Sexual Health Flashcards
When should antiretroviral treatment be offered for HIV patients?
As soon as they are diagnosed!
There is no level of CD4 count correlating to when treatment should be offered.
When is a test of cure recommended for chlamydia infection?
- pregnancy
- suspected poor compliance
- persistent symptoms after treatment
Which is the only criterion with a complete contraindication to use of the progesterone implant?
current breast cancer
When can sildenafil (a PED5 inhibitor) be offered for erectile dysfunction in a patient post MI?
6 months post MI if now stable
note the SHIM assessment can be useful for patients presenting with ED-sexual health inventory for men
Recommended treatment for chlamydia infection?
100mg PO Doxycycline BD for 7/7
NOT IN PREGNANCY
What potential serious complication limits use of dianette (co-cyprindiol) for only severe cases of acne?
liver tumours
also high risk of VTE
AIDs defining CD4 count?
<200
Treatment for bacterial vaginosis?
if symptomatic offer metronidazole PO 400mg BD for 5-7/7, can give single 2g PO dose if adherence an issue (note higher risk of recurrence)
alternatives: intravaginal metronidazole gel or clindamycin cream
above can be used if symptomatic in pregnancy apart from high dose PO metronidazole, d/w obstetrician if pt asymptomatic
Treatment for trichomonas vaginalis?
metronidazole-400-500mg PO BD for 5-7/7 OR single 2g dose of PO metronidazole or tinidazole-high dose NOT to be used in pregnancy/breast feeding
if HIV +ve, 500mg BD for 5-7/7 recommended
treat partners and r/f to GUM for STIs
clotrimazole pessary can be used in pregnancy to treat sx NOT infection if metronidazole declined
Treatment for a recurrence of genital herpes?
aciclovir 800mg TDS for 2/7
When should prophylactic aciclovir be considered for genital herpes?
- if at least 6 episodes of genital herpes in a year
- or if particularly distressing infections
Suppressive treatment=aciclovir 400mg BD-usually for 1 year and then review
When should aciclovir suppressive treatment be offered in pregnant patients with know herpes?
from 36 weeks-PO aciclovir 400mg TDS may prevent HSV lesions at term
Treatment of gonorrohea infection?
1g IM Ceftriaxone-usually would not initiate this in primary care as patients requires to be seen in GUM due to high rates of resistance
if antibiotic susceptibility known prior to tx can treat with 500mg PO ciprofloxacin STAT.
alternative-cefixime plus azithromycin
When can the Cu coil be inserted for emergency contraception?
Within 5 days of earliest ovulation date or within 5 days since earliest date of UPSI in that cycle, whichever is latest.
How long should sex be avoided for after tx of chlamydia with azithromycin?
sex should be avoided until after patient and their partner have completed treatment, and for 7 days after treatment with azithromycin (or until any sexual partners have completed their treatment)
Chlamydia treatment for women who are pregnant or breastfeeding?
Azithromycin 1g daily for 1 day then 500mg daily for 2 days OR
Amoxicillin 500mg TDS for 7/7 OR
Erythromycin 500mg QDS for 7/7
1st line Abx treatment for PID?
-Ceftriaxone 1g IM single dose, then 14/7 of PO doxycycline 100mg BD and PO metronidazole 400mg BD for 2 weeks (preferred regime if high risk of gonococcal infection e.g. severe sx/recent travel abroad with sex contact)
OR
-PO ofloxacin 400mg BD and PO metronidazole 400mg BD for 2 weeks.
ensure review within 72 hrs and after 2-4 weeks
Abx tx for PID if initial test for mycoplasma genitalium is positive?
PO moxifloxacin 400mg OD for 2 weeks
Who should be contacted as part of contact tracing of women with PID?
current sexual partner and other sexual partners from last 6 months
Contraindications to phsophodiesterase-5 inhibitor tx for erectile dysfunction?
coprescription of a nitrate
if sexual activity not advisable for pt
hx of non-arteritic optic neuropathy
retinal degeneration
severe hepatic disorders
end stage renal disease on dialysis (only for vardenafil)
heart failure
uncontrolled HTN/arrhythmia (tardalafil only)
use of indinavir/ketoconazole/itraconazole in pts over age of 75 (vardenafil only)
NICE guidance on rpt testing for chlamydia after treatment?
all patients under age of 25 should be offered rpt chlamydia testing 3-6months after completion of tx to check for re-infection
When to offer a test of cure after tx of gonorrhoea?
to ALL patients after tx of gonorrhoea
if asymptomatic test at least 2/52 after tx-NAAT
if sx persist, test with culture at least 3/7 after completing tx, may test again with NAAT after 1/52 if culture negative
Tx of first infection with genital herpes?
PO aciclovir 400mg TDS for 5-10/7 OR PO aciclovir 200mg 5 times a day for 5-10/7
treat for 5/7 in 1st and 2nd and 3rd trimester of pregnancy, but in 3rd may need C section if within 6/52 of due delivery date
valaciclovir and famciclovir are alternatives
clean with salt water
can use vaseline or topical anaesthetic
1st line tx of syphilis?
IM benzathine penicllin (and procaine penicllin)
note unlicensed in UK and not readily available for use in primary care
if suspect syphilis in primary care-r/f to GUM!
Additional precautions for a women with an implant who is started on liver enzyme-inducing medication?
additional contraception required during treatment and for 1 month afterwards
*note liver enzyme inducing medication does NOT affect efficacy of the progestogen injection or mirena but does affect efficacy of POP
Advice for person on COCP who has missed taking the pill for 48hours or more?
barrier contraception should be used until 7 consecutive active pills have been taken
consider emergency contraception if pills missed in the 1st week and pt had UPSI in last 7 days
if fewer than 7 pills left in the pack after missing more than 1 pill may need to start next pack without a break
Management of missed POP?
take missed pill as soon as remember and adopt usual pill taking regime
if pill more than 3 hrs late (or 12 hrs with desogestrel), additional contraception needed for next 2 days
consider need for EC if UPSI after missing the pill or within 48 hours of restarting it
What is recommended as defining an area as having a high prevalence of HIV?
if 2 or more/1000 of the population aged 15-59 have HIV-people should be offered a test each time they register with a GP and if having a blood test for another reason and not had a HIV test in the last 1 year
extremely high prevalence=5 or more per 1000 population-consider testing opportunistically at every consultation
When is PCP prophylaxis given to a patient with HIV?
co-trimoxazole should be given if CD4 count <200
When can the progesterone only injection be given after childbirth?
any time!
When should PO aciclovir be offered to pregnant women with chickenpox?
if woman presents within 24hrs of onset of rash and she has reached 20 weeks of gestation
note in general practice specialist advice should be sort if pregnant woman develops chickenpox
Management of woman not immune to chickenpox who is exposed in pregnancy and is 20 weeks gestation or less?
VZIG-effective up to 10 days post exposure
if>20wks gestation either VZIG or antivirals should be given 7-14 days after exposure
Tx of urethritis if mycoplasma genitalium proven?
doxy followed by azithromycin
to avoid sex for 14 days from start of tx and until sx have resolved
From what age is there a clearer association between the COCP and breast cancer risk?
over the age of 35
Presenting features of chancroid?
painful genital ulcer with ragged, undermined border and unilateral painful inguinal LN enlargement in patient with hx of foreign travel
caused by haemophilus ducreyi
Average age that puberty starts in boys?
12 years (11 years for girls-breast development) 1st sign in boys-testicular growth
Management of recurrent vulvovaginal candidiasis in females?
(4 or more episodes per year with at least partial resolution of sx between episodes)
-PO fluconazole 150mg 3 doses each given 3 days apart as induction OR intravaginal antifungal for 10-14 days, then tx as required e.g. PO fluconazole 150mg once a week if sx occur or once weekly maintenance for 6 months.
Management of vulvovaginal thrush in pregnancy?
7/7 of intravaginal clotrimazole or miconazole
