STIs / Contraception Flashcards
What are some resources for STIs?
PHAC
CDC manual
CPS
RX
SK Prevention
Government of Sask
Saskatoon sex health
Sex life sask
What is important when providing care on STI
safe private area
confidentiality
build rapport
plain inclusive language
What are the three groups of STI’s
viral= ie) HPV, HIV
bacterial= ie) syphilis, gonorrhoea
Parasitic- trichomoniasis
Risk factors for STIs
Multiple partners, no barrier, previous STI, substance use,
What can we do to help STI prevention?
assess and discuss risk
educate about signs
vaccine
treat and follow up
What things should we ask to assess risk?
sexually active?
any sx?
contraception?
avoiding STI?
Concerns?
last period?
Pap test?
share sex toys?
True or False: Most STI’s are asymptomatic
True
Who should be screened regularly
sexually active
Which STI’s don’t have to be reported?
HPV
herpes
What options do we have of barrier protection?
external condom, internal condom, dental dams
What is the issue with barrier protection?
syphylis, HPV, HSV= shedding or external lesions= lower protection
What type of a condom is not recommended?
spermicidal lube condom containing nonoxynol-9
What are some goals of therapy for STI?
Treat infection
remove sx
lower spread
decrease vertical transmission to newborns
lower complications
True or false STIs can spread through breast feeding?
true
How does vertical transmission of chlamydia affect baby?
preterm birth, conjunctivitis, pneumonia
How does vertical transmission of Gonorrhea affect baby?
systemic infection, ophthalmia neonatorum
How does vertical transmission of Syphilis affect baby?
systemic sx, fetal loss
What are some STI-associated syndromes
cervicitis, epididymitis, proctitis, vaginitis, anogenital ulcer, PID
How do we know if it is yeast vaginitis?
curdy white and itchy
How do we know if it is trichomonas vaginitis?
yellow frothy
How do we know if bacterial vaginitis?
fishy odour, grey discharge
What can cause anogenital ulcers?
HSV, syphilis
What HPV causes warts?
6+11
What STI’s affect pregnancy?
HPV, HSV,
True or false syphilis can make you infertile?
true
What is the most commonly reported STI in Canada?
Chlamydia
Most common sx in chlamydia
dysuria, urethritis, cervicitis, proctitis, conjunctivitis
Chlamydia complications
PID, Infertility, Reiter syndrome,
Treatment of Chlamydia
Preferred= Doxy 100 BID for 7 days
or Azithro 1 g once= pregnant or amoxicillin 500 TID for 7 days
Counselling points on doxycycline
with food and no iron or calcium within 3 hours photosensitivity
When can you start sex again during chlamydia treatment?
7 days after azithro dose or end of regimen and no sx
When should you follow up on chlamydia treatment?
Test of cure= 3-4 weeks following positive repeat 6 months after
What is LGV?
L1,2,3 genotype of chlamydia and is more invasive
rare and affects lymph primarily
What is primary LGV?
3-30 days= small painless papules
What is secondary LGV/
2-6 weeks after primary
swell of lymph, fever, fatigue, ocular inflammation disease
What is tertiary LGV?
chronic inflam lesions= scars
lymph obstruction= genital elephantiasis
destruction of genitalia
What is treatment for LGV/
Doxy 100 BID for 21 days
azithro 1 gm weekly for 3 weeks
True or false, gonorrhoea is curable if treated quickly
True
What other STI is concomitant with gonorrhoea?
chlamydia
What are sx of gonorrhoea?
vag discharge, ab pain, dysuria, bartholinitis, painful sex, itch, testical pain
What are the complications of gonorrhoea
PID
Infertility
ectopic pregnancy, DGI, arthritis, meningitis
What is treatment for gonorrhoea?
Ceftriaxone 250mg IM once AND azithro 1 gm once
OR
cefixime 800mg once and azithro 1 gm once
What are some points for gonorrhoea counselling?
adherence= resistance is a concern
take with food for azithro
same no sex as chlamydia
What is the follow up for gonorrhoea
TOC 4-5 days following treat, NAAT no but if needed 4 weeks after positive. repeat after 6 months
What STI is highest rate in Canada
syphilis
What is primary syphilis
painless lesions for 3 weeks
What is secondary syphilis?
rash, fever, headache, meningitis fro 2-12 weeks
What is early latent syphilis?
asymptomatic for less than a year of infection
What is late latent syphilis?
asymptomatic for more than a year of infection
What is cardiovascular syphilis?
aortic aneurysm, stenosis= 10-20 years
What is gumma?
tissue destruction of any organ from syphilis= 1-46 years
What is neurosyphilis/ocular?
can be asymptomatic, or headaches, vertigo, dementia can be early or late (1-20)
What is the symptoms of early congenital syphilis?
<2 years old 2/3 asymptomatic can be anemia, neurosyph, rhinitis, osteochondritis
What is the symptoms of early congenital syphilis?
> 2 years old 2/3 asymptomatic can be anemia, neurosyph, osteochondritis, hutchinson
What is the treatment of syphilis?
benzathine pen G 2.4 mill U IM once for primary, secondary and early
for late= same but weekly for 3 doses
What us follow up for syphilis
No TOC
titre change= four fold after 6 months
What is jarisch-herxheimer rxn?
acute febrile reaction
occurs within first 24 hours of therapy
NOTa allergic reaction
manage with NSAIDS
may induce labour
What is the most common STI in the world
HPV
What are the high risk HPV types
16,18
What complications from HPV
cervical cancer, cancer
What are symptoms of HPV
asymptomatic
itch, discomfort, bleeding, warts
cancer= need Pap test
What treatment for HPV
Imiquimod cream 3.75% daily and wash off after 8 hours
OR 5% cream 3x a week and remove after 6-10 hours
OR
Sinecatechins 10% (green tea leaves) apply strand TID
OR CRYO, lazer, surgery, podophyllin 25%
What can we give for pain of HPV lesions?
lidocaine
When can you have sex again after HPV breakout?
avoid while treating lesions= until they are gone
What vaccine can we give for HPV
Gardasil 9
Cervarix
When do you get the vaccine for HPV?
grade 6
At what point is Gardasil not free?
over the age of 26 years
How effective is Gardasil?
97%
What is s/e of Gardasil?
headache, fever, dizzy
What is the difference between HSV1 and HSV2
1= oral infection but can cause genital
2= genital
Which gender has more HSV
Women
What are sx of HSV
prodromal, then ulcers for 9-11 days
Which lasts longer the primary infection or non for HSV
Primary
Treatment of HSV genital?
Acyclovir 200 five x/day for 5-10 days
OR
famciclovir 250 TID for 5 days
OR
Valalcyclovir 1000 BID for 10 days
What is treatment for pregnant HSV2
acyclovir regimen
What is treatment for recurrent HSV 2
Acyclovir 200 five x/day for 5-10 days
OR
famciclovir 125 BID for 5 days
OR
Valalcyclovir 500 BID for 10 days OR 1g OD for 3 days
What is treatment for suppressive HSV 2
Acyclovir 200 five x/day
OR
famciclovir 250 BID for
OR
Valalcyclovir 500 BID(if >9 recurrences) or 500 if <9
What happens if neonatal herpes occurs
60% of death
systemic infection in organs
Treatment of Neonatal herpes?
acyclovir 45-60mg/kg/day IV in q8 for 14-21 days
Counselling on HSV
use as early until healed
no sex during episodes
shedding can occur during asymptomatic stage
lifelong
What is monkey pox?
viral disease
spread in direct contact of lesions, fluids, mucosal surfaces
What is sx of Mpox?
rash on face and extremities, fever, fatigue
What is treatment for Mpox?
vaccine (smallpox)
POP
PrEP
or just own body after 2-4 weeks
What percentages of pregnancies are unplanned and how many end up in abortion?
40-60%
abortion= 50%
What is the role of each hormone in the menstrual cycle?
GnRH= release FSH,LH
FSH= maturation of follicle
Estrogen= thickens endometrium, inhibit FSH and stim LH
LH= trigger ovulation
progesterone= for implantation, stop FSH and LH
How long is the average cycle?
28 days
What happens I the follicular phase?
increase FSH and one follicle becomes dominant and produces estrogen
this estrogen limits FSH and causes surges of LH
How long does it take to ovulate after LH surge ?
28-32 hours= day 14
What happens in the luteal phase?
release of ovum
follicle becomes corpus luteum, if implant= continue progesterone for endometrium, if no implant progesterone stops
What is the plant version of estrogen?
esterol
General MOA of hormonal contraceptives?
estrogen to stop release of FSH
progestin suppress LH and FSH and thicken cervical mucus and stop implantation
What is the history of the pill?
Margaret Sanger made titbit was at a really high dose= clots
Why is there a break period for contraception?
period= not pregnant, can’t tell if on it (good for church)
What is the difference between mono,bi,triphase OC?
mon= fixed levels of both
Bi= fixed EE and more progestin in 2nd phase
Tri= fixed or variable EE and high progestin in all three phases
True or false Multiphase products are better at preventing pregnancy?
No they are the same in all respects
If we are doing continuous dosing what product should we probably give?
monophaseic <50mcg of EE
Why do people want to do continuous dosing of OC?
less chance of ovulation, less period, more forgiving if missing dose
Do periods build up if you skip them?
fuck no
What day should the pill be started?
most effective on day 1 of period BUT start anytime just use other contraception for 7 days
Why do you need to use back up contraception if not starting on day one of period?
takes 7 full days of EE to prevent ovulation
What is the percent failure of combined OC use?
perfect use= <0.3%
Typical=3-8%
What to do if missed dose?
Take immediately then continue as usual, if in week 2-3 skip hormone free interval
What are the side effect of combined OC and when do they typical stop?
first 3 months
bleed=adherence up estrogen
breast tender= lower estrogen
nausea= take with food
weight gain is minimal
headache
depression
acne= initial worse then improve
What are the benefits of OC other than stop pregnancy?
less frequent period and lower pain, endometriosis, osteoporosis, acne
What risk are there with OC?
VTE, MI and stoke
Cancer of breast and cervical= could be due to sex tho
What factors put you at risk of CVD events with OC?
smoke >35, hTN, >50mcg of EE
What are some DI with combined OC?
some antibiotics reduce enterohepatic circulation= not an issue though
CYP 3A4- anticonvulsants (lamotrigine)= use higher EE or alt method
What are contraindication of OC?
VTE, HTN, stroke, breast cancer, migraine with aura, post partum, smoke
When can we start combined OC after pregnancy?
3-6 weeks after
True or false OC and transdermal have same efficacy?
True
What are the components in transdermal contraception?
0.6 EE and 6mg of norelgestromin
How do you use transdermal patch?
1 patch weekly for 3 weeks to arm, butt, ab,
What happens if you forget a patch?
take it immediately and skip HFI if in week 2 or 3
When are transdermal contraception less effective
> 90kg
What does the ring do for contraception?
EE ring that sits in vagina
What is a missed dose for the ring?
out for longer than 3 hours
How long is the ring stable at room temperature?
4 months
POP has two types of progestin what are they?
norethindrone 35mcg
drospirenone 4mg
True or false you need to take the ring out for sex?
false
Of the two POP’s how does each stop pregnancy?
norethindrone=alters mucus and endometrium MAY cause no ovulation
drospirenone=stop ovulation
How long is the HFI for both POP’s
norethindrone= NONE
drospirenone= 4 days
How long is a missed dose for POP?
3 hours
but drospirenone is more forgiving
What is an issue with POP in post partum?
for norethindrone hard to take at same time with new baby
What drug could be an issue when on drospirenone?
rampril or other diuretics
What is the injectable contraception?
150 mg of medroxyprogesterone
How does the injectable contraception work?
stop ovulation increases mucus, alter endometrium
How often do you need the depo shot?
q12 weeks
What is something that MUST be counselled on if administering depo shot?
delayed fertility for 9 months after and BONE LOSS
How long does copper IUD last for?
3-10 years
How does copper IUD work?
copper is toxic to sperm and stops implantation
What is in hormonal IUD and how does it work?
levonorgestrel
thicken mucus, change endometrium, may suppress ovulation
How long does hormonal IUD last?
5 years
Contraindication of IUD
pregnancy-duh
cancer of women
STI or pelvic infection last 3 months
What is in the implantable contraception and how does it work?
progestin only= etonogestrel
stop ovulate and change mucus
How long does implantable BC last?
3 years
What is failure rate of condoms?
97% or 86%
What other barrier methods?
diaphragms = cap overs cervix
sponges= spermicidal
cervical cap
spermicides-nonoxynol-9
What are permanent contraceptive methods?
tubal ligation
vasectomy
What is the fail rate of pull out method?
22%
How do you do natural family planning?
take temp in morning
if temp increase of at least 0.2 degrees= ovulate
3 days of higher temp= fertility period over
OR look at mucus
How do you do the calendar method of family planning?
subtract 21 from shortest cycle= fertility begins
subtract 10 from longest cycle= fertility ends
True or false, if you breast feed you don’t ovulate.
True
When does implantation occur?
6-14 days after fertilization
What are the three EC options?
LNG
UPA
cu IUD
For the three EC how long are the good for?
LNG- up to 72hrs
UPA= 120hrs
Cu-IUD= 7 days
Could IUS be an option for EC?
not inferior but pricey and need a physician
How does UPA work?
prevents ovulation
How does LNG work?
delay ovulation and inhibit sperm and ovum travel
What are some side effects of EC?
nausea, vomit, cramps, fatigue, headache, breast tenderness
What causes nausea in EC and OC?
estrogen
What happens if you ovulate and take EC?
may still get pregnant
Benefit of UPA over LNG
UPA can be taken if longer than 3 days and can be right up to peak of LH
in heavier women
Why would we want LNG over UPA?
LNG won’t interact with BC
UPA can interact with progestin and it not work
How long do we have to wait before restarting BC after using UPA?
5 days
I have a BMI of 34 what EC do I need?
copper iud
I have a BMI of 27 what EC do I need?
UPA
True or false UPA and LNG work if unprotected sex after it was taken?
False
How long is an egg viable for?
1 day
What are the only contraindications of oral EC?
pregnancy and allergy
What medication terminates pregnancy?
mifepristone
What does misoprostal do?
cause contractions
Why are people not using the abortion drugs?
pharmacy does not stock cause ti is expensive
What is age of consent?
16 years
Can we give BC to kids without parental approval? And if the parent asks if they have it can we tell them?
NOOOO
When must we report by law a sexual assault?
if it is on a minor
What is conscientious objection and what must pharmacists do?
object due to moral reasons
don’t say why just object and provide referral BUT HAVE to in emergencies
