STIs and Contraception Flashcards
What are the components of a sexual history?
PC- dysuria, pain, itch, discharge, bleeding, systemic syx
BBV risk
Gynae history
Partners
Gender based violence
What questions should you ask in the BBV risk section?
nationality of partner
IV drug use
Partner high risk HIV/Hep B/C?
Non professional tattoo/piercing
Paid for sex?
What should you ask about in the gynae history?
assess pregnancy risk
last menstrual period
contraception
smear up to date
HPV vaccines
What test is available for herpes simplex virus?
PCR test via swab
What is the management of herpes?
aciclovir
saline bathing
What is the latest time post exposure prophylaxis for HIV can be administered?
72 hours
What is the length of course for post exposure prophylaxis?
28 days
What agents are used for post prophylactic exposure?
truvada and raltegravir
Patient presents to A&E with unprotected anal sex with another male. When would you test for HIV?
at 8 weeks
Name one criteria for prescribing HIV pre exposure prophylaxis
MSM or transwoman who has had >2 partner in past 12 months or STI in past 12 months
Partner with HIV detectable viral load
Which virus causes genital warts?
HPV 6 and 11
What is the management of genital warts?
Imiquimod
Cryotherapy
Podophyllotoxin
What is the most common cause of abnormal discharge?
bacterial vaginosis
What is normal vaginal pH?
4-4.5
What is the pH of someone with bacterial vaginosis?
> 4.5
How is bacterial vaginosis diagnosed?
Thin homogenous discharge
High pH
Miscroscopy
What is the name of the criteria to diagnose bacterial vaginosis?
Amsel’s criteria
Which cells can be seen on microscopy in bacterial vaginosis?
clue cells
What is the most common causative agent of candida?
candida albicans
How is candida diagnosed?
history and macroscopic appearance
pH <5
miscroscopy
What is the management of uncomplicated candida?
pessary or cream clotrimazole
fluconazole
Name two indicator conditions for HIV
thrombocytopaenia
recurrent shingles
recurrent bacterial pneumonia
dementia
any STIs
What are the stages of syphilis infection?
primary lesion (chancre)
secondary lesion (Rash)
latent serology
tertiary syphilis (CDV, neuo)
How many days after giving birth do you need contraception?
21 days
How many days after an abortion to you require contraception?
5 days
When do you need to use contraception until?
45-50 and 2 years amenorrhoea (with no OCP use)
50 and 1 year amenorrhoea
until 55 years old
How long does it take to exclude pregnancy following unprotected sex?
3 weeks/21 days
Name three contraception options where there are no user failures
copper IUD
Female and male sterilisation
Levonorgestrel releasing intrauterine system
progestogen only implant
List three side effects of hormonal contraception
irregular bleeding
headache
mood swings
acne
weight gain
breast tenderness
vaginal dryness
greasy skin/hair
chloasma
What is chloasma?
=melasma (facial pigmentation)
What is the MOA of the implant?
prevents ovulation
What is the MOA of the hormonal intrauterine device?
progestogen- thins endometrium and thickens mucus
10% inhibition of ovulation
What is the lifespan of IUS?
3-5 years
What are the disadvantages of IUS?
minor medical procedure to insert- can be painful
risk of vaginal bleeding/spotting 3-6 months after
small chance of infection
What is the MOA of the IUD/copper coil?
copper kills sperm, stops implantation, mucus thicker
Name two disadvantages of the IUD
painful
heaver bleeding
perforation and expulsion risk
infection risk
What is the MOA of progestogen injection?
prevents ovulation
Name two disadvantages of progestogen injection?
every 3 months
delay in return to fertility
weight gain
erratic bleeding
What are the two options for progestogen only injection?
depo provera
sayana press- sub cut injection (Self-administered)
Which OCP can be used in migraines?
progestogen only pill
Name one example of progestogen only pill?
desogestrel
Which contraceptive methods reduce the risk of endometrial and ovarian cancer?
progestogen only pill and injection
What is the MOA of the combined hormonal pill?
prevents ovulation
Which contraceptive method is associated with increased risk of breast and cervical cancer?
combined OCP
List three contraindications for combined hormonal contraception
CDV disease
VTE risk factors
migraine with aura
cancer- breast/liver
post-natal
Female missed one pill. What advice do you give them?
no condoms needed, no emergency contraception. Take the last missed pill and continue the pack (2 in one day)
Female misses three pills in a row. What do you advise them?
need to ask where in the pack (for any >2 pills)
Female misses two pills in the first week. What advice do you give her?
condoms for 7 days
emergency contraception might be needed- seek advice
Female misses three pills in the second week. Advice?
Use condoms for 7 days
NO EC needed
carry on taking pills as usual
Female misses 4 pills in week 3. Advice?
condoms for 7 days and no EC needed. Start next packet of pills without a break
How do you assess Fraser competency?
Is the child mature and intelligent enough to understand the nature and implications of the treatment proposed?
Is it impossible to persuade the child to tell their parents, or let the Doctor tell them?
Are they likely to begin or continue having sexual intercourse with or without contraception?
Are their physical or mental health likely to suffer unless they get the advice or treatment?
Is the advice or treatment in their best interest?
List two options for emergency contraception
Cu IUD
Ulipristal acetate EC
Levonorgstrel EC
What is the time frame of Cu IUD?
within 5 days of unprotected sex
When can Cu IUD be inserted?
A copper IUD can be inserted up to 5 days after unprotected intercourse or 5 days after the calculated ovulation day or anytime in the cycle if a high sensitivity pregnancy test is negative.
Patient needs emergency contraception 4 days after they had unprotected sex. Which EC method can they not opt for?
can’t do levonorgestrel (within 72 hours)
List three unacceptable risks wherein the combined OCP cannot be prescribed/considered
UKMEC4:
- >35 years old and smoker of > 15 cigarettes per day
- migraine with aura
- Personal history of deep vein thrombosis or pulmonary embolism
- Personal history of stroke or ischaemic heart disease
- Uncontrolled hypertension
- Breast cancer
- Recent major surgery with prolonged immobilisation
- Breast feeding and < 6 weeks postpartum earliest expected day of ovulation
Aside from contraception, name three other indications for the COCP
aids heavy menstrual bleeding
dysmennorhoea
symptoms of endometriosis
treatment of PCOS
menopausal symptoms may improve
acne
reduction in benign ovarian cysts and tumours
Which cancers does COCP reduce the risk of?
endometrial and ovarian cancer
colorectal cancer
Name two contraindications for COCP
high BMI
smoking
VTE
IHD
migraines
hypertension
stroke hx
liver disease
How does the COCP prevent pregnancy
inhibits ovulation
thickens cervical mucus
thins endometrium
