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Sexual Health Flashcards

1
Q

What test can be done to assess for ovulation and how is the timing of this worked out if the patient doesn’t have a regular menstrual cycle.

A

21 day progesterone level test

If a patient doesn’t have a regular cycle. Subtract 7 days from when the period will start. This will give you the 7 day post ovulation - in which progesterone should be high.
*remember luteal phase is more consistent than follicular phase

*normal level is >25picommol.

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2
Q

What are the most common causes of anovulation?

A

PCOS

Hypothalamic amenorrhea
- physiological stress stops GnRH being released

Endocrine disorders

  • Hypothyroidism
  • Hyper-prolactinomas
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3
Q

List 6 main types of contraception:

A
  1. Barrier - condoms
  2. Pill
    - combined
    - Progesterone only
  3. Implant
    - last 3 years
  4. Injection
    - every 3 months
    - long acting progesterone
  5. intrauterine
    - Copper
    - Mirena
    * Mirena up to 5 years use
  6. Sterilisation
    Female - Clips on tubes or Tubal ligation

Male - Vasectomy

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4
Q

What are some risk factors for STIs?

A

Not using Barrier protection

<25 years of age

High number of sexual partners

New sexual partners

Men who have sex with men

Commercial sex workers

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5
Q

Why should two condoms not be used at once?

A

More like to tear

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6
Q

Following a positive screen for chlamydia, when should a person be retested?

A

3-6 months later

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7
Q

What are some of the clinical signs of chlamydia?

A

Cervicitis
Cervical contact bleeding
PID
Reactive arthritis*

Typical symptoms:

  • Lower abdominal pain
  • Dyspareunia
  • Dysuria
  • Intermenstrual bleeding
  • Post-coital bleeding
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8
Q

What type of urine sample is required for STI testing in men?

A

First void urine

*not MSSU

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9
Q

What is the treatment for chlamydia? how long should one abstain from sex and what else should be done?

A

Doxycycline or Azithromycin

Pregnant:
- Erythromycin

7 days no sex - even with condom.

Contact tracing

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10
Q

What is the management of Gonorrhoea?

A

Referral to sexual health clinic.

Ceftriaxone 500mg STAT
+
Azithromycin 1G STAT

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11
Q

What are the Urogenital complications of Gonorrhoea?

A

Females:

  • PID
  • Bartholin’s cyst
  • Endometritis

Male:

  • Epididymitis
  • Infection of penile glands (Tyson’s glands)
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12
Q

What are the symptoms of primary HSV and what are the complications?

A 
Malaise with flu like symptoms. 
Lymphadenopathy 
Stinging/ tingling sensation in genital area 
Vesicle formation in genitals 
Dysuria

Complications:

  • Urinary retention
  • Constipation
  • Aseptic meningitis
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13
Q

What is the cause of genital warts and what is the treatment?

A

HPV

Treatment:

  • Podophyllotoxin cream
  • Imiquimod
  • Cryotherapy
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14
Q

What is the vaccine against HPV?

A

HPV vaccine against:

  • 6
  • 11
  • 16
  • 18

Administered to all girls at school
+
Men who have sex with men <45 years old

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15
Q

What in the clinical history and symptoms can help differentiate between bacterial vaginosis and Trichomonas vaginalis?

A

Discharge:
BV: grey and watery

TV: Frothy and Yellow

Symptoms:
BV: Usually asymptomatic

TV: Dysuria

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16
Q

What investigations should be done into vaginal discharge?

A

Vaginal pH

High Vaginal swab / HVS

Pregnancy test 
(retained products of conception can cause discharge)

Chlamydia and gonorrhoea swab
+/-
urethral/ rectal and pharyngeal swab

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17
Q

What are the Emergency contraception options? and which is the most effective contraception?

A

Copper IUD
- most effective

Levonorgestrel

Ulipristal Acetate (progesterone receptor modulator)

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18
Q

When is a copper IUD effective for Emergancy contraception till?

A

Up to 5 days following the unprotective sex
or
5 days after ovulation (day 19 in normal cycle)

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19
Q

When can ulipristal acetate be used up till for Emergancy contraception?

A

Up to 120 hours

Inhibits or delays ovulation

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20
Q

How long after unprotected sex is levonorgestrel effective?

A

72 hours

1.5mg given.
Dose should be 3mg (Doubled) if:
- BMI >26
- On liver enzyme inducing medication

Inhibits ovulation - delaying or preventing follicular rupture.

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21
Q

What are the grounds of a termination?

A

An abortion can only be carried out if 2 or more doctors agree that the pregnancy should be terminated on 1 or more grounds.
These include:
• Continuance of pregnancy would involve risk to the life of the pregnant woman greater than if continued.

* Termination is necessary to prevent grave physical or mental injury of the pregnant woman 
* Pregnancy has not exceeded 24 weeks and the continuance of pregnancy would not involve greater risk to pregnant woman both physically and mentally 
* Pregnancy has not exceeded 24 weeks and the continuance of pregnancy would not involve greater risk to the family of the pregnant woman both physically and mentally

That there is a sufficient risk if the child was born it would suffer such severe mental or physical handicaps

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22
Q

What pre-abortion investigations are needed?

A

Bloods:

  • FBC
  • Blood grouping
  • Kleihaur test
  • Rh Negative will need prophylactic anti D

Orifices:

  • STI screen
  • cervical cytology

Baby:
- gestational age

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23
Q

What are the medical options for abortion?

A
  • Mifepristone (progesterone antagonists)
    24-48 hours later given:
  • Misoprostol (prostaglandin)

**used most successfully <7 weeks but can be used late 1st trimester

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24
Q

What are the surgical options for a late abortion (2nd trimester)

A

Dilation and evacuation

  • cervical dilation
  • surgical removal of fetus
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25
Q

What type of surgical abortion can be performed in 1st trimester?

A

<7 weeks:
- manual vacuum aspiration

7-14 weeks:
- suction or vacuum aspiration achieved by manual or electrical pump

*follow up of hCG is needed

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26
Q

What are the complications of abortion?

A

Retained products of conception
- prophylactic antibiotics
+/- surgical removal

Failure of abortion

Post abortion infection
- pre- STI screen/ prophylactic antibiotics

Trauma to genital tract

Psychological sequalae

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27
Q

What is the screening programme for cervical cancer?

A

25 - 64 years old.

  • 25 - 49: every 3 years
  • 50 - 64: every 5 years.

**liquid cytology is conducted

CIN 1 - observe

CIN 1 + High grade HPV - colposcopy

CIN >2 - referral for colposcopy

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28
Q

When is the best time to take a cervical smear?

A

Mid - menstrual cycle

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29
Q

What is the management of a woman with an abnormal smear?

A

*high grade HPV + Dyskarosis

Colposcopy 
\+ 
Acetic acid. 
\+/- 
Punch biopsy

Options are:

  • see and treat
  • punch biopsy and treat later
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30
Q

What is follow up after treatment of CIN?

A

Test of cure
- 6 month smear for HPV testing

if normal - discharge onto normal screening
if abnormal - refer back to colposcopy

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31
Q

Women post partum can be protected from pregnancy naturally depending on what? what is this called? and what is the criteria to make it effective?

A

Breast feeding exclusively protects from pregnancy.

Called: Lactational Amenorrhoea Method (LAM)

  • Exclusively breast feeding (>85%)
  • Amenorrhoeic
  • <6 months post- partum
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32
Q

After birth when is the mother at risk of becoming pregnant again?

A

21 days post partum

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33
Q

How long following an abortion will a urinary pregnancy test remain high for?

A

4 weeks

34
Q

Which cancer is the combined oral contraceptive pill protective against?

A

Endometrial and ovarian

35
Q

Where is the rod inserted into?

A

Non dominant arm - Sub dermally

1/3rd up.

36
Q

When starting the combined oral contraceptive, when in the cycle is a woman safe from pregnancy?

A

If started in the first 5 days of the cycle she is safe.

If started afterwards she will need to use barrier protection for 7 days

37
Q

What are the complications of IUCs?

A

Lost threads

Abnormal bleeding

Ectopic pregnancy

Actinomyces infection and PID

**PID infection true for first 20 days then returns to normal thereafter

38
Q

What are the contraindications to the COCP?

A

Previous VTE
Thrombophilia disease
BMI >35
Smokes >15 a day + >35 years old

Arterial disease

Migraine with aura

Breast cancer

Rifampicin use

39
Q

If the progesterone only pill is started after the 1st day of menstrual cycle, how long does it take to work? how to does this compare to the COCP?

A

2 days

COCP = 7 days

40
Q

At what age would you refer to social services for underage sex?

A

Under 13

41
Q

How long does contraceptive cover need to be given for women when menopausal?

A

<50 years and menopausal (over 1 year since last period)
- 2 years of contraception

> 50 years and menopausal
- 1 year of contraception

42
Q

How long does the implant work for, how does it work and what are some common side effects?

A

3 years.

Progesterone:

  • stops ovulation
  • thickens cervical mucus
  • thins lining of womb

Side effects:

  • no periods
  • irregular bleeding
  • unpredictable bleeding
43
Q

What is the injection that can be used and name some side effects:

A

Given every 13 weeks./ 3 months
Uses progesterone.

Side effects:

  • stop periods, irregular bleeding
  • weight gain
  • Osteoporosis
  • can take up to 1 year to start ovulating again
44
Q

Contrast the difference between the IUD copper device and the progesterone device:

A

Copper:

  • non- hormonal
  • can be used as emergency contraception
  • can cause heavier bleeds to begin with
  • last 5-10 years

Progesterone:

  • hormonal
  • lasts for 3-5 years
  • lighter and less painful periods
  • abnormal bleeding
45
Q

Other than the contraindications to the COCP what other factor must you consider when prescribing it?

A

RIsk of pregnancy
- contraindicated if pregnant

*hence why not used as emergency contraception

46
Q

HIghlight the differenceis between Fraser guidelines and Gillick’s compotence:

A

Frasers: concerned with contraception

Gillicks: concerned with treatment of any medical condition

47
Q

What are the aspects to Fraser’s guidelines?

A

Understanding

Parental involvement - encourage them to speak to parents

Sexual activity - is it going to occur even without contraception

Suffering - mental and physical well being suffer?

Interests - is it in their interest?

48
Q

Which act governs abortion in the UK mainland, and what is needed for an abortion to take place?

A

1967 abortion act

*need 2 doctors to sign it off and to be on the medical grounds for the patient

49
Q

Which act limits the abortion to 24 weeks? and what are some caveats to this?

A

The human fertilisation and embryology Act 1990

abortion can take place later if there is:

  • serious deformity
  • life threatening risk to mother
50
Q

Do partners of the pregnant women have any legal rights over the abortion?

A

no.

51
Q

How many women by the age of 45 have had an abortion?

A

1 in 3

52
Q

In scotland what are the time frames for an abortion?

A

Medical up to 18 weeks

  • home (< 10weeks)
  • > 10 weeks inpatient

Surgical up to 13 weeks

If >18 weeks then need to be referred to England via British Pregnancy Advisory Service (BPAS)

53
Q

Highlight the medical procedure of abortion:

A
  • Mifepristone - progesterone antagonist
    followed 24-48 hours by
  • Misoprostol - to promote uterine expulsion
    *starts within 2-3 hours
    *painful
    *completed within 24 hours
54
Q

What things need to be considered other than gestational age in an abortion?

A

Contraception
- needed 5 days following procedure

Antibiotics?

Anti D prophylaxis - if mother Rh - and:
- < 10 weeks medical not needed
> 10 weeks medical needed
Surgical

Cervical screening

STI screening

Gender based violence

55
Q

List some abortion complications and their management:

A

Failure to end pregnancy

Retained products of conception

  • additional dose of misoprostol
  • surgical wash out

Infection / endometritis
- broad spectrum Abx +/- Sepsis 6 if septic

Uterine perforation
- laparotomy/ laparoscopy procedure

Cervical tear

**these can account for symptoms of bleeding, abdo pain etc following an abortion and must be investigated for.

56
Q

What are some contraindications to medical abortion? and surgical abortion?

A 
Medical: 
Corticosteroid use 
Adrenal disease 
Hypertension 
High Cholesterol
Sickle cell

Surgical:
BMI 40
BMI 35 + comorbidities
Anaesthesia

57
Q

What is the major side effect of the intrauterine copper device?

A

Heavy bleeding with cramping

58
Q

What are the antibody screening tests for syphilis and how does it relate to treatment?

A

Group specific antigens

  • TPHA (Treponema pallidum haemagglutinin antigen)
  • remains positive even after treatment

Non-specific antigens

  • VDRL
  • RPR
  • changes to negative following treatment
59
Q

How long following insertion of a IUS or rod is protection effective?

A

7 days

60
Q

How would you advise someone who missed taken their COCP?

A

If one pill has been missed then:
- take the missed pill immediately, even if it means taking two pills in one day

If more than one pill has been missed then:
- Take the last missed pill immediately, even if it means taking two pills in one day
+
Barrier protection for 7 days

*if she had unprotected sex during the first 1-7 days of the cycle and missed more than 1 pill then Emergancy contraception is also needed.

61
Q

What would you advise if someone misses their POP?

A

Out with 3 hours of normally taking it.

Take the missed pill immediately, even if it means taken 2 in one day.
+
Barrier protection for 48 hours
+/-
Emergancy contraception if she had unprotected sex in that time

62
Q

What is the progesterone only injection known as and how is provided?

A

DMPA

Sub cut
or
IM

63
Q

What are the two unique side effects to progesterone injection?

A

Weight gain

Osteoporosis

Long time to recovery of normal cycle

64
Q

What is the contraindication to the progesterone implant and injection?

A

Active breast cancer

65
Q

What tests / should be done in women prior to implanting the coil?

A

Tests:
- STI screen in those at risk

BP and HR monitored before and after

Examination:
- bimanual examination to assess for the position of the uterus

66
Q

What advice should be given to females prior to removal of coils?

A

Refrain from sex or use condoms for least 7 days prior#

*due to the risk of ectopic

67
Q

What disease is the copper IUD contraindicated in?

A

Wilson’s disease

68
Q

What things need to be considered when giving the emergency contraception?

A

BMI of patient
Malabsorption (including D&V)
Enzyme inducers/ inhibitors

69
Q

If you have to give ulipristal acetate as Emergancy contraception how long should you wait before restarting COCP or POP?

A

5 days

70
Q

What contraception is considered safe during breast feeding?

A

POP

Rod

Copper coil

IUD

*all except oestrogen

71
Q

If levongestrol is taken and the patient vomits within 3 hours what should she do?

A

Take a second dose

- if vomiting within 3 hours

72
Q

When is COCP contraindicated following pregnancy?

A

< 6 weeks postpartum

73
Q

What are some of the relative and absolute contraindications to the COCP?

A

UKMEC3 (relative)

  • > 35 years old and smoking <15 cigarettes
  • Controlled HTN
  • family history of DVTs
  • Immobile (wheelchair use)
  • BRCA1/ BRCA2 mutation

UKMEC 4 (absolute)

  • > 35 years old and smoking >15 cigarettes
  • Migraine with aura
  • DVTs
  • Breast cancer
  • Ischemic heart disease
  • Major surgery with immbolity
  • Postpatum <6 weeks
  • Breast feeding
74
Q

What advice should be given to females starting the pill?

A

Hypertension
- need regular BP monitoring

DVT advice
- to seek immediate help if they haves symptoms of DVT

If they develop migraines to seek help

D&V
- may need additional cover due to lack of absorption

Missed pill advice

Drug interactions which may reduce efficacy of the pill:

  • St John’s wort
  • Ridampicin
  • Anti-epileptics - phenytoin

Doesn’t protect against STIs

75
Q

What are some advantages and disadvantages of the COCP?

A

Advantages;

  • Effective 99%
  • Easy to use
  • Reduced risk of ovarian and endometrial cancer
  • Doesn’t interfere with sex

Disadvantages:

  • Increased risk of cervical and breast cancer
  • Increased risk of stroke
  • increased risk of heart disease
  • Temporary side effects N&V, breast tenderness
76
Q

What advice can be given for those trying to conceive?

A

Optimise BMI

Regular vaginal sex

Stop smoking

Don’t try and time with ovulation
- causes unwanted stress

77
Q

Which drug can cause ovarian hyperstimulation and what are the symptoms?

A

Clomiphene
and
GnRH

N&V
Abdominal pain (follicular cyst formation)
Ascites
Pleural effusions

78
Q

How can pre-menstrual syndrome be treated?

A

Lifestyle
New- generation COCP
SSRIs if severe

79
Q

What test can be conducted to assess ovarian reserve?

A

Anti- Mullerian Hormone

80
Q

When testing someone for an STI - what other infections are routinely investigated for as well?

A

Chlamydia

Gonorrhoea

Syphilis

HIV

Hep B

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