful genital ulcer and is often associated with inguinal lymphadenopathy.

Question 4

What is the treatment for genital warts?

Answer 4

multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy

Question 5

How is HIV diagnosed?

Answer 5

combination tests (HIV p24 antigen (present in early disease) and HIV antibody (presnt usually from 6weeks)) are now standard for the diagnosis and screening of HIV

Question 6

Bacterial cause of most BV?

Answer 6

Gardnerella vaginalis

Question 7

BV vs trichomonas? Mx?

Answer 7

Trichomonas vaginalis - offensive ‘musty’, frothy, green vaginal, strawberry cervix

BV- thin, white discharge
clue cells on microscopy
vaginal pH > 4.5
positive whiff test - fishy when add potassium hydroxide

PO metronidazole

Question 8

Gonorrhoea mx

Answer 8

IM ceftriaxone

Question 9

What are the different options for emergency contraception? How would u decide one vs another?

Answer 9

copper coil - 1st line - CI if STI or after 5 days post coital. If pt wants it removed after - take out at next period
Levonorgestrel - can be used up to 72 hrs post coital
Ulipristal - used up to 120 hrs post coital. CI in severe asthma

Question 10

When is PEP given?

Answer 10

Within 72 hrs of exposure, the sooner the more effective

Question 11

Levonorgestrel vs ullipristal as emergency contraception?

Answer 11

Levonorgestrel:
must be taken in 72 hrs
can take normal contraception straight away

Ullipristal:
must be taken in 120 hrs
normal contraception wont work for 5 days after
Have to pause breastfeeding
CI in asthma

Both can be used more than once in the same menstrual cycle

Question 12

How far back do you need to notify partners if u are pos for chlamydia?

Answer 12

Chlamydia - partner notification:
symptomatic men: all partners from the 4 weeks prior to the onset of symptoms
women + asymptomatic men: all partners from the last 6 months or the most recent sexual partner

Question 13

Absolute CI of COCP

Answer 13

Absolute contra-indications for the combined oral contraceptive pill (category 4) include:

Migraine with aura
Breastfeeding <6 weeks post-partum
Age 35 or over smoking 15 or more cigarettes/day
Systolic 160mmHg or diastolic 95mmHg
Vascular disease
History of VTE
Current VTE (on anticoagulants)
Major surgery with prolonged immobilisation
Known thrombogenic mutations
Current and history of ischaemic heart disease
Stroke (including TIA)
Complicated valvular and congenital heart disease
Current breast cancer
Nephropathy/retinopathy/neuropathy
Other vascular disease
Severe (decompensated) cirrhosis
Hepatocellular adenoma
Hepatoma
Raynaud’s disease with lupus anticoagulant
Positive antiphospholipid antibodies

Question 14

When can you restart COCP post birth? What about if breastfeeding?

Answer 14

The COCP should not be used in the first 21 days due to the increased venous thromboembolism risk post-partum

6 weeks if breastfeeding

Question 15

How do the different contraceptive work?

Answer 15

All inhibit ovulation, except:
- POP: thickens cervical mucus (Exception to this is desogestrel POP which inhibits ovulation)
- IUD copper: kills sperm
- IUS: prevents endometrial proliferation (get amenorrhea with this)

Question 16

How long does it take for contraceptive to be effective? (if not 1st day of period)

Answer 16

instant: IUD

2 days: POP

7 days: COC, injection, implant, IUS