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part 2 > SRH > Flashcards

SRH Flashcards

1
Q

asymptomatic STI screening women

A

vulvovagina +/- anal swab for chlamydia and gonorrhea NAAT;

Blood test - HIV, syphilis

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2
Q

asymptomatic STI screening for hetero man

A

first catch urine: chlamydia/gonorrhea NAAT

Blood test - HIV, syphilis

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3
Q

asymptomatic STI screening for MSM

A

first catch urine: chlamydia/gonorrhea NAAT
Blood test - HIV, syphilis
rectal+throat swab NAAT
HBV/HCV

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4
Q

testing window period for NAAT

A

2/52

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5
Q

testing window period for HIV

A

4/52

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6
Q

testing window period for syphilis

A

3/12

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7
Q

testing window period for hepatitis

A

6/12

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8
Q

what % will develop PID after untreated chlamydia

A

10% within 12 month

untreated, 50% will clear spontaneously

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9
Q

Rx for chlamydia

A

Doxycycline 100mg BD x 7/7

or
Azithromycin 1g PO then 500mg OD x 2/7

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10
Q

Rx for chlamydia in pregnancy

A 
azithromycin 1g then 500mg x 2/7
or
erythromycin 500mg QDS x 7/7(or BD x 14/7)
or
amoxicillin 500mg TDS x 7/7
\+ test of cure after 3/12
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11
Q

advice for chlamydia treatment

A

full STI screen,
Sexual partners screened within 6/12,
avoid sex x7/7

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12
Q

% coinfection gonorrhea/chlamydia

A

40%

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13
Q

% ophthalmia neonatum after exposure to gonorrhea

A

50%

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14
Q

Rx for gonorrhea

A

ciprofloxacin 500mg PO if sensitive
Ceftriaxone 1g IM stat if unknown

test of cure required 1-2 weeks post treatment

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15
Q

causes of urethritis and cervicitis

A

chlamydia, gonorrhea, mycoplasma

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16
Q

causes of vaginal discharge

A

trichomonas, BV, VVC

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17
Q

causes of genital ulceration

A

herpes, syphilis

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18
Q

% of partners co-infected with chlamydia

A

75%

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19
Q

% of chlamydia that will resolve untreated

A

50%

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20
Q

% of chlamydia pts that will also have mycoplasma coinfection

A

3-15%

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21
Q

chlamydia neonatal transmission rate

A

25%

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22
Q

gonorrhea morphology

A

gram negative diplococcus

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23
Q

gonorrhea: what % of women are symptomatic?

A

<50%

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24
Q

gonorrhea partner notification

A

all contacts within preceding 3 months, at least 14 days after exposure should be screened with NAATs

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25
Q

trichomonas morphology

A

flagellated protozoan

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26
Q

trichomonas: what % of women are asymtpomatic

A

10-50%

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27
Q

trichomonas: most common site of infection

A

urethra (90%)

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28
Q

trichomonas: risk of transfer perinatally

A

5%

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29
Q

trichomonas rx

A

metronidazole 2g PO stat, or 400mg BD x 5-7/7

alternative tinidazole 2g PO stat

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30
Q

trichomonas treatment advice

A

sexual partners screened and treated
abstinence advised until treatment completed
full STI screen
Test of cure only if was asymptomatic

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31
Q

prevalence of BV

A

50% of women - most common cause of abnormal vaginal discharge

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32
Q

BV organisms

A

gardnerella, mycoplasma, prevotella

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33
Q

normal vaginal pH

A

<4.5

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34
Q

BV in pregnancy associated with

A

late miscarriage
PTL
PPROM
postpartum endometritis

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35
Q

amsels criteria for BV:

A

3 of 4 of:

1) thin, white homogenous discharge
2) clue cells on wet mount
3) pH >4.5
4) fishy odour with KOH added

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36
Q

BV rx PO regimens

A

Metronidazole 2g stat of 400mg BD x 5-7/7

Tinidazole 2g stat

Clindamycin 300mg BD x 7/7

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37
Q

BV rx PV regimens

A

metronidazole 0.75% gel PV OD x 5/7

clindamycin 2% cream PV OD x 7/7

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38
Q

recurrent or persistent BV

A

may require up to 6/12 of topical metronidazole

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39
Q

VVC: what % of women are asymptomatic

A

10-20%

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40
Q

recurrent candida criteria

A

> 4 episodes in 1 year with at least 2 confirmed by microscopy or culture

<5% of women, usually with underlying systemic illness or frequent ABX use

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41
Q

recurrent candida Rx

A

fluconazole 150mg q72h x 3, then 150mg weekly for 6/12

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42
Q

aciclovir dosing for HSV

A

400mg TDS, or 200mg 5/day, x 5/7

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43
Q

valaciclovir dosing for HSV

A

500mg BD x 5/7

44
Q

famciclovir dosing for HSV

A

250mg TDS x 5/7

45
Q

partner transmission rate for syphillis

A

10-60%

46
Q

codylomata lata

A

warty lesions on moist areas
SECONDARY SYPHILIS
occurs 6-12 weeks after infection

47
Q

partner notification for syphilis

A 
primary = 3 months,
secondary = 2 years
48
Q

Rx for early syphilis

A

benzathine penicilin G 2.4MU IM stat

49
Q

Rx for early syphilis in pregnancy

A

same: benzathine penicillin G 2.4 MU IM stat,
but in 3rd trimester repeat on day 8

alternative, ceftriaxone 500mg IM OD x 10/7

50
Q

fetal loss in syphilis

A

30-40%

51
Q

neonatal transmission rates for syphilis

A

100% primary;
40% early
10% late latent

52
Q

% of neonates developing congenital syphilis after in utero infection

A

33%

53
Q

% of babies with congenital syphilis who are asymptomatic at birth

A

66%

–> two thirds will develop signs and symptoms within 8 weeks –> most present by 12 weeks

54
Q

vasomotor symptoms rx

A

offer HRT - estrogen and progesterone (with uterus), or estrogen alone (without uterus).

do not offer SSRIs, SNIRs, or clonidine as 1st line.

55
Q

menopause - psychological symptoms rx

A

consider HRT or CBT.

SSRI or SNRI - no clear evidence

56
Q

menopause - altered sexual function rx

A

consider testosterone supplementation if HRT alone not effective.
ensure urogenital tissues are adequately estrogenized.

57
Q

menopause - urogenital atrophy rx

A

offer vaginal estrogen, moisturizes and lubricants can be used as adjuncts

58
Q

menopause rx review

A

at 3 months to assess efficacy and tolerability; annually thereafter

59
Q

vaginal estrogen regimen

A

used nightly for 2 weeks and then twice weekly, can be continued long term

60
Q

risk of DVT/PE with HRT

A

2-3x background risk; greatest risk in first 12 months

61
Q

risk of breast cancer with HRT

A

after 5 years, over age of 50, additional 3-4 cases per 1000 women.

risk associated with estrogen alone is very much less.

62
Q

incidence of herpes in pregnancy

A

1.65-3.3/100 000

63
Q

M/M of local HSV CNS neonatal disease

A

mortality 6%

morbidity 70%

64
Q

M/M of disseminated HSV neonatal disease

A

mortality 30%

morbidity 17%

65
Q

empirical Rx for first or second trimester primary HSV

A

aciclovir 400mg PO tds x 5/7
suppresion aciclovir 400mg TDS for 36/40
Vaginal delivery if not <6/52

(refer to GUM for confirmation by PCR)

66
Q

Rx for primary HSV in third trimester

A

aciclovir 400mg PO TDS x 5/7
suppression 400mg TDS
C/S

67
Q

risk of neonatal transmission HSV in third trimester first episode

A

41% with SVD

68
Q

risk of neonatal herpes with recurrent genital lesions

A

0-3%

69
Q

rx recurrent genital herpes

A

aciclovir 400mg TDS from 36/40 for suppression

70
Q

rx for primary HSV at time of labour

A

if decides to proceed with labour, intraprtum aciclovir 5mg/kg 8 hrs

71
Q

PPROM primary HSV

A

MDT + C/S + IV aciclovir with expectant management

72
Q

PPROM recurrent HSV

A

if <34/40, expectant management with PO aciclovir 400mg TDS

73
Q

women presenting with first episode of genital herpes in third trimester, what tests to do

A

type specific HSV antibody testing (IgG to HSV1 and 2)

74
Q

% of neonatal HSV cases acquired postnatally

A

25%

75
Q

% of PID that is polymicrobial

A

30-40%

76
Q

lifetime prevalence of PID

A

1.7%

77
Q

PPV fo clinical diagnosis of PID

A

65-90%

78
Q

NPV of absence of endocx or vaginal pus, for PID

A

95%

79
Q

% of CT that progresses to PID

A

10%

80
Q

how often does cervical motion tenderness occur in appendicitis

A

25%

81
Q

how often does N/V occur in PID

A

50%

82
Q

OPD Rx for PID, first line - 1

A

IM ceftriaxone 500mg PO stat + PO doxycycline 100mg BD + PO metronidazole 400mg BD x 14/7

83
Q

OPD Rx for PID, first line - 2

A

PO ofloxacin 400mg BD + metronidazole 400mg BD x 14/7

84
Q

OPD Rx for PID, first line - 3

A

PO moxifloxacin 400mg OD x 14/7

85
Q

which abx for PID should be avoided in pts who are at high risk of gonococcal PID

A

ofloxacin and moxifloxacin

86
Q

which abx for PID provides the highest microbiological activity against M genitalum

A

moxifloxacin

87
Q

quinolones side effects

A

tenson, muscles, joing, nervous system

88
Q

OPD Rx for PID, second line /alternative regimens

A

IM ceftriaxone 1g stat + PO azytirhomycin 1g/week for 2 weeks

89
Q

INPT Rx for PID, first line - 1

A

IV ceftriaxone 2g OD + IV/PO doxycyline 100mg BD,

followed by:
PO doxycyline 100mg BD and PO metronidazole 400mg BD x 14/7

90
Q

INPT Rx for PID, first line -2

A

IV clindamycin 900mg TDS, + IV gentamicin 2mg/kg loading dose then 1.5mg/kg TDS

followed by:
PO clindamycin 450mg QDS to complete 14 days or PO doxycycline 100mg BD to complete 14 days, + PO metronidazole

91
Q

f/u for PID

A

at 72h, then 2-4 weeks

92
Q

incidence of tubal factor infertility following PID

A

20%

93
Q

incidence of ectopic pregnancy following PID

A

10%

94
Q

incidence of chronic pelvic pain following PID

A

20%

95
Q

when to consider surgical management for TOA

A

if >8 cm, if no response to medical treatment 24-48h, if deterioration

96
Q

success rate for medical rx of TOA

A

<70%, but increased recurrence

97
Q

rx for actinomyces

A

penicillin

98
Q

risk of pregnancy after vaginal rape

A

5%

99
Q

assault, DNA collection timeframes

A

7 days vaginal,
3 days anal,
2 days oral

100
Q

assault, toxicology screens

A

3 days blood,

14 days urine

101
Q

when contraception can be stopped for women >55

A

anytime

102
Q

when contraception can be stopped for women 50-55yo, if taking hormonal contraception

A

after two FSH levels >30 taken at least 6 weeks apart

103
Q

when contraception can be stopped for women 50-55, not taking hormonal contraception

A

1 year after LMP

104
Q

when can contraception be stopped for women <50yo

A

2 years after LMP

105
Q

recurrent UTI in postmenopausal women

A

20% because of atrophy of urothelium due to estrogen deficiency

part 2 (21 decks)

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