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
COCP | Two or more pills missed
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
IUD effective
Immediately after insertion
27
IUS effective
7 days after insertion
28
Side effects IUD
Periods heavier, longer, more painful | Small risk PID
29
Side effects IUS
Associated with initial frequent uterine bleeding and spotting. Later typically intermittent light menses with less dysmenorrhea and some women become amenorrhoeic
30
Nexplanon
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
Nexplanon effective
From day 1 if inserted on day 1-5 of cycle | After day 7 of not
32
Adverse effects of Nexplanon
Irregular/heavy bleeding Progestogen effects - headache, nausea, breast pain
33
Nexplanon | UKMEC 3
``` IHD/stroke Unexplained, suspicious vaginal bleeding Past breast cancer Severe liver cirrhosis Liver cancer Positive antiphospholipid antibodies ```
34
Nexplanon | UKMEC 4
Current breast cancer
35
Examples of POP
Norethisterone Levonorgestrel Cerazette
36
Depo Provera | Given
Every 12 weeks but can go up to 14 without extra protection
37
Depo Provera disadvantages
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
Contraception for acne
Dianette
39
POP | Missed pill
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
Delayed patch change
Action required if delayed patch change over 48hours Barrier protection for 7 days and emergency contraception if required
41
Contraceptives | Time until effective
IUD - instant POP - 2 days COCP, injection, implant, IUS - 7days
42
Is the woman ovulating?
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
POP disadvantages
Irregular bleeding
44
Contraceptive patch regime
Wear one patch a week for three weeks and then don't wear patch on week four
45
Postpartum and not breastfeeding - how long don't need contraceptive cover
21 days
46
COCP and surgery
Stop 4 weeks before, Start again 2 weeks after Can switch to POP four weeks before if want
47
History of breast cancer
Copper Coil
48
Contraception to help with heavy bleeding
Mirena IUS