sexual health and contraception Flashcards
cause bacterial vaginosis
normal vaginal flora is disturbed, leading to a reduction in the numbers oflactobacillibacteria in the vagina, allowing growth of other microorganisms e.g. Gardnerella vaginalis,anaerobes and mycoplasmas. NOT AN STI
features BV
Offensive fishy smelling vaginal discharge, Not usually associated with soreness, itching or irritation, Thin, white/grey, homogenous vaginal discharge
mx BV
Metronidazole. This can be taken orally (400mg twice daily for 5-7 days, or a single dose of 2g) or as a gel applied directly to the vagina
cause of thrush
Candida albicans. This particular yeast-like fungus. NOT AN STI
featurs thrush
Itch, diacharge - white, curd-like and non-offensive, dysuria
mx thrush
intravaginal antifungal - clotrimazole or fenticonazole, Oral antifungal -fluconazole
cause trichomoniasis
protozoan - Trichomonas vaginalis
presentation trichomoniasis
F: Offensive vaginal odour, Abnormal vaginal discharge – thick/thin/frothy and yellow-green, Itchiness or soreness of the vulva, Dyspareunia, Dysuria, strawberry cervix
M: Urethral discharge, Dysuria,Urinary frequency,pain or itching around the foreskin
mx trichomoniasis
Metronidazole 2g orally in a single dose or
Metronidazole 400-500mg twice daily for 5-7 day
cause chlamydia
Bacterium:Chlamydia trachomatis - obligate intracellular gram negative bacterium
presentation chlamydia
F: dysuria, yellow/green vaginal discharge, Intermenstrual or postcoital bleeding, Deep dyspareunia, Lower abdominal pain
M: Urethritis (Dysuria, Urethral discharge),
Epididymo-orchitis (Testicular pain)
mx chlamydia
Doxycycline100mg twice daily for 7 days or
Azithromycin1g single dose
If CI: Erythromycin500mg twice daily for 10- 14days
cause gonorrhoea
Neisseria gonorrhoeae - Gram-negative diplococcus
presentation gonorrhoea
F: Altered/increased vaginal discharge (commonly thin, watery, green or yellow), Dysuria, Dyspareunia
Lower abdominal pain
M: Mucopurulent/purulent urethral discharge, Dysuria
mx gonorrhoea
intramuscularceftriaxone 1g
cause HIV
HIV is asingle strandedRNA retrovirus that infects and replicates with CD4 cells
presentation HIV
- Seroconversion Illness (flu – like)
- Symptomatic HIV (Weight loss, High temperatures, Diarrhoea, Frequent minor opportunistic infections, e.g. herpes zoster or candidiasis)
- AIDS defining illnesses (pnuemocystis jiroveci pneumonia, non-Hodgkin’slymphoma, and TB)
mx HIV
Highly active antiretroviral therapy(HAART) – combination of drugs
cause pubic lice
Phthirus pubis
presentation pubic lice
Intense itching
mx pubic lice
Insecticide (permethrin or malathion), wash clothes and bedding
reducing the risk of HIV transmission in pregnancy to baby
Antenatal antiretroviral therapyduring pregnancy and delivery
Avoidance of breastfeeding
Neonatal post-exposure prophylaxis
if followed and undetectable viral load CS not needed
cause of genital warts
HPV 6 and 11
presentation genital warts
warts affecting the penis, scrotum, vulva, inside the vagina, cervix, perianal skin or inside the anus. Usually painless, fleshy growths, soft or hard and can be singular or multiple. Occasionally warts may cause irritation or become inflamed
mx genital warts
Topical: Podophyllotoxin (small warts), Imiquimod (larger, partly keratinised)
Physical ablation: excision, cryotherapy
cause genital herpes
HSV 1 and 2
presentation genital herpes
Primary infection: Small red blistersaround the genitals that are very painful and can form open sores, Vaginal or peniledischarge, Flu-like symptoms, Itchy genitals
Secondary/recurrent: burninganditchingaround the genitals, Painful red blistersaround the genitals
mx genitala herpes
Primary infection =acyclovir
Secondary= painkillers,petroleum jellyandice packs, episodic acyclovir (when sx start)
cause syphilis
pirochete gram-negative bacterium-Treponema pallidum subspecies pallidum
presentation syphilis
Primary: papule will ulcerate into chancre (painless ulcer)
Secondary: rash, fever, wt loss, arthralgia, lymphadenopathy
Tertiary: gummatous, neurosyphilis, cardiovascular
mx syphilis
Early syphilis: Benzathine penicillin 2.4 MU IM single dose.
Late syphilis: Benzathine penicillin 2.4 MU IM 3 doses at weekly intervals
cause balanitis
Vary - candidiasis, dermatitis, bacteria
presentation balanitis
inflammation of the glans penis
cause chancroid
tropical disease - Haemophilus ducreyi
presentation chancroid
painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border.
mx chancroid
Azithromycin1 gm orally in a single dose OR Ceftriaxone250 mg IM in a single dose OR Ciprofloxacin500 mg orally 2 times/day for 3 daysOR
Erythromycinbase 500 mg orally 3 times/day for 7 days
cause lymphogranuloma venerum
Chlamydia trachomati
presentation lymphogranuloma venerum
Stage 1: small painless pustule which later forms an ulcer
stage 2: painful inguinal lymphadenopathy
stage 3: proctocolitis
mx lymphogranuloma venerum
doxycycline.
Jarisch Herxheimer reaction
with syphilis: an inflammatory response secondary to death of treponemes, and results in a flu-like illness within 24 hours of treatment. Supportive measures are all that is required, unless a patient has cardiovascular or neurosyphilis, in which case oral steroids should be administered prior to antibiotics to reduce the risk of an acute localised inflammatory reaction
hypoactive sexual desire disorder
Lack or loss of sexual desire, Absent/deficient sexual and erotic thoughts
causes hypoactive sexual desire disorder
Chronic medical conditions – obesity, CVD, DM, anaemia. Hormonal disorders – androgen deficiency, hypothyroidism, hyperprolactinaemia, Addison’s disease. Post-pregnancy. Medications – OCP, oral HRT, tamoxifen, anti-depressants, anti-psychotics, beta blockers. Post-surgery – bilateral oopherectomy. Psychological problems – depression, anxiety, body image disorder, life/work stressors, history of abuse, relationship problems
mx hypoactive sexuaal desire disorder
therapy, testosterone in M
causes erectile dysfunction
Chronic medical conditions – CVS, DM, neurological disease. Hormonal disorders – androgen deficiency, hyperprolactinaemia. Iatrogenic – post prostate surgery, prescribed medications (antihypertensives, SSRIs). Age. Ineffective sexual stimuli. Pain. Veno-occlusive disorder. ED can be an early sign of CVD and diabetes
mx erectile dysfunction
sildenafil (viagra), tadalafil, intracavernosal injection, stimulating routines, therapy
vaginismus
Spasm of the pelvic floor muscles that surround the vagina
paraphilia
disorder of sexual preference
SE of hormone therapy fpr gender transition
Increased risk of thrombosis
Causes infertility – so important to council the person about storing their eggs/sperm before this happens (not available on NHS)
Hormone therapy can cause weight gain (important to address this plus other cardiovascular RF)
how long live in gender role before hormone therapy
2y
CI to combined hormonal contraception
BMI greater than 35, Breast feeding, Smoking over the age of 35, Hypertension, History of or family history of venous thromboembolisms, Prolonged immobility due to surgery or disability, Diabetes mellitus with complications e.g. retinopathy, History of migraines with aura, Breast cancer or primary liver tumours
which contraceptive linked to osteoporosis
depo injection
MOA combined hormonal contraception
primarily toinhibit ovulation, progesterone also acts to inhibit proliferation of the endometrium, and increases the thickness of cervical mucus
MOA POP
Primarily tothicken the cervical mucus, also inhibits ovulation and thins cervical mucous
MOA progesterone implant
inhibit ovulation and also thicken cervical mucous and thin endometrium
MOA depo injection
inhibition of ovulationand thethickening of cervical mucus.
MOA IUD
Unfavourable environment and inhibiting implantation
MOA IUS
It thins the endometrium, and thickens cervical mucus
contrwception with no user failure
injection
implant
iud
ius
sterilisation
contraceptive injection
progesterone
lasts 8-13w
takes a while to regain fertility
implant
under skin in arm that releases progesterone
lasts 3y
IUS
progesterone releasing
works for 3-5y
lighter and shorter and less painful periods, maybe irregular bleeding
IUD
copper
can last 5-10y
may have heavier or more painful periods
contraceptive methods with user failure
patch, ring, COCP, POP, condom, diaphragm, family plnning
contraceptoive patch
on skin and releases oestrogen and progesterone
can make bleeds lighter
contraceptive vaginal ring
releases oestrogen and progesterone
1 ring stays in for 3w - self insert
COCP
oestrogen and progesterone
reduces bleeding and pain
POP
progesterone only
condoms
protect against STIs
diaphragm with spermicide contraceptove
put in before sex
need right size
emergency hormonal contracpetion
Levonorgestrel (marketed as Levonelle One Step): Licensed for use within 72 hours of unprotected sex.
Ulipristal acetate(EllaOne): Licensed for use within 120 hours of unprotected sex.
The Intrauterine Device: must be inserted within5 daysof unprotected sex
CI ulipristal acetate
Diseases of malabsorption e.g. Crohn’s, Hypersensitivity to Ulipristal Acetate, Severe hepatic dysfunction, Enzyme inducing drugs e.g. rifampicin, Breast feeding –avoid breastfeeding for 7 days after taking UPA, Asthma insufficiently controlled by corticosteroids, Drugs increasing gastric pH e.g. omeprazole, ranitidine
CI copper IUD
Uterine fibroids with distortion of the uterine cavity, Documented or suspected pelvic inflammatory disease (PID), Documented or suspected STI (especially chlamydia or gonorrhoea)
