STIs and Contraception Flashcards
Candida Infection - predisposing factors
Recent antibiotic therapy
High oestrogen levels (pregnancy, certain contraceptives)
Poorly controlled diabetes
Immunocompromised
Candida - presentation, diagnosis and treatment
Intensely itchy white discharge
Clinical diagnosis, high vaginal swab for culture - majority C. albicans
Topical clotrinazole pessary or cream over the counter
Oral fluconazole
Bacterial vaginosis - symptoms, diagnosis, treatment
Thin watery fishy discharge
Raised vaginal pH
HVS - clue cells
Oral metronidazole
Treatment of chlamydia
Azithromycin 1g Oral Stat for uncomplicated
Gonorrhoea
Gram negative diplococci
Treatment is IM ceftriaxone and oral azithromycin
Syphilis
Treponema pallidum
4 stages
Primary and secondary lesions - Microscopy for spirochetes, PCR swab
Serology
Long acting preparations of penicillin
Stages of syphilis
1 - chancre - not painful
2 - blood circulation - can get mouth ulcers, generalised rash, flu like symptoms
Latent stage - no symptoms
Late stage - CVS or neurovascular complications years later
Genital warts
Commonest viral STI
HPV
6&11
Cryotherapy or podophyllotoxin cream (not in pregnancy)
Genital Herpes
HSV 1 and HSV 2
Diagnosis - swab of blister for PCR
Treatment - acyclovir if early enough and pain relief
Trichomonas Vaginalis
Vaginal discharge and irritation in females and ?urethritis in makes
Diagnosis - HVS
Treatment - oral metronidazole
Pubic lice
Treatment - malathion lotion
Emergency Contraception
Levonelle
Oral
Up to 72 hours post UPSI
1.5mg Levonorgestrel, efficacy reduced over time, can’t use with enzyme inducers or increased BMI, inhibits ovulation
Emergency Contraception
EllaOne
Oral
Can be used up to 120 hours post UPSI
30mg ulipristal acetate, lower failure rate, can’t use with antacids, inhibits/delays ovulation
Emergency Contraception
Copper IUD
Should be offered to all seeking EC
Toxic to sperm, anti implantation
Insertion: up to 120hrs post UPSI
OR
up to 5 days after earliest expected date of ovulation
Screen +/- treat high risk for STI before insertion as risk of PID
Medical TOP
Oral mifepristone 200mg (anti-progesterone)
24-48 hours later vaginal or oral prostaglandin - misoprostal
IUD mode of action
Decreased sperm motility and survival
IUS mode of action
Primary - prevents endometrial proliferation
Secondary - thickens cervical mucous
COCP mode of action
Inhibits ovulation
POP mode of action
Thickens cervical mucous
Desoegestrel only pill, injectable and implantable contraception
Mode of action
Primary - inhibits ovulation
Secondary - thickens cervical mucous
COCP
UKMEC 3
“Disadvantages generally outweigh advantages”
Over 35 and smoking under 15cigs/day BMI over 35 Migraine without aura and over 35 Family history of thromboembolic disease in first degree relatives under age 45 Controlled hypertension Immobility Breast feeding 6weeks-6months postpartum
COCP
UKMEC 4
“Unacceptable health risk”
Over 35 years and smoking over 15cigs/day Migraine with aura History of thromboembolic stroke History of stroke or IHD Breast feeding under 6 weeks post partum Uncontrolled hypertension Breast cancer VTE current or history of Positive antiphospholipid antibodies Decompensated cirrhosis
COCP
Risks and benefits
Small risk blood clots, heart attacks and strokes
Increased risk of breast and cervical cancer
Reduced risk of endometrial and ovarian cancer
COCP
Missed one pill
Take two pills in one day and continue.
No additional protection needed
