SRH Flashcards
asymptomatic STI screening women
vulvovagina +/- anal swab for chlamydia and gonorrhea NAAT;
Blood test - HIV, syphilis
asymptomatic STI screening for hetero man
first catch urine: chlamydia/gonorrhea NAAT
Blood test - HIV, syphilis
asymptomatic STI screening for MSM
first catch urine: chlamydia/gonorrhea NAAT
Blood test - HIV, syphilis
rectal+throat swab NAAT
HBV/HCV
testing window period for NAAT
2/52
testing window period for HIV
4/52
testing window period for syphilis
3/12
testing window period for hepatitis
6/12
what % will develop PID after untreated chlamydia
10% within 12 month
untreated, 50% will clear spontaneously
Rx for chlamydia
Doxycycline 100mg BD x 7/7
or
Azithromycin 1g PO then 500mg OD x 2/7
Rx for chlamydia in pregnancy
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
advice for chlamydia treatment
full STI screen,
Sexual partners screened within 6/12,
avoid sex x7/7
% coinfection gonorrhea/chlamydia
40%
% ophthalmia neonatum after exposure to gonorrhea
50%
Rx for gonorrhea
ciprofloxacin 500mg PO if sensitive
Ceftriaxone 1g IM stat if unknown
test of cure required 1-2 weeks post treatment
causes of urethritis and cervicitis
chlamydia, gonorrhea, mycoplasma
causes of vaginal discharge
trichomonas, BV, VVC
causes of genital ulceration
herpes, syphilis
% of partners co-infected with chlamydia
75%
% of chlamydia that will resolve untreated
50%
% of chlamydia pts that will also have mycoplasma coinfection
3-15%
chlamydia neonatal transmission rate
25%
gonorrhea morphology
gram negative diplococcus
gonorrhea: what % of women are symptomatic?
<50%
gonorrhea partner notification
all contacts within preceding 3 months, at least 14 days after exposure should be screened with NAATs
trichomonas morphology
flagellated protozoan
trichomonas: what % of women are asymtpomatic
10-50%
trichomonas: most common site of infection
urethra (90%)
trichomonas: risk of transfer perinatally
5%
trichomonas rx
metronidazole 2g PO stat, or 400mg BD x 5-7/7
alternative tinidazole 2g PO stat
trichomonas treatment advice
sexual partners screened and treated
abstinence advised until treatment completed
full STI screen
Test of cure only if was asymptomatic
prevalence of BV
50% of women - most common cause of abnormal vaginal discharge
BV organisms
gardnerella, mycoplasma, prevotella
normal vaginal pH
<4.5
BV in pregnancy associated with
late miscarriage
PTL
PPROM
postpartum endometritis
amsels criteria for BV:
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
BV rx PO regimens
Metronidazole 2g stat of 400mg BD x 5-7/7
Tinidazole 2g stat
Clindamycin 300mg BD x 7/7
BV rx PV regimens
metronidazole 0.75% gel PV OD x 5/7
clindamycin 2% cream PV OD x 7/7
recurrent or persistent BV
may require up to 6/12 of topical metronidazole
VVC: what % of women are asymptomatic
10-20%
recurrent candida criteria
> 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
recurrent candida Rx
fluconazole 150mg q72h x 3, then 150mg weekly for 6/12
aciclovir dosing for HSV
400mg TDS, or 200mg 5/day, x 5/7
valaciclovir dosing for HSV
500mg BD x 5/7
famciclovir dosing for HSV
250mg TDS x 5/7
partner transmission rate for syphillis
10-60%
codylomata lata
warty lesions on moist areas
SECONDARY SYPHILIS
occurs 6-12 weeks after infection
partner notification for syphilis
primary = 3 months, secondary = 2 years
Rx for early syphilis
benzathine penicilin G 2.4MU IM stat
Rx for early syphilis in pregnancy
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
fetal loss in syphilis
30-40%
neonatal transmission rates for syphilis
100% primary;
40% early
10% late latent
% of neonates developing congenital syphilis after in utero infection
33%
% of babies with congenital syphilis who are asymptomatic at birth
66%
–> two thirds will develop signs and symptoms within 8 weeks –> most present by 12 weeks
vasomotor symptoms rx
offer HRT - estrogen and progesterone (with uterus), or estrogen alone (without uterus).
do not offer SSRIs, SNIRs, or clonidine as 1st line.
menopause - psychological symptoms rx
consider HRT or CBT.
SSRI or SNRI - no clear evidence
menopause - altered sexual function rx
consider testosterone supplementation if HRT alone not effective.
ensure urogenital tissues are adequately estrogenized.
menopause - urogenital atrophy rx
offer vaginal estrogen, moisturizes and lubricants can be used as adjuncts
menopause rx review
at 3 months to assess efficacy and tolerability; annually thereafter
vaginal estrogen regimen
used nightly for 2 weeks and then twice weekly, can be continued long term
risk of DVT/PE with HRT
2-3x background risk; greatest risk in first 12 months
risk of breast cancer with HRT
after 5 years, over age of 50, additional 3-4 cases per 1000 women.
risk associated with estrogen alone is very much less.
incidence of herpes in pregnancy
1.65-3.3/100 000
M/M of local HSV CNS neonatal disease
mortality 6%
morbidity 70%
M/M of disseminated HSV neonatal disease
mortality 30%
morbidity 17%
empirical Rx for first or second trimester primary HSV
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)
Rx for primary HSV in third trimester
aciclovir 400mg PO TDS x 5/7
suppression 400mg TDS
C/S
risk of neonatal transmission HSV in third trimester first episode
41% with SVD
risk of neonatal herpes with recurrent genital lesions
0-3%
rx recurrent genital herpes
aciclovir 400mg TDS from 36/40 for suppression
rx for primary HSV at time of labour
if decides to proceed with labour, intraprtum aciclovir 5mg/kg 8 hrs
PPROM primary HSV
MDT + C/S + IV aciclovir with expectant management
PPROM recurrent HSV
if <34/40, expectant management with PO aciclovir 400mg TDS
women presenting with first episode of genital herpes in third trimester, what tests to do
type specific HSV antibody testing (IgG to HSV1 and 2)
% of neonatal HSV cases acquired postnatally
25%
% of PID that is polymicrobial
30-40%
lifetime prevalence of PID
1.7%
PPV fo clinical diagnosis of PID
65-90%
NPV of absence of endocx or vaginal pus, for PID
95%
% of CT that progresses to PID
10%
how often does cervical motion tenderness occur in appendicitis
25%
how often does N/V occur in PID
50%
OPD Rx for PID, first line - 1
IM ceftriaxone 500mg PO stat + PO doxycycline 100mg BD + PO metronidazole 400mg BD x 14/7
OPD Rx for PID, first line - 2
PO ofloxacin 400mg BD + metronidazole 400mg BD x 14/7
OPD Rx for PID, first line - 3
PO moxifloxacin 400mg OD x 14/7
which abx for PID should be avoided in pts who are at high risk of gonococcal PID
ofloxacin and moxifloxacin
which abx for PID provides the highest microbiological activity against M genitalum
moxifloxacin
quinolones side effects
tenson, muscles, joing, nervous system
OPD Rx for PID, second line /alternative regimens
IM ceftriaxone 1g stat + PO azytirhomycin 1g/week for 2 weeks
INPT Rx for PID, first line - 1
IV ceftriaxone 2g OD + IV/PO doxycyline 100mg BD,
followed by:
PO doxycyline 100mg BD and PO metronidazole 400mg BD x 14/7
INPT Rx for PID, first line -2
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
f/u for PID
at 72h, then 2-4 weeks
incidence of tubal factor infertility following PID
20%
incidence of ectopic pregnancy following PID
10%
incidence of chronic pelvic pain following PID
20%
when to consider surgical management for TOA
if >8 cm, if no response to medical treatment 24-48h, if deterioration
success rate for medical rx of TOA
<70%, but increased recurrence
rx for actinomyces
penicillin
risk of pregnancy after vaginal rape
5%
assault, DNA collection timeframes
7 days vaginal,
3 days anal,
2 days oral
assault, toxicology screens
3 days blood,
14 days urine
when contraception can be stopped for women >55
anytime
when contraception can be stopped for women 50-55yo, if taking hormonal contraception
after two FSH levels >30 taken at least 6 weeks apart
when contraception can be stopped for women 50-55, not taking hormonal contraception
1 year after LMP
when can contraception be stopped for women <50yo
2 years after LMP
recurrent UTI in postmenopausal women
20% because of atrophy of urothelium due to estrogen deficiency
