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
