Sexual Health Flashcards
List some questions you’d ask in a sexual history?
Last sexual intercourse
No. of partners in last 3 months
Previous STIs
Contraceptive use
Any psychosexual issues
Are there any concerns about relationship
What symptoms would you ask a woman about during a sexual history?
Change in vaginal discharge
Vulval problems
Lower abdo pain
Dysuria
Menstrual cycle
Pregnancy history
Contraception
Cervical smear history
What symptoms would you ask a man about during a sexual history?
Urethral discharge
Dysuria
Genital skin problems
Testicular swellings, pain
Peri-anal, anal symptoms
What info do you need to ask about the partner(s) of your patient?
Age, gender
About the relationship
Use of condoms
Type of sex: oral, vaginal, anal
Are they a sex worker?
Any overseas partners in the last year
What do you need to ask in a gynaecological history?
Cervical smears
Last menstrual period, any abnormalities?
Any children? About the delivery
Hysterectomy
Prolapse
Describe normal vaginal discharge and how it’s different during the cycle?
Increases during luteal phase (day 14-period)
When progesterone dominates discharge is thick and sticky
When oestrogen dominates its clear, wet, stretchy
Always non-offensive and clear
You see a patient with thin, grey discharge that smells fishy. What’s the likely cause?
Bacterial vaginosis
You see a patient with itching and soreness down below. She has white discharge. What’s the likely cause?
Candida albicans
Thrush?
You see a patient with offensive purulent discharge. She has pain when urinating and needs to go more frequently. What are the likely causes?
STI
Chlamydia trachomatis
Neisseria gonorrhoea
You see a patient with yellow discharge, abdo pain and itch and soreness down below. What’s the likely cause?
Trichomonas vaginalis
An STI
You see a child who’s had some offensive discharge containing streaks of blood. She has some abdo pain and has been withdrawn since this has started. What’s the likely cause?
Foreign body
You see a 35 year old lady with blood stained offensive discharge. What needs to be ruled out?
Carcinoma
You should only offer a chaperone when the patient is of the opposite sex to you. True or false?
False, you should always offer a chaperone.
What must a chaperone be? What qualities should they have?
A medical professional, not a family member or friend
Someone who is impartial
Who will be sensitive and respect dignity
Who will raise concerns if they have any
If the patient doesn’t want a chaperone but you do, you can wait for one to become available. True or false?
True. You don’t have to continue without one if you want one present.
What’s the Fraser criteria?
WHat’s the difference between Gillick and Fraser?
What are the points in it?
Gillick = child having capacity to consent on anything Fraser = specific to contraception
The YP understands the advice given
The YP can’t be persuaded to inform parents
The YP will likely continue to have sex with or without contraception
The YP’s health may suffer if you withhold contraception advice and treatment
It’s in the best interests of the YP to give advice and treatment
At what age is a teenager able to consent to sex definitely or in some situations?
Below 13, no capacity to consent
Age 13-16 is a grey area, they have limited capacity
16+ they have proper consent but still be aware of possibility of abuse etc.
How does the combined OCP work?
Suppresses release of FSH and LH
Inhibits ovulation
Thickens cervical mucus so sperm can’t get to uterus
Thins endometrium to prevent fertilised egg implanting.
How does the progesterone only OCP work?
Thickens cervical mucus to prevent sperm getting to the uterus
Prevents ovulation in 60% of women
Which pill is taken without breaks and must be taken at the same time every day?
Progesterone only
How does the contraceptive implant work?
How long does it last?
Contains a progesterone only hormone
Which thickens cervical mucus so sperm can’t get to uterus
Thins endometrium to prevent fertilised egg implanting
Lasts for 3 years
How does the contraceptive Depo injection work?
What’s its full name?
How long does it last for?
Contains a progesterone hormone
Thickens cervical mucus so sperm can’t get to uterus
Thins endometrium to prevent fertilised egg implanting
Possibly prevents ovulation
Depo-Provera
Lasts 12 weeks
What are the two types of coil?
How long do they last?
Where are they implanted?
Copper coil (IUD)
Progesterone based (IUS)
They last 3-5 years
They go in the uterus
How does the IUD work?
IUD is the copper coil
Copper is spermicidal and prevents fertilised egg from implanting
How does the IUS work?
Releases progesterone over time
Thickens cervical mucus so sperm can’t get to uterus
Thins endometrium so egg can’t implant
Prevents ovulation in 60% women
Which contraceptives help with menorrhagia?
IUS (progesterone)
Depo-Provera
Combined OCP
Which contraceptives would you not prescribe for a woman being treated for TB? Why?
Both pills
Implant
As these interact and become less effective with rifampicin
Which contraceptives would you advise for a lady who doesn’t want to have any hormonal side effects?
IUD (copper)
What are the two types of emergency contraceptives?
Pill, 2 types
IUD (copper)
Briefly describe how the two emergency contraceptive pills work?
Levonelle: contains progesterone which does it’s usual thing
EllaOne: more effective but more expensive, stops progesterone working normally
What examinations should you do before prescribing contraception for a patient?
BP
BMI
List some conditions that pose health risks during pregnancy.
Bariatric surgery within 2 years Cardiomyopathy Rheumatoid arthritis Organ transplant Idiopathic intracranial hypertension Breast, ovarian, ovarian cancer Diabetes Hypertension Morbid obesity
How does female sterilisation work?
Laparoscopy under GA
Put titanium clips on the fallopian tubes
How does male sterilisation work?
Cut in scrotum, vas deferens cut and cortorised
Under local anaesthetic
In a sexual health clinic what would you screen for in an asymptomatic patient?
How is it done in men and women?
Is it different for MSM?
Gonorrhoea, chlamydia
- self taken swab for women
- first void urine for men
Blood test for syphilis and HIV
For MSM also do:
- pharyngeal and rectal swab for C+G
- blood for Hep B
List some common symptoms women with an STI get?
Vaginal discharge
Vulval itching
Dyspareunia: deep or superficial
Vulval lumps, ulcers
Bleeding:
- between periods
- after sex
List some common symptoms men with an STI get?
Dysuria
Urethral pain
Urethral discharge
Genital ulcers, lumps
Rash on penis or general area
Scrotal pain and swelling
What investigations would you do for a woman with symptoms of a STI?
Vulvo-vaginal swab for chlamydia + gonorrhoea
High vaginal swab:
- b. vaginosis
- trichomonas vaginalis
- candida
Cervical swab for gonorrhoea
Urinalysis
Blood for syphilis and HIV
What investigations would you do for a heterosexual man with symptoms of a STI?
Urethral swab and first void urine for chlamydia + gonorrhoea
Urinalysis
Blood for syphilis and HIV
What investigations would you do for a MSM with symptoms of a STI?
Urethral swab and first void urine for chlamydia + gonorrhoea
Urinalysis
Blood for syphilis and HIV
^^ as with heterosexual man
Also:
Urethral, rectal and pharyngeal cultures
Hep B
Who should be screened for Hep B?
MSM
Commercial sex workers
IVDUs past or present
People from high risk areas: Africa, Asia, E. Europe
AND all partners of the above
What is NAAT?
Nucleic acid amplification test
Gram negative diplococci?
N. gonorrhoea
Management of chlamydia? Gonorrhoea?
Chlaymydia (azithromycin)
Gonorrhoea (ceftriaxone, azithromycin)
Management of trichomonas?
Metronidazole
