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Reproduction/Sexual Health > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Contact tracing in chlamydia

A

Male urethral - past 4 weeks
Any other infection - past 6 months

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2
Q

Contact tracing in gonorrhoea

A

Male urethral - past 2 weeks
Any other infection - past 3 months

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3
Q

When is contact tracing not req?

A

Warts (asymptomatic)
Herpes (asymptomatic)
Thrush (not STI)
BV (not STI)

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4
Q

Vax available for STI

A

Hep B/A
HPV
Mpox

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5
Q

PEP

A

3 antiretrovirals
Within 72H
28 days total

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6
Q

Hep B PEP

A

HBV vax up to 7 days
OR Immunoglobulin in vax non-responders

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7
Q

Contraception involving prevention of ovulation

A

Suppression of FSH/LH
Most common type e.g. COCP, implant
Emergency contraception delays ovulation

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8
Q

Contraception involving prevention of fertilisation

A

Mechanical/surgical barrier
External - condoms, diaphragm, spermicides
Internal - tubal ligation, vasectomy
Hormonal - mirena coil, causes hostile cervical mucous effect to reduce sperm penetration
Negative effect on tubal motility e.g. POP, CHC

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9
Q

Contraception involving prevention of implantation

A

Hormonal creating hostile thin endometrium
IUDs causing local endo inflam reaction and toxicity to sperm/ova (this is secondary mech of copper coil, esp in emergency)

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10
Q

Contraception which thickens cervical mucous

A

LNG-IUD,
DMPA, POP,
SDI

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11
Q

Contraception causing endometrial change

A

Cu- and LNGIUD, SDI,
DMPA, POP,
CHC

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12
Q

What is LARC?

A

Long-acting reversible contraception

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13
Q

5 most effective contraceptive methods

A

Subdermal implant
Vasectomy
IUS (mirena)
Female sterilisation
IUD (copper)

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14
Q

Non-contraceptive benefits of hormonal contraception

A

DECREASE IN:
 Period pain
 Heavy menstrual bleeding
 Irregular PV bleeding (mainly CHC, LNG-IUD and DMPA)
 Ovulation pain (if ov supp)
 PMS (mainly CHC)
 Cyclical breast tenderness
 Ovarian cysts (if ov supp)
 Endometriosis
 Ovarian cancer (if ov supp)
 Acne or hirsutism (CHC only)
 Perimenopausal symptoms (CHC only)

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15
Q

Contraindications of coils

A

Submucosal fibroids
Uterine malformation etc

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16
Q

How is copper bearing IUD used as emergency contraception?

A

Up to 5 days after sex or 5 days after earliest estimated day of ovulation
Copper coil causes direct toxicity to sperm and egg and prevents implantation

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17
Q

Use of mirena coil other than contraception

A

Treatment of heavy period
HRT
Therapeutic use in endometriosis, hyperplasia

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18
Q

Describe SDI and its main side effect

A

Most effective, safe, lasts 3 years
Low stable level of hormones - less hormonal side effects
Main SE - prolonged PV bleeding
Bleeding may be cervicitis/endometritis from STI, preg complication, cancer/polyp
Bleeding can be controlled by additional COC

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19
Q

How to take COCP?

A

Start in first 5 days of period
OR
At any time in cycle when prob sure not pregnant, plus condoms for 7 days

Take daily for 21 days and then 7 day break

Some can be taken continuously with no interval

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20
Q

Factors affecting effectiveness of CHC

A

Impaired absorption
– GI conditions (COC)
Increased metabolism
– Liver enzyme induction or
drug interaction
Patch
– less effective >90kg

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21
Q

Main risks of CHC

A
  1. Venous thrombosis
    - depends on dose, but more common with other RFs present, prescribe with lowest risk
  2. Arterial disease
    - incr risk of MI esp with smokers/incr BP, incr ischaemic stroke, check BP initially and annually
  3. Adverse effects on some cancers
    - WHILE USING, RETURNS TO BASELINE AFTER 10Y: incr risk of breast cancer while using esp with BRACA mutation, small incr in cervical cancer
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22
Q

Why is CHC contraindicated in migraine with aura?

A

Increases risk of ischaemic stroke

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23
Q

Benefit of CHC in cancer

A

Reductio in ovarian cancer and endometrial cancer

Benefit can last decades after stopping CHC

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24
Q

Non-contraceptive benefits of CHC

A

Acne reduction
Less bleeding
Fewer functional ovarian cysts
Improvements with PMS and PCOS

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25
Q

Side effects of CHC

A

Nausea
Bleeding
Spots
Breast tenderness
Weight gain
Mood swings
Pretty much anything you can think of

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26
Q

Mode of action of desogestrel PO methods

A

Inhibition of ovulation
Start day 1-5 of period or anytime if reasonably certain not pregnant plus condoms for 7 days (2 days if POP)
Now available OTC

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27
Q

Risk and side effects of POP

A

Small risk of breast cancer
All similar to COCP plus anything you can think of

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28
Q

Mode of action of depo provera/sayana press

A

Suppression of FSH
Lowers estradiol

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29
Q

Side effects of depot contraception

A

Nausea
WG (more likely if <18 or BMI >30)
Bleeding
Spots
Headache
Small incr risk of breast and cervical cancer
Caution in terms of bone health with under 18s and over 50s

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30
Q

How is vasectomy performed and complications?

A

Local/gen anaesthetic
NO SCALPEL

Comps include: pain, infection, inefficacy, bleeding/haematoma

Failure is usually due to early non compliance and late semen analysis

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31
Q

4 types of female sterilisation

A

Removal
Band
Clip
Essure

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32
Q

3 main emergency contraceptive methods

A

Levonorgestrel (levonelle)
- progesterone, 72h afterwards, delays ov, OTC, 60-80% effective
Ulipristal acetate (ella one)
- progesterone receptor mod, 120h afterwards, delays ov, LH surge, OTC, 60-80% effective
IUD
- 5 days after sex or 5 days after ovulation, 99% effective

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33
Q

Describe microbio of neisseria gonnorhoeae

A

Gm- diplococci
Screen with PCR
Grown on chcocolate agar
Causes urithritis, cervicitis, disseminated disease, PID, pharyngitis, proctitis

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34
Q

Management of gonorrhoea

A

1G Ceftriaxone IM,
NOT ciprofloxacin 500mg oral unless sensitivity known
2nd line: cefixine 400mg oral + azithromycin 2G
Treatment failure is usually in pharynx infection where there is limited penetration of antibios

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35
Q

Describe clinical pres of chlamydia trachomatis

A

Increased vaginal discharge, post-coital bleeding, dysuria, dyspareunia, rectal pain
Complications: PID, salpingitis, endometritis, tubal infertility, ectopic pregnancy, perihepatitis, reactive arthritis

36
Q

Testing and treatment of chlamydia

A

Test with NAAT
Manage: 100mg BD doxycycline 1 week or azithromycin 1g stat followed by 2 days 50mg

37
Q

Describe lymphogranuloma venereum

A

Caused by serovar L2 (and L1/L3)
Presents as outbreaks of chlamydia
Clinical: Painless ulcers and/or haemorrhagic proctitis, pharyngitis, lymphadenopathy (often unilateral)

38
Q

Anaerobic bacterial causing infections which are not STIs

A

Gardnerella vaginalis
Prevotells sp.
Mobiluncus sp.
Atopobium sp.

Most commonly causing BV
Test with gram stain
Manage with metronidazole oral/gel or clindamycin cream

39
Q

Describe pres, testing ad treatment of mycoplasma genitaleum

A

Pres: PID and urethritis
Not stainable as lacking cell wall, usually NAAT
Treatment: doxycycline/moxyfloxacin

40
Q

Describe pres/testing of ureaplasma

A

Sexually transmitted and then becomes part of normal genital flora
Pres: urethritis, epididymitis, prostatitis
Test with PCR or liquid culture for sensitivity

41
Q

Describe cause of syphilis

A

Trponema pallidum whichis a spirochate
Sex, blood transfusion, pregnancy

42
Q

How is syphilis tested for?

A

PCR from lesion sample
Treponemal serology
- Test 1: treponemal IgG and IgM
- Test 2 if test 1 positive: specific Treponema pallidum assay & RPR (Rapid plasma reagin)/VDRL

43
Q

Clinical pres of syphilis

A

Primary: chancre (painless ulcers on genitals)
Secondary: rash incl palms and soles, mucous pathes, condyloma lata, hepatitis, splenomegaly, glomerulonephritis
Latent after 3-12 weeks
Late/tertiary disease: neuro/cardio/gummatous syphilis

44
Q

Management of syphilis

A

Benzathine penicillin
OR penicillin relative or doxy or azithromycin or erythromycin

45
Q

Pres of HSV as STIs

A

Most asymptomatic
HSV-1 mainly transmitted via oral-to-oral contact => “cold sores”
HSV-2 mainly sexually transmitted => genital herpes with lesions

46
Q

Complications of HSV

A

Increases risk of HIV transmission 3x
Severe disease in immunocompromised people
- Frequent recurrences
- HSV-1 – keratitis
- HSV-1 – encephalitis
- HSV-2 - Meningoencephalitis
- Dissemintated infection
Neonatal herpes

47
Q

Management of HSV

A

Aciclovir 400mg 3x daily for 5 days
Prevention incl vaccine is much better than treatment

48
Q

How does HPV present as a sexual health concern?

A

HPV 16 and 18
=> 70% of cervical cancers
HPV 6 and 11
=> genital warts

49
Q

Describe Mpox

A

Causes vesicles similar to HSV, can be severe disease
Outpreaks of pox-like disease, ongoing since May 2022 globally
Smallpox vaccine up to 85% effective in prevention
ARV available for severe disease

50
Q

How can varicella zoster be differentiated from HSV?

A

PCR

51
Q

Complications of varicella zoster

A

Complications of primary infection:
- Pneumonia
- Encephalitis
- Pregnancy: fetal injury
Complications of recurrent infection:
- Lasting nerve damage
- Visual impairment

52
Q

Mangaement of varicella zoster

A

Aciclovir in severe casess
Live attenuated vaccine available

53
Q

Pres and management of yeast infection

A

GM pos fungi, mostly candida albicans

Pres: range of infections incl vulvovaginal candidiasis

Manage: topical or systemic antifungals

54
Q

Pres, testing and management of trichomonas vaginalis

A

Unicellular protozoa, ST
Pres: Discharge with vulval itching, dysuria, Prostatitis, may cause preterm delivery
Testing: micro from vaginal swab, NAAT, point of care test
Manage: metronidazole 400mg BD and partner notification

55
Q

Hx urethral symptoms to ask for

A

Duration of sxs
Colour/amount
Other urinary sxs
Testicular sxs
Systemic sxs
Sexual hx (history of STIs)

56
Q

Presentation of cystitis

A

Dysuria
Frequency
Urgency
Nocturia
Haematuria
Suprapubic pain
Systemic

Usually due to gut bacteria

57
Q

Presentation of urethritis

A

Dysuria
Discharge
No bladder Sx
Nil systemic

Usually caused by:
Chlamydia
Gonorrhoea
Non-specific urethritis

58
Q

Presentation of dermatitis

A

“External dysuria”
Discomfort +/- itch
Rash or ulcers

Usually caused by:
Candidiasis
Trichomoniasis
Herpes simplex
Dermatoses

59
Q

Investigations for urethritis

A

Clinical Examination

Urethral swab for Gram stain and microscopy

Urethral swab for gonorrhoea culture and sensitivities

First void urine, Throat and rectal swabs for chlamydia and gonorrhoea NAAT

Blood for syphilis and HIV

60
Q

Diagnosis of urethritis on microscopy

A

More than 5 polymorphs on high powered field

Gm- intracellular diplococci = gonnococcal urethritis

None of above = non-gonococcal urethritis

61
Q

Complications of gonnorhoea

A

Lower gen tract
- bartholinitis, tysonitis
Upper gen tract
- endomitritis, PID
Disseminated
- skin lesions, septic arthritis

62
Q

Most common cause of non-specific urtheritis

A

Chlamydia

63
Q

Deep dyspareunia suggests?

A

Upper genital tract infection

64
Q

Cervical excitation/motion tenderness?

A

Pain on touch or movement of cervix

65
Q

Symptomatic sampling of discharge

A

Cervical microscopy (gram stain)
Vaginal microscopy (gram stain and wet prep) and pH (narrow range)
Amies swab (HVS culture and sensitivity) if recurrent/persistent, unknown cause, preg/PP, PID

66
Q

When is diag and treatment of PID considered?

A

sexually active woman who has
- recent onset, lower abdominal pain
- associated with local tenderness on bimanual vaginal examination
- pregnancy excluded
- no other cause for the pain

67
Q

Presentation of chlamydia

A

SYMPTOMS
Urethral discharge (milky)
Irregular bleeding (PCB/IMB) (this is red flag)
Abdominal pain
Dysuria

SIGNS
Urethritis
Cervicitis
Epididymo-orchitis
Proctitis (LGV)

68
Q

Complications of chlamydia

A

PID
Ectopic pregnancy
Reactive arthritis
Conjunctivitis
Fitz Hugh-Curtis (perihepatitis)

69
Q

Management of PID

A

Ceftriaxone 1G IM
Doxycycline 100mg BD x 2 weeks
Metronidazole 400 mg BD x 2 weeks

70
Q

Management of BV

A

Reassure

Metronidazole 400mg bd 5/7
Topical clindamycin 2% cream or metronidazole 0.75% gel

pH gels from pharmacy for prevention of recurrence
If persistent cnsider suppressive therapy (metro)

Worsening/recurring advice

71
Q

Management of candidiasis

A

Reassure

Clotrimazole 500mg pessary OR Fluconazole 150mg stat

Clotrimazole 1% cream for external symptoms x2 weeks

Worsening/recurring advice
Consider HIV test if recurrent

72
Q

Why can sex trigger BV?

A

Semen can incr pH of vagina

73
Q

Findings of BV on exam

A

Genital mucosae normal

Film of grey/white homogenous discharge at introitus and around cervix
Normal cervis

74
Q

RFs for candidiasis

A

Diabetes mellitus
SGLT2i (Type 2 DM)
Recent antibiotic use
Immunosuppression

75
Q

How is HSV transmitted?

A

close contact of oral or genital tract with an individual who is shedding virus

  • mouth, anogenital, eyes

virus travels along sensory nerves to dorsal root ganglion and remains inactive

causes symptom distribution in nevrve root, can be asymptomatic

reactivation more often in HSV 2

76
Q

Presentation of primary HSV

A

Symptoms:
Pain, dysuria, discharge, painful lymphadenopathy, systemic symptoms, rectal symptoms

Signs:
Erythema, vesicles/ulcers (scab), lymphadenopathy, cervicitis

HSV 1 and 2 often present the same but HSV 2 most likely to be asymptomatic

77
Q

Symptoms of recurrent HSV

A

Prodrome (tingling, itching, burning), localised vesicles/ulcers, heal with scab, lasts 5-10 days

78
Q

Inv for herpes

A

Swab lesion for HSV 1 and 2 PCR
Recommend a full STI screen (chlamydia, gonorrhoea, syphilis and HIV)

79
Q

Acquiring primary herpes in last 6 weeks of pregnancy may lead to?

A

Neonatal herpes

80
Q

Describe pres of primary syphilis

A

Incubation 10-90 days
Painless chancre
- mouth, vulval, tip of penis, anal
Resolves in 3-6w without treatment

81
Q

Describe pres of secondary syphilis

A

Incubation<2y
Haematogenous and lympathic dissemination causing multi-system disease

Systemic symptoms/fluey:
- low grade fever
- sore throat
- headache
- lymphadenopathy
- rash (esp palms and soles)
- wart like lesions in warm/moist areas (vulva, anus)

82
Q

Inv for syphilis

A

Swab from lesion for treponema pallidum PCR

Venous blood for syphilis IgG/IgM (EIA) - serology is not v specific but is best

TPPA is confirmatory, then RPR to monitor disease prog

Consider repeating STI screen if previously not definitive

83
Q

ST causes of gential lumps

A

Genital warts (HPV)
Molluscum contagiosum
Monkeypox
Scabies

84
Q

Non-ST causes of genital lumps

A

Physiological
Folliculitis
Hydradenitis suppurativa
Seborrhoeic keratoses
Cancers
Bartholin’s abscess
Skin tags
Lichen planus
Pyoderma granuloma

85
Q

Mnagaement of genital warts

A

Cryotherapy

Topical podophylotoxin
- Solution (0.5%)
- Cream (0.15%)

Imiquimod

Cataphen

Surgical
- Electrocautery
- Curette
- Debulking

86
Q

Is HPV persistent?

A

No not usually
70% DNA negative at 12m and 80% negative at 24m

Persistence more common in immunosuppressed or people who smoke

87
Q
A

Reproduction/Sexual Health (9 decks)

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