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Revision lectures > STIs and Contraception > Flashcards

STIs and Contraception Flashcards

1
Q

Candida Infection - predisposing factors

A

Recent antibiotic therapy
High oestrogen levels (pregnancy, certain contraceptives)
Poorly controlled diabetes
Immunocompromised

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2
Q

Candida - presentation, diagnosis and treatment

A

Intensely itchy white discharge

Clinical diagnosis, high vaginal swab for culture - majority C. albicans

Topical clotrinazole pessary or cream over the counter
Oral fluconazole

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3
Q

Bacterial vaginosis - symptoms, diagnosis, treatment

A

Thin watery fishy discharge

Raised vaginal pH

HVS - clue cells

Oral metronidazole

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4
Q

Treatment of chlamydia

A

Azithromycin 1g Oral Stat for uncomplicated

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5
Q

Gonorrhoea

A

Gram negative diplococci

Treatment is IM ceftriaxone and oral azithromycin

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6
Q

Syphilis

A

Treponema pallidum

4 stages

Primary and secondary lesions - Microscopy for spirochetes, PCR swab

Serology

Long acting preparations of penicillin

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7
Q

Stages of syphilis

A

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

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8
Q

Genital warts

A

Commonest viral STI

HPV

6&11

Cryotherapy or podophyllotoxin cream (not in pregnancy)

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9
Q

Genital Herpes

A

HSV 1 and HSV 2

Diagnosis - swab of blister for PCR

Treatment - acyclovir if early enough and pain relief

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10
Q

Trichomonas Vaginalis

A

Vaginal discharge and irritation in females and ?urethritis in makes

Diagnosis - HVS

Treatment - oral metronidazole

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11
Q

Pubic lice

A

Treatment - malathion lotion

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12
Q

Emergency Contraception

Levonelle

A

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

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13
Q

Emergency Contraception

EllaOne

A

Oral

Can be used up to 120 hours post UPSI

30mg ulipristal acetate, lower failure rate, can’t use with antacids, inhibits/delays ovulation

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14
Q

Emergency Contraception

Copper IUD

A

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

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15
Q

Medical TOP

A

Oral mifepristone 200mg (anti-progesterone)

24-48 hours later vaginal or oral prostaglandin - misoprostal

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16
Q

IUD mode of action

A

Decreased sperm motility and survival

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17
Q

IUS mode of action

A

Primary - prevents endometrial proliferation

Secondary - thickens cervical mucous

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18
Q

COCP mode of action

A

Inhibits ovulation

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19
Q

POP mode of action

A

Thickens cervical mucous

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20
Q

Desoegestrel only pill, injectable and implantable contraception

Mode of action

A

Primary - inhibits ovulation

Secondary - thickens cervical mucous

21
Q

COCP
UKMEC 3
“Disadvantages generally outweigh advantages”

A 
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
22
Q

COCP
UKMEC 4
“Unacceptable health risk”

A 
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
23
Q

COCP

Risks and benefits

A

Small risk blood clots, heart attacks and strokes

Increased risk of breast and cervical cancer

Reduced risk of endometrial and ovarian cancer

24
Q

COCP

Missed one pill

A

Take two pills in one day and continue.

No additional protection needed

25
Q

COCP

Two or more pills missed

A

Take the last missed one, two in one day and continue on
Abstain until had seven days of pills in a row

Days 1-7 emergency contraception considered if unprotected sex in pill free interval or in week 1
Days 8-14 No need for emergency contraception
Days 15-21 Finish pills in current pack and start new pack next day, omit pill free interval

26
Q

IUD effective

A

Immediately after insertion

27
Q

IUS effective

A

7 days after insertion

28
Q

Side effects IUD

A

Periods heavier, longer, more painful

Small risk PID

29
Q

Side effects IUS

A

Associated with initial frequent uterine bleeding and spotting. Later typically intermittent light menses with less dysmenorrhea and some women become amenorrhoeic

30
Q

Nexplanon

A

Releases the progesterone hormone etonogestrel

Tricep of non dominant arm

Lasts three years

No oestrogen so can use if history of VTE, migraine etc

Can be inserted immediately after termination

31
Q

Nexplanon effective

A

From day 1 if inserted on day 1-5 of cycle

After day 7 of not

32
Q

Adverse effects of Nexplanon

A

Irregular/heavy bleeding

Progestogen effects - headache, nausea, breast pain

33
Q

Nexplanon

UKMEC 3

A 
IHD/stroke
Unexplained, suspicious vaginal bleeding
Past breast cancer
Severe liver cirrhosis
Liver cancer
Positive antiphospholipid antibodies
34
Q

Nexplanon

UKMEC 4

A

Current breast cancer

35
Q

Examples of POP

A

Norethisterone
Levonorgestrel
Cerazette

36
Q

Depo Provera

Given

A

Every 12 weeks but can go up to 14 without extra protection

37
Q

Depo Provera disadvantages

A

Return to fertility may take up to 12 months

Irregular bleeding

Weight gain

May increase risk of osteoporosis, only use in adolescents if no other method suitable

38
Q

Contraception for acne

A

Dianette

39
Q

POP

Missed pill

A

Traditional POP
take within three hours
If over three hours follow below

Cerazette if less than 12hours late take as normal
If over 12 hours see below

Take missed pill. Continue. Extra precautions should be used until pill taking re established for 48 hours

40
Q

Delayed patch change

A

Action required if delayed patch change over 48hours

Barrier protection for 7 days and emergency contraception if required

41
Q

Contraceptives

Time until effective

A

IUD - instant
POP - 2 days
COCP, injection, implant, IUS - 7days

42
Q

Is the woman ovulating?

A

Test day 21 serum progesterone

If 28 day cycle.

Always 7 days before end of cycle i.e. If 35 day cycle do on day 28

43
Q

POP disadvantages

A

Irregular bleeding

44
Q

Contraceptive patch regime

A

Wear one patch a week for three weeks and then don’t wear patch on week four

45
Q

Postpartum and not breastfeeding - how long don’t need contraceptive cover

A

21 days

46
Q

COCP and surgery

A

Stop 4 weeks before, Start again 2 weeks after

Can switch to POP four weeks before if want

47
Q

History of breast cancer

A

Copper Coil

48
Q

Contraception to help with heavy bleeding

A

Mirena IUS

Revision lectures (15 decks)

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