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GP > Sexual Health > Flashcards

Sexual Health Flashcards

1
Q

List some questions you’d ask in a sexual history?

A

Last sexual intercourse

No. of partners in last 3 months

Previous STIs

Contraceptive use

Any psychosexual issues

Are there any concerns about relationship

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2
Q

What symptoms would you ask a woman about during a sexual history?

A

Change in vaginal discharge

Vulval problems

Lower abdo pain

Dysuria

Menstrual cycle
Pregnancy history
Contraception
Cervical smear history

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3
Q

What symptoms would you ask a man about during a sexual history?

A

Urethral discharge

Dysuria

Genital skin problems

Testicular swellings, pain

Peri-anal, anal symptoms

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4
Q

What info do you need to ask about the partner(s) of your patient?

A

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

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5
Q

What do you need to ask in a gynaecological history?

A

Cervical smears

Last menstrual period, any abnormalities?

Any children? About the delivery

Hysterectomy
Prolapse

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6
Q

Describe normal vaginal discharge and how it’s different during the cycle?

A

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

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7
Q

You see a patient with thin, grey discharge that smells fishy. What’s the likely cause?

A

Bacterial vaginosis

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8
Q

You see a patient with itching and soreness down below. She has white discharge. What’s the likely cause?

A

Candida albicans

Thrush?

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9
Q

You see a patient with offensive purulent discharge. She has pain when urinating and needs to go more frequently. What are the likely causes?

A

STI

Chlamydia trachomatis
Neisseria gonorrhoea

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10
Q

You see a patient with yellow discharge, abdo pain and itch and soreness down below. What’s the likely cause?

A

Trichomonas vaginalis

An STI

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11
Q

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?

A

Foreign body

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12
Q

You see a 35 year old lady with blood stained offensive discharge. What needs to be ruled out?

A

Carcinoma

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13
Q

You should only offer a chaperone when the patient is of the opposite sex to you. True or false?

A

False, you should always offer a chaperone.

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14
Q

What must a chaperone be? What qualities should they have?

A

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

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15
Q

If the patient doesn’t want a chaperone but you do, you can wait for one to become available. True or false?

A

True. You don’t have to continue without one if you want one present.

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16
Q

What’s the Fraser criteria?
WHat’s the difference between Gillick and Fraser?

What are the points in it?

A 
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

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17
Q

At what age is a teenager able to consent to sex definitely or in some situations?

A

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.

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18
Q

How does the combined OCP work?

A

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.

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19
Q

How does the progesterone only OCP work?

A

Thickens cervical mucus to prevent sperm getting to the uterus

Prevents ovulation in 60% of women

20
Q

Which pill is taken without breaks and must be taken at the same time every day?

A

Progesterone only

21
Q

How does the contraceptive implant work?

How long does it last?

A

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

22
Q

How does the contraceptive Depo injection work?

What’s its full name?

How long does it last for?

A

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

23
Q

What are the two types of coil?

How long do they last?

Where are they implanted?

A

Copper coil (IUD)

Progesterone based (IUS)

They last 3-5 years

They go in the uterus

24
Q

How does the IUD work?

A

IUD is the copper coil

Copper is spermicidal and prevents fertilised egg from implanting

25
Q

How does the IUS work?

A

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

26
Q

Which contraceptives help with menorrhagia?

A

IUS (progesterone)
Depo-Provera
Combined OCP

27
Q

Which contraceptives would you not prescribe for a woman being treated for TB? Why?

A

Both pills

Implant

As these interact and become less effective with rifampicin

28
Q

Which contraceptives would you advise for a lady who doesn’t want to have any hormonal side effects?

A

IUD (copper)

29
Q

What are the two types of emergency contraceptives?

A

Pill, 2 types

IUD (copper)

30
Q

Briefly describe how the two emergency contraceptive pills work?

A

Levonelle: contains progesterone which does it’s usual thing

EllaOne: more effective but more expensive, stops progesterone working normally

31
Q

What examinations should you do before prescribing contraception for a patient?

A

BP

BMI

32
Q

List some conditions that pose health risks during pregnancy.

A 
Bariatric surgery within 2 years
Cardiomyopathy
Rheumatoid arthritis
Organ transplant
Idiopathic intracranial hypertension
Breast, ovarian, ovarian cancer
Diabetes
Hypertension
Morbid obesity
33
Q

How does female sterilisation work?

A

Laparoscopy under GA

Put titanium clips on the fallopian tubes

34
Q

How does male sterilisation work?

A

Cut in scrotum, vas deferens cut and cortorised

Under local anaesthetic

35
Q

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?

A

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
36
Q

List some common symptoms women with an STI get?

A

Vaginal discharge

Vulval itching

Dyspareunia: deep or superficial

Vulval lumps, ulcers

Bleeding:

  • between periods
  • after sex
37
Q

List some common symptoms men with an STI get?

A

Dysuria

Urethral pain

Urethral discharge

Genital ulcers, lumps

Rash on penis or general area

Scrotal pain and swelling

38
Q

What investigations would you do for a woman with symptoms of a STI?

A

Vulvo-vaginal swab for chlamydia + gonorrhoea

High vaginal swab:

  • b. vaginosis
  • trichomonas vaginalis
  • candida

Cervical swab for gonorrhoea

Urinalysis

Blood for syphilis and HIV

39
Q

What investigations would you do for a heterosexual man with symptoms of a STI?

A

Urethral swab and first void urine for chlamydia + gonorrhoea

Urinalysis

Blood for syphilis and HIV

40
Q

What investigations would you do for a MSM with symptoms of a STI?

A

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

41
Q

Who should be screened for Hep B?

A

MSM

Commercial sex workers

IVDUs past or present

People from high risk areas: Africa, Asia, E. Europe

AND all partners of the above

42
Q

What is NAAT?

A

Nucleic acid amplification test

43
Q

Gram negative diplococci?

A

N. gonorrhoea

44
Q

Management of chlamydia? Gonorrhoea?

A

Chlaymydia (azithromycin)

Gonorrhoea (ceftriaxone, azithromycin)

45
Q

Management of trichomonas?

A

Metronidazole

GP (13 decks)

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