X Flashcards
What does LSC stand for?
Last sexual contact
What does PSC stand for?
Past sexual contacts
From what year would you expect a woman to have had the Hpv vaccine
1995
From what year would you expect a man to have had the Hpv vaccine
2005
What would you ask to determine HIV/HEP B risk?
Intravenous drug user? Sex worker? Homeless? Partner with Bloodborne disease? Unprotect sex?
What does SDI stand for?
Subdermal implant
How does the SDI work?
By suppressing ovulation - prevents a luteinising hormone surge which keeps FSH + oestradiol in normal ranges preventing ovulation. It also thickens cervical mucus and prevents sperm penetration.
How long does the SDI last?
3 years
What does cu-IUD stand for?
Copper IUD
How does the copper IUD work?
Prevents fertilisation
Copper is a spermicide
Inflammatory effect on the endometrium which helps prevent implantation
How long does the cu-IUD last?
5 or 10 year use
What does LNG-IUS stand for?
Levonogestrel intrauterine system
What progestogen does the LNG-IUS contain?
Levonogestrel
What are the options for the length of time the LNG-IUS?
3/5/6 year options
How does the LNG-IUS work?
Prevents pre-fertilisation i.e. thickens cervical mucus and thins the endometrium preventing sperm penetration
What is another anacronym for the depot infection?
DMPA
How does the DMPA work?
Suppresses ovulation by preventing the LH surge which maintains the FSH and oestradiol ranges
What are the two types of DMPA?
Depot and sayana press
Which DMPA injection id self-admin licensed
Sayana
How often is the DMPA Injections given ?
Every 13 weeks
How long are DMPA Injections effective
Up to 14 weeks
What progestogens do traditional progesterone only pills contain and the amounts?
Levogestrel 350mcg + Northisterone 30mch
How do traditions POP’s work?
Preventing pre-fertilisation i.e. thickening cervical mucus and preventing sperm penetration
What is the other type of POP and what hormone does it contain?
Desogestrel instead of LNG + northisterone
How do desogestrel POPs work?
Cervical mucus thickening like the LNG one but also by suppressing ovulation
What are the 3 types of CHC?
COC - combined oral contraceptive
CTP - combined transdermal patch
CVR - Combined vaginal ring
How do CHC work
Preventing ovulation and thickening cervical mucous
What does UPSI stand for?
Unprotected sexual intercourse
What are the 3 types of emergency contraception?
- cu-IUD
- Levonogestrel pill
- ulipristal acetate pill
Within how many hours should the cu-IUD be fitted from UPSI?
120 hours from the 1st UPSI. T
What is the dose of the LNG emergency pill?
1500mcg
Within how many hours should the LNG pill be given from UPSI?
Within 72 hours
How does the LNG pill work?
Delays ovulation
WHat is the dose of the ulipristal acetate pill (UPA)?
30mg
What is ulipristal acetate
Progesterone receptor modulater
How does the UPA pill work?
Delays ovulation up to 5 days
Within how many hours should the UPA be given from UPSI?
120hours
What is a caution of using the UPA pill?
Shouldn’t use if has had progesterone within 7 days prior and should take progesterone 5 days after as this may inhibit the effect of UPA
What does NAATs stand for?
Nucleic acid amplification tests
What does the NAAT test stand for?
Gonorrhoea and Chlamydia and sometimes trichomonas
What are the 2 STI related causes of genital ulcerations?
Genital herpes HSV and syphillis
Where can secondary syphillis cause a rash?
Palms and soles of feet
What diseases can mimic genital herpes
1). Syphillis
2). Steven - Johnson syndrome
3). Behcets disease
4). Monkey pox
5). Erosive lichen planus and erosive lichen sclerosus
What does eye-involvement i.e. conjunctivitis suggest if genital ulceration is present ?
Steven Johnson syndrome
What are the two types of HSV?
HSV 1 AND 2
What is the incubation period for HSV 1 + 2?
2-14 days
What percentage of genital ulcerations due to HSV recognised as symptomatic lesions?
20% - the majory have astypical presentation (i.e. fissures, splits, cuts) or are asymptomatic
Describe prodromal symptoms for hsv
Itching, aching, lymph swelling, fever
Describe the progression of lesions relating to HSV
Starts as a group of papules, becoming vesicles which ulcerates and they then coalesce , which crust and heal within 2 weeks
What is the causative organism for HSV
Herpes zoster
What is the causative organism for Chlamydia trachomatous L1-3
Lymphogranuloma venereum
Describe the 5 phases of HSV lesion evolution
- Erythema -accompanied by itching/soreness
- Blisters/ vesicles
- Coalescence - joining of ulcers to form larger lesions. They wi have serpiginous edges (moving from one to the other) which ooze blood when knocked
4.crusting and scabbing - Healed
Are HSV lesions usually unilateral or bilateral?
Bilateral
What usually accompanies HSV ?
Tender inguinal lymphadenopathy
How long do systemic symptoms for hsv last and when are they at their worst?
Up to 3 weeks and they can worse after 11 days
What is the difference in initial and recurrent HSV infections in the time they had and their presentation?
More often unilateral and only last a few days
How much of the HSV1 + HSV2 genome is identical?
50% -if you are already infected with one type of herpes then newly acquired other versions of the virus are usually milder
What tends to be the most severe manifestation of herpes?
Primary Genital infections
What type of HSV is most likely to cause genital herpes?
HSV1
Do men or women tend to have more extensive and severe infections with HSV?
Women
What are the most common symptoms for women with HSV?
- Pain in the vulva/urethra/vagina/anus/rectum/buttocks/thighs
- dysuria
- Urinary retention
- constipation is infected on anus/rectum
- abnormal urethral/vaginal/cervical and anal discharge
- or no symptoms
Why can HSV lead to retention?
Dysuria caused by passing urine over lesions leading to reflex retention
What organisms typically cause an infection of the lesions to occur secondary to the HSV?
Staphylococcus and streptococci, also fungi
What does an erythematous halo around a lesion suggest?
Infection of lesions
What is the complication ‘autoinoculation’ with HSV?
When HSV is innoculated in the eczematous patches usually on the eyes or fingers, leading to eczema herpeticum. It is rare this occurs with recurrences
What are some neurological complications with HSV
Radiculitis
Transverse myelitis
Autonomic neuropathy
Meningism
Encephalitis
What % of oral aciclovir is absorbed?
25%
Despite prompt Initiation, what will aciclovir not have an affect on?
No affect on the latent virus or natural history of the disease. It will just help reduce severity of recurrences
What is the preferred aciclovir regimens?
Aciclovir 400mg TDS or valaciclovir 500mg BD
What are an alternative aciclovir regimens?
Aciclovir 200mg 5x per day
What is the recommendation with aciclovir of there is new lesion formation at 5 days?
Continue for 10 days
How likely are recurrences with HSV1 infections
Rare
What % of patients with HSV2 will have more than 10 recurrences in a year
10% - 90% will have fewer than 10
What are the clinical features of recurrence of HSV?
Typically last 2-5 days
Usually unilateral lesions (25% have bilateral lesions)
Rarely associated with systemic symptoms
Unilateral lymphadenopathy
Rarely have troublesome prodromal symptoms or neuralgic pain
Most won’t require antivirals
I’m immunocompetent patients lesions will heal quickly without scarring
What will taking a short course of antivirals during the early phases of infections do?
- diminish amount of viral replication
- limit extent of lesion development (up to 1/3 of lesions will not ulcerate with treatment)
- control local neuralgia, itch and pain
What people with HSV would episodic therapy not be helpful for?
- people whose lesions have already progressed beyond the papule stage
- people with severe prodrome
When might continuous / suppressive antiviral regime be appropriate?
- frequent troublesome disease
- prodrome symptoms being the main problem
- no warning signs to infection which make it difficult to start episodic treatment early in infection
- complex disease with systemic symptoms
- management of psychosexual problems and transmission anxiety
What does IMB stand for?
Intramenstrual bleeding
What does PCB stand for?
Post-coital bleeding
When recording PSC for how many / for how long do you record them?
Record details for last 2 PSC and get number of PSC for last 3-6 months
What does IVDU mean?
Intravenous drug use
What is the most common cause of abnormal vaginal discharge?
BV
Is BV an STI?
No - but it can make other STIs more susceptible
What is the good bacteria in the vagina called?
Lactobacilli
What does lactobacilli do?
Keeps vaginal fluid mildly acidic
How does BV occur?
When there is an overgrowth of bad bacterias (anaerobes) which disturbed the pH and makes it more alkaline
What can increase the risk of BV
- new or multiple sexual partners
- douching or using vaginal washes or soaps
- smoking
- oral sex
What are symptoms of BV?
- fishy smell, worse after sex
- thin and white/grey watery discharge
What symptoms are BV not associated with?
Soreness, itching or irritations unless thrush is occuring also
What % of women have no symptoms with Bv
50%
What abx is used for BV?
Metronidazole (PO or PV gel)
Or clindamycin PV gel
What implications can BV have with abortion
Can increase the risk of bacterial infection spreading from vagina to cervix during surgical abortion which may lead to PID
What are the symptoms of thrush in women?
White vaginal discharge like cottage cheese
Discharge doesn’t smell
Vulval itching and irritation
Soreness and stinging during sex
Dysuria
Is trichomonal vaginalis an STI
Yes
What is trichomonal vaginalis (TV) caused by?
A protozoan (a tiny one-celled parasite called trichomonas vaginalis)
What % of people with TV do not have symptoms?
70%
When can symptoms of TV show?
Usually within 5-28 days but sometimes not til much later
Without treatment howong can TV last?
Months or even years
What symptoms occur in women with TV?
Increased vaginal discharge
Unpleasant smelling discharge
Dysuria
Vulval itching and soreness
Dyspareunia
What is the treatment for TV?
Metranidazole
When can you have sex again if you have had TV?
Should not have sex even with a condoms until one week after both person and partner have finished treatment
What bacteria causes Chlamydia?
Chlamydia trachomatis
Which body parts can Chlamydia infect?
Urethra, vagina, cervix, testi, ovaries, rectum, throat and eyes
What is the most common STI in the UK currently?
Chlamydia
Symptoms of Chlamydia in women?
IMB
Low abdo pain and deep dyspareunia
Dysuria
Change in colour/amount of discharge
How long after possible infection with Chlamydia should you be tested ?
2 weeks at least as may not show up earlier than that
What complications can arise in women if chlamydia is left untreated?
PID - if it passes to the fallopian tubes or ovaries which increases the risk of infertility and/or ectopic pregnancy
What is SARA and how does it relate to Chlamydia?
Sexually acquired reactive arthropathy - rarely Chlamydia can cause this, pain in joints. More common in men
How long after Chlamydia infection should someone wait to have sex after treatment?
1 week Including oral/anal/with condoms (if treated with a sine dose of azithromycin) and until the course of abx is done with 7 day course of Doxycycline
What bacteria causes gonorrhoea?
Neiserria gonrrhoeae
Where can gonhorroea infect
Urethra, vagina, cervix, uterus, fallopian tubes, ovaries, testis, rectum, throat and sometimes eyes
In which part of the body would you likely not notice symptoms with gonorrhoea?
Cervix, throat, rectum
Symptoms of gonorrhoea?
IMB
Low abdo pain or deep dyspareunia
Dysuria
Increased vaginal discharg
When can someone have sex again after treatment for gonorrhoea?
7 days after you have taken treatment (incl. Oral and condom sex)
How long after treatment should you get retested to ensure gonorrhoea is gone completely?
2 weeks
What complications can arise from untreated gonorrhoea?
Spreading of infection to womb or ovaries causing PID which can cause infertility and pain
Can spread to the blood and cause sepsis (rare)
What is the 2nd most common STI in the UK?
Gonorrhoea
What should co sider when taking the history of a patient with abnormal bleeding ?
- current contraceptive method (duration and adherence)
- bleeding pattern
- period hx.
- drug interactions
- comorbidities
- cervical screening hx.
- possibility of pregnancy
- sti’s?
- other symptoms
What fraction of women in Britain will have an abortion by time they are 45?
1/3
How many women globally die each year from complications associated with unsafe abortions?
47000 women
How many clauses can an abortion be signed off within according the the abortion act 1967?
5 clauses A-E
What two clauses of the abortion act 1967 dictate that termination can only be performed up to 24 weeks?
Cause C and D
Both clauses C + D dictate that termination be carried out before 24 weeks and if continuation of pregnancy is of higher risk that termination. Which clause dictates that the clause is of higher risk to the woman, and the risk is of higher risk to family + existing children?
Clause C - risk of continuing preg is of higher risk than termination to the woman
cLause D - risk of continuing of pregnancy is higher risk than termination to woman, family or existening children
Which clauses of the abortion act have no time limit for termination?
Clause A, B + E
What does clause A of the abortion act state I’d the required eligibility to have a termination signed off at any gestation?
States that continuing the pregnancy would involve risk of life to the pregnant woman, greater than if the baby was terminated
What does clause B of the abortion act state I’d the required eligibility to have a termination signed off at any gestation?
Termination is necessary to prevent grave permanent I just to the physical and mental health of the women
What does clause E of the abortion act state I’d the required eligibility to have a termination signed off at any gestation?
There is substantial risk that if the child were born it would suffer from physical and mental abnormalities as to be seriously handicapped
What are the 3 forms that must be signed to agree a termination?
HSA1, HSA2, HSA4
What are the 3 forms that must be signed to agree a termination?
HSA1, HSA2, HSA4
How many drs are required to sign a HSA1 form?
2
What is the HSA4 form
Abortion notification form to inform chief medical officer and department of health
What % of women are asymptomatic with trichomonas?
10-50%
What % of women present with abnormal vaginal discharge with TV?
70%
What % of women with TV have frothy yellow discharge ?
10-30%
What % of women with TV with have an appearance of a strawberry cervix?
2%
What STI does this statement apply to: “urethral infection is found in 90% of women but the urethra is the sole site of infection in only 5%”
TV
What complications may arise with TV
- preterm birth and low birth weight
- predisposition to postnatal sepsis if present at delivery
- increase HIV transmission
How do you text for TV?
- swab in post fornix on spec examination
- urine testing has an acceptable sensitivity to the protazoa of 88%
What is the spontaneous cure rate for TV?
20-25%
What antibiotics are used for TV in what doses?
- single dose 2g metranidazole
- 7 days 500mg BD metranidazole (more effective)
