Sexual and Reproductive Health 2

Question 1

What are the two different types of morning after pill?

Answer 1

levonella

ulipristal (ellaOne)

Question 2

How does levonellse work?

Answer 2

single 1.5 mg dose of progesterone
best taken within 24 hours and no later than 72 hours
affects sperm function, endometrial receptivity and prevents follicular rupture
vomiting and menstrual disturbances in following cycle

Question 3

How does Ulipristal work?

Answer 3

selective progesterone receptor modulator
prevents/delays ovulation, reduces embryo implantation
as effective as levonelle can be used up to 120 hours
blocks action of progesterone therefore reduces the effectiveness of progesterone containing contraceptives

Question 4

How can the IUD be used as emergency contraception?

Answer 4

Insertion of IUD usually prevents implantation
Can be inserted up to 5 days after unprotected intercourse or expected day of ovulation
Antibiotic prophylaxis given at time of insertion

Question 5

What are the causes for failure to use adequate contraception?

Answer 5

major problem
contraception must be appropriate to woman’s lifestyle
misunderstandings and dislikes lead to non-compliance
fully counsel woman on major problems and minor Res

Question 6

What are the failure rates of the different types of contraception?

Answer 6

Combined oral contraceptive pill/combined transdermal patch/combined vaginal
ring – 0.2 per 100 woman years
Male condom/female condom - 2-15 per 100 woman years
Diaphragms/caps – about 5 per 100 woman years
Female sterilisation – 1 in 200 lifetime risk of failure
Male sterilisation – 1 in 2000 lifetime risk (after 2 negative semen analyses)
Intrauterine device – <0.5 per 100 woman years

Question 7

What are the surgical methods used for abortion?

Answer 7

suction curettage - between 7-13 weeks

dilation and evacuation,, proceeded by cervical preparation - after 13 weeks safe and effective

Question 8

What are the medical methods for abortion?

Answer 8

antiprogesterone and prostaglandin are most effective at <7 weeks - can also be used 7-9 weeks and mid trimester 13-24 weeks

foeticide preformed (KCL into umbilical cord or fatal heart) beyond 22 weeks

Question 9

What are the complications of abortions?

Answer 9

haemorrhage 
infection 
uterine peroration 
cervical trauma at time of surgical abortion 
failure

Question 10

What is candidiasis/thrush?

Answer 10

infection with candida albicans

found in 20% women

Question 11

What are the RFs for candidiasis?

Answer 11

pregnancy
diabetes
antibiotic use

Question 12

How does candida present?

Answer 12

asymptomatic
cottage cheese discharge with vulval irritation and itching
superficial dyspareunia and dysuria
vagina is inflamed and red

Question 13

What is the treatment for candidiasis?

Answer 13

topical imidazole

oral fluconazole

Question 14

What is bacterial vaginosis?

Answer 14

normal lactobacilli overgrown by mixed flora

12% women

Question 15

How does bacterial vaginosis present?

Answer 15

grey-white discharge but vagina not red/itchy
characteristic fishy odour
raised vaginal pH

Question 16

How is bacterial vaginosis managed?

Answer 16

metronidazole or clindamycin cream

Question 17

What are the other causes of vaginal discharge?

Answer 17

foreign bodies
sexual abuse
atrophic vaginitis
retained tampon - toxic shock syndrome

Question 18

How does chlamydia present?

Answer 18

usually asymptomatic
urethritis
vaginal discharge
can cause pelvic inflammation leading to tubal damage –> sub fertility +/- chronic pelvic pain

Question 19

How is chlamydia diagnosed?

Answer 19

PCR swabs

Question 20

What is the treatment of chlamydia?

Answer 20

azithromycin 1g PO STAT
or
doxycycline 100mg PO BD 7 days (rectal infection)
Contact tracing

Question 21

How does gonorrhoea present?

Answer 21

usually asymptomatic 
vaginal discharge 
urethritis 
barthonlinitis 
cervicitis 
pelvis commonly infected 
can cause bacteraemia and acute septic arthritis

Question 22

How is gonorrhoea diagnosed?

Answer 22

culture of endocervical swabs

Question 23

What are the treatment options for gonorrhoea?

Answer 23

Ceftriaxone 500mg IM STAT and Azithromycin 1g PO STAT
Contact tracing
test of cure

Question 24

How do genital warts present?

Answer 24

tiny patches of vulval skin to small papillifrom swellings

usually multiple and may affect cervix

Question 25

How are genital warts treated?

Answer 25

cryotherapy
topical podophyllin or imiquimod cream

high recurrence rate

Question 26

How does genital herpes present?

Answer 26

HSV type 2 
primary infection causes multiple small painful vesicles and ulcers around introitus 
local lymphadenopathy 
dysuria 
systemic symptoms 
rare: secondary bacterial  infection

Question 27

Does genital herpes reactivate?

Answer 27

virus lies dormant in dorsal root ganglia

75% reactivate but less painful/severe

Question 28

How is the diagnosis of genital herpes made?

Answer 28

examination

viral swabs

Question 29

What is the treatment of genital herpes?

Answer 29

acyclovir 200mg PO 5 a day for 5 days
analgesia

valaciclovir/gamciclovir in severe infections

Question 30

What is the cause of syphilis?

Answer 30

treponema pallidum

common in the developing world

Question 31

How does primary syphilis present?

Answer 31

solitary painless vulval chancre

Question 32

How does secondary syphilis present?

Answer 32

weeks later

rash, influenza like symptoms, warty genital or perioral growths

Question 33

How does tertiary syphilis present?

Answer 33

rare 
aortic regurgitation 
dementia 
tabes dorsalis 
gummata in skin and bone

Question 34

What is the investigations for syphilis?

Answer 34

bloods

Question 35

How is syphilis treated?

Answer 35

benzathine penicillin 2.4MU IM

contact tracing