GUM Flashcards
(112 cards)
1
Q
GUM History Taking
- Steps
A
Sexual History Taking
- Steps
- Concerns and expectations
- Check identity/pronouns
- PMC
- Drug history
- chemsex - If uterus
- Gynae/smear/HPV vaccine
- Menstrual
- Contraception
- Pregnancies - Social Hx
- Sexual History
- Chemsex - BBI risk (blood born)
2
Q
HPV vaccine
- Valency
- Age
- Years introduced
A
HPV
- Vaccine
1. Now quadra-valent
2. Was bi-valent - Age
3. 12-13 - Years introduced
4. 2008 onwards
3
Q
GUM
- Presenting complaint AFAB
A
GUM AFAB
- Presenting complaint
- Vaginal discharge
- Lumps/ulcers
- IMB/PCB
- Dyspareunia (deep/superficial)
- Urinary symptoms
- Abdo pain
- STI contact
- contraception - Rectal symptoms
- Sexual assault
- Asymptomatic screens
4
Q
GUM AMAB
- Presenting complaint
A
GUM AMAB
- Presenting complaint
- Urethral discharge
- Urinary symptoms
- Lumps/ulcers
- Testicular pain/swelling
- Rectal symptoms
- Sexual dysfunction
- Asymptomatic screens
5
Q
GUM
- Sexual history
A
GUM
- Sexual history
- STI Hx
- Last sex episode
- Male/female/trans
- Regular or casual contact
- Duration of sexual relationship
- Sexual activity
- use of barriers - Type of sex
- MSM (active/passive) - Partner details/contact tracing
6
Q
GUM
- BBI risk factors
A
GUM
- BBI risk factors
- IVDU
- MSM/Anal sex
- Swingers
- Partners
- High risk countries - Paid-for sex
- Blood products
- 1985 or abroad - Tattoos/piercings
7
Q
GUM
- Examination principles
A
GUM
- Examination principles
- Explain rationale
- Consent
- offer to stop at any point - Chaperone
- Document even if declined - Privacy for dressing/undressing
- Expose only area needed
8
Q
GUM
- Male examination
A
GUM
- Male examination
- Palpate inguinal region
- lymphadenopathy - Inspect pubic area and scrotum
- Inspect penis
- retract foreskin (eg thrush) - Palpate scrotum
- symmetry of size, firmness,
- swelling/cyst/hydrocele - MSM
- Peri-anal
- Proctoscope
9
Q
GUM AMAB
- Symptomatic investigations
A
GUM
- Symptomatic investigations
- Urethral smear
- GC or NSU (non-specific)
- GC culture (gonorrhoea) - First pass urine
- GC/CT dual Naats - Bloods
- HIV/syphilis
- Hep B/C - Rectal/pharyngeal swab/culture
- MSM
- “Triple site testing” - Other swabs
- MC&S/Candida/Herpes - Urine dip
10
Q
GUM AFAB
- Examination
A
GUM AFAB
- Examination
- Lithotomy position
- Inspect and palpate inguinal region
- Lymphadenopathy - Inspect pubic area
- labia majora/minora
- perianal areas - Speculum exam
- Bimanual exam (PID - CMT cervical movement tenderness)
- Abdominal pain
- Deep dyspareunia
11
Q
Speculum examination
- Technique
A
Speculum examination
- Technique
- Lubricant and warmed
- Insert using dominant hand
- Part labia with non-dominant hand
- Slowly insert
- open blades to visualize the cervix
12
Q
Bimanual examination
- Technique
A
Bimanual examination
- Technique
- Gloved right hand
- separate labia - Index and middle finger
- insert into vagina and palpate cervix - Left hand
- palpates uterus and adnexa
13
Q
GUM
- Symptomatic afab investigations
A
GUM
- Symptomatic afab investigations
- TV, BV, Candida
- High vaginal loop swab for MC & pH - Chlamydia and gonorrhoea
- Vulvovaginal swab ‘dual NAAT’
- May offer triple site testing - Bloods
- HIV/Syphilis
- Hep B/C - History dependant
- TV - High vaginal charcoal/PCR
- Gonorrhoea - endocervical
- Herpes simplex - PCR
- Pregnancy test (?PID)
14
Q
GUM - Asymptomatic screening
- Afab
A
GUM - Asymptomatic screening
- Afab
- Self- vulvo-vaginal swab
- Dual NAAT chlamydia - Serology
- STS, HIV - Pregnancy test/Urinalysis
15
Q
Partner notification
- Definition
A
Partner notification
- Definition
- Contacting and advising
- Those at high risk of
- STI/HIV
- encouraged to attend
16
Q
GUM - Partner notification
- Securing co-operation
A
GUM - Partner notification
- Securing co-operation
- Voluntary
- Non-judgement and supportive
- Emphasize patient choice
- Confidentiality
- Risk of re-infection
- Partner at risk from infections
- Risk of transmission
17
Q
GUM
- Identifying partner’s at risk
A
GUM
- Identifying partner’s at risk
- Look-back period
- infection specific - Memory prompts can help recall
- Document details to track progress
- Safer sex advice
18
Q
GUM
- HIV non-notification
A
GUM
- HIV non-notification
- In ‘x’ time, if you have not notified, we will
19
Q
Genital Warts
- Latin name
- Pathology
A
Genital Warts
- Latin name
1. Condyloma acuminata - Pathology
- HPV manifestation
20
Q
Condyloma acuminata
- Commonest
- High risk
A
Condyloma acuminata
- Commonest (90%)
- Types 6, 11 - 16 & 19
-High risk
21
Q
HPV types
- Hands
- Face
- Genital/laryngeal
- CIN
- Head and Neck Ca
A
HPV types
- Hands
2, 4, 26, 27 - Face
2 - Genital/laryngeal
6,11 - CIN
16,18 - Head and Neck Ca
18
22
Q
HPV
- Pathophysiology
A
HPV
- Pathophysiology
- Basal layer invaded
- Latent phase
- Dormancy - Viral DNA, capsids
- Wart formation
23
Q
HPV
- Infectivity rate
- Incubation
- Prevention
A
HPV
- Infectivity rate
1. 60% (sexual contact)
- Incubation
2. 2. weeks to 8 months
3. 3 Months average - Prevention
4. Condoms do NOT prevent skin contact
24
Q
Gential warts
- Presentations
A
Gential warts
- Presentations
- Usually asymptomatic and painless
- Noticed after sexual contact aqcuiring them
- Itching or sore
- Peri-anal common
- Internal lesions
- Bleeding from urethra, anus, cervix
- Distorsion of urine flow - Pscyhological distress
- Site of trauma
- Warm or moist conditions
- Multifocal infection
- Ano-genital
25
Condyloma acuminata (Warts)
- Clinical appearance
Condyloma acuminata (Warts)
- Clinical appearance
1. Solitary or often multiple
2. Can be
- Broad based
- Pedunculated
- Pigmented
3. Warm, moist, non-hairy skin
- soft
- non keratinised
4. On hariry skin
- firm and keratinised
26
Condyloma acuminata (warts)
- Female follow up
Condyloma acuminata (warts)
- Female follow up
1. Sepculum exam
2. Colposcopy
- if internal warts
3. Proctoscopy
- if rectal bleeding
27
Condyloma acuminata (warts)
- Common differentials
- Other things to consider
Condyloma acuminata (warts)
- Common differentials
1. Fordyce spots
2. Pearly papules
3. Skin tags
4. Follicles
5. Tyson’s glands
6. Vestibular papillosis
7. Haemangiokeratoma
8. Sebaceous cysts
- Other things to consider
1. Conylomata lata (syphilis)
2. VIN, PIN, SCC
3. Molluscum contagiosum
28
Buscheke-Lowenstein
- Pathology
Buscheke-Lowenstein
- Pathology
1. Giant condyloma accuminata
- HPV
2. Higher rate of malignant transformation
29
Condyloma acuminata
- Mx
Condyloma acuminata (Warts)
- Mx
1. Screen for STIs
2. Reassure
- Cosmetic rather than immune
4. cryoRx
5. Podophyllotoxin
- antimitotic
6. Immune modifiers
- Imiquimod cream
7. Catephen
- Green tea leaf extract
8. Surgery
30
Condyloma accuminata
- Patient applied therapy
Condyloma accuminata
- Patient applied therapy
1. Softer warts
2. 4 weeks to 16 weeks
3. Include:
- Podophyllotoxin
- Imiquimod
- Catephen
31
Genital warts
- Threshold to refer
Genital warts
- Threshold to refer
1. Suspicious/uncertain/internal
2. Recalcitrant lesions (consider HIV)
3. Cervical lesions
4. Meatal warts
5. Immunosuppressed
6. Pregnant
7. Children/young
8. Elderly
9. High risk
32
HPV
- Quadravelent vaccine
HPV
- Quadravelent vaccine
- 6&11
- 16&18
33
Genital warts in pregnancy
1. Vertical transmission
2. Management
Genital warts in pregnancy
1. Vertical transmission
- Very low risk
2. Management
- Watch and wait
- Cryoablation
- Surgical if extreme
34
HIV
- Replication
HIV
- Replication
1. Uses reverse transcriptase
2. Generates proviral DNA from RNA
35
HIV Presentation
1. Asymptomatic
2. Early infection
3. Advanced HIV
HIV Presentation
- Asymptomatic
0. screening
- Early infection
1. Seroconversion symptoms
2. TB
3. Blood dyscrasias
4. Lymphomas
- Advanced HIV
1. PCP
2. Cryptococcal meningitis
3. Malignancies/pathology
- KC
36
HIV Seroconversion illness
- Mx
HIV Seroconversion illness
- Mx
1. Early treatment
- TasP (treatment as prevention)
2. Risk behaviour modification
3. PN
37
HIV
- Testing
HIV
- Testing
1. EIA
- 4th Generation combo assay
- Detects antibodies
- Detects P24 antigen
- 45 day window
2. Immunoblot in lab
- other antigens
3. PCR
- Viral load measure
38
HIV
- Testing in Sero-conversion
HIV
- Testing in Sero-conversion
1. False negatives possible
- Test and repeat over time
2. Viral load
- help diagnose before antibodies (45 day window)
3. Pro-viral DNA
- considered in some circumstances
4. PrEP and PEPSE
- Delayed or unusual seroconversion
39
HIV
- Monitoring tests
HIV
- Monitoring tests
1. CD4 count
2. Viral load
3. HIV resistance testing
4. Patient health
- FBC, U&E, LFT, Bone, Physical, Fundoscopy, Urine dip
5. Infection screening
- STIs/BBIs
- TB
- OI
40
HIV
- TasP
HIV
- TasP
1. Treatment as prevention
2. Valid if VL<50 for 6mo
41
HIV
- PrEP
- PEPSE
HIV
- PrEP
1. High risk eligible patients
2. Truvada daily or 'event based'
3. At least 86% successful
- PEPSE
1. Within 72 hours of exposure
2. Truvada and Raltegravir for 28 days
42
HIV
- Treatment
HIV Treatment
- Triple Anti-retroviral
1. Typically 2 NRTI + 3rd agent
2. Many one pill OD
3. Monitored 6 monthly
- viral load
- regular blood tests
43
HIV
- Drug classes
HIV
- Drug classes
1. NRTI
- Nucleoside reverse transcriptase inhibitors
eg. Tenofovir, abacovir, emtricitabin, lamivudine
2. NNRTI
eg. Efavirenz, doravarine
3. Protease inhibitors
- co-prescribed with a booster
eg. Darunavir pulus Ritonovir
4. Integrase inhibitors
- eg. Raltegravir, bictegravir
44
Hepatitis C
- Virus
- Transmission
Hepatitis C
- Virus
1. RNA
2. Flaviviridae family
- Transmission
1. Parenteral
2. Vertical (5% risk)
3. Sexual transmission (very low)
- UP AI
- Fisting, rimming, chemsex IV 'slamming'
45
Hepatitis C
- Symptoms
- Incubation
- Progression
Hepatitis C
- Symptoms
1. Icteric hepatitis
2. Chronic hepatitis
- Incubation
1. 6 wks (4-20)
2. 90% positive serology at 3/12
- Progression
1. 80% progress to chronic
2. 30% to Cirrhosis
3. Hepatocellular carcinoma
46
Hep C
- Testing
Hep C
- Testing
1. Anti-HCV
- CUrrent or past infection
- 4-10 weeks after exposure
- Some detect HCV-Ag
2. HCV RNA
- Current vs past infection
3. Hep C genotyping
- guides treatment
47
Hep C
- Mx
Hep C
- Mx
1. Curable
2. Liver function
- hepatology involvement
3. DAAs
- Direct acting antivirals
- eg. Harvoni
48
Hepatitis B
- Virus
- Transmission
Hepatitis B
- Virus
1. DNA virus
- Transmission
1. Parenteral
2. Vertical
3. Sexual
- Rimming, multiple partners
49
Hep B
- Presentation
Hep B
- Presentation
1. Children
- no Sx
2. Incubation for 40-160 days
3. Acute phase
- Similar to Hep A
- Prodrome/icteric phase
50
Hep B
- Complications
Hep B
- Complications
1. Acute liver failure/mortality
<1%
2. Chronic
- 5-10% of symptomatic cases
- Higher in HIV, immunosuppressed, LD
3. 90% of infants will progress to chronic unless treated quickly
51
Hep B Prevention
- Pregnancy
- Sexual contacts
- Household contacts
Hep B Prevention
- Pregnancy
1. Antivirals in high load
2. Vaccination of neonate
3. HBIG if HR
- Sexual contacts
1. Vaccinate
2. HBIG if recent (<7 days)
3. Condoms until immune
- Household contacts
1. Vaccination
2. Do not share razors/toothbrushes
52
Hepatitis B Serology
- Interpretation
Hepatitis B Serology
- Interpretation
1. Surface antigen
- Hep B activity
2. Core antibody?
- Hep B exposure
3. Surface antibody
- Immunity
53
Hep B
- Management
Hep B
- Management
1. Notify
2. Self-limiting acute infection
3. Hepatology referral for persistent
4. STI/BBI screening
5. Vaccinate against Hep A
6. Treatment options
- Peg interferon alpha 2a
- Antivirals (Entecavir, tenofovir)
54
Genital sores
- Infective causes
Genital sores
- Common infectious causes
1. Candida
2. Herpes simplex
3. Herpes zoster
4. Syphilis
5. Tropical diseases
- LGV
- Granuloma inguinale
6. Chancroid
55
Genital soreness
- Non-infective causes
Genital soreness
- Non-infective causes
1. Trauma
- physical/chemical
2. Dermatological
- Drug reactions
- Bechets
- Apthosis
- Lichen planus
- Pemphigus
3. Malignancy
56
Herpes simplex
- Incubation period
- Stages of primary attack
Herpes simplex
- Incubation period
1. 3-14 days
- Stages of primary attack
1. Tingling and itching
2. Fluid filled blisters
3. Burst, painful sores
4. Scabbing, itching, cracking
57
HSV
- Tests
HSV Tests
- Immediate
1. PCR
- Delayed
1. Full STI screen
2. Syphilis serology
3. HIV antibody test
58
HSV 1 vs HSV 2
1. Location
2. Seropositivity
3. Recurrence in year 1
HSV 1 vs HSV 2
1. Location
- Orofacial vs genital
2. Seropositivity
- 80% vs 7%
3. Recurrence in year 1
- 1 vs 4
59
HSV
- Management
HSV Management
- Supportive
1. Rest
2. Analgesia (eg lidocaine 5%)
3. Saline washing
- Medical
1. Antivirals
- in systemic infection
eg. Aciclovir 400mg TDS 5/7
60
Herpes simplex
- Complications
Herpes simplex
- Complications
1. Urinary retention
2. Adhesions
3. Meningism
4. Recurrence/emotional distress
61
HSV
- Pregnancy
1. Recurrence
2. Trimesters
HSV
- Pregnancy
1. If recurrent - low risk
2. If third trimester, caesarian
62
Syphilis diagnosis
- Lesions
- Blood
Syphilis diagnosis
- Lesions
1. Dark ground microscopy
2. Treponemal PCR
- Blood
1. EIA
- Treponemal enzyme immunoassay
2. TPPA
- Treponema pallidum particle agglutination assay
3. RPR
- Rapid plasma reagin test
63
Syphilis
- Natural history
Syphilis
- Natural history
- Infectious
1. Primary
2. Secondary
3a. Early Latent period (<2y)
- Non-infectious
3b. Late latent (>2y)
4. Tertiary
64
Syphilis
- Mx
Syphilis
- Mx
1. Benzathine Penicillin
- IM
2. Once weekly when infectious
3. Thrice weekly in late latent
- CVS and gummatous syphilis
65
MPox
- Virus
- Symptoms
MPox
- Virus
1. Zoonotic disease
2. Monkeypox virus
- Symptoms
1. Rash
- face and body
- Palms and soles
2. Anorectal symptoms
66
PID
- Complications
PID
- Complications
1. Ectopic
2. Infertility
3. Tubo-ovarian abscess
4. Chronic pelvic pain
5. Fitz-Hugh-Curtis
- Peri-hepatitis
- CT PID
67
PID
- Locations
PID
- Locations
1. Cervicitis
2. Endometritis
3. Salpingitis
4. Intra-abdominal
68
PID
- Infections
PID
- Infections
-STIs
1. Chlamydia
2. Gonorrhoea
3. Mycoplasma genitalium
Non-STIs
1. Anaerobes
2. Gardnerella vaginalis
3. Vaginal flora
- Poly-microbial
69
PID
- Symptoms
PID
- Symptoms
1. Abdo pain
- bilateral and lower
2. Deep dyspareunia
3. Discharge
- ICB/HMB
4. Dysmenorrhoea
- Purulent dischrge
- Fever, rigors, chills, night sweats
70
PID
- Signs
PID
- Signs
1. Abdo tenderness
- bilateral lower
2. Uterine/adnexal tenderness
3. Cervical motion tenderness
4. Adnexal mass
- abscess
5. Muco-purulent vaginal discharge
6. Cervicitis/contact bleeding
7. Pyrexia
8. Peritonitis
9. Fitz-Hugh-Curtis
71
PID
- Differentials
PID
- Differentials
- Gynae
1. Ectopic
2. Ovarian cyst (torsion, rupture, haemorrhage)
3. Endometriosis
- UTI
1. Cystitis
- GI
1. IBD
2. Appendicitis
3. IBS
72
PID
- Ix
PID
- Ix
1. Swabs
- Gonorrhoea, chlamydia, trichomonas vaginalis, mycoplasma genitalium
- Confirmation, not exclusion
2. Urine Dip/MSU
- Exclude urinary tract
3. Pregnancy
4. Microscopy
- Discharge
5. TUS
- If uncertainty, severity
6. Laparoscopy
- In severe cases with uncertainty
73
PID
- Empirical treatment
PID
- Empirical treatment
1. Low threshold
- Sexually active
- New onset lower bilateral abdo pain
- Tenderness
2. Condition
- Pregnancy excluded
- No other cause of pain
74
PID
- Outpatient treatment
PID
- Outpatient treatment
1. Stat IM Ceftriaxone (gonorrhoea)
+Doxycycline PO (chlamydia)
+ Metronidazole PO (anaerobes)
2. Mycoplasma:
Moxifloxacin OD PO
3. Analgesia
4. Rest
5. Abstinence
- self and partner treated
75
PID
- Outpatient follow-up
PID
- Outpatient follow-up
1. 72hrs
- Consider removing IUC
- Consider IV abx
2. 2-4 weeks
- Symptom resolution
- Abx compliance
- Screening of contacts
76
PID
- Inpatient indications
PID
- Inpatient indications
1. Nausea, vomiting, high fever
2. Peritonitic
3. Pregnant
4. Unresponsive to po abx
5. Uncertain diagnosis
77
PID
- Inpatient abx
PID
- Inpatient abx
1. IM Ceftriaxone
+ IV doxycycline
-> PO Met and PO Doxy
2. IV clindamycin
+ IV gentamicin
-> PO Clinda and PO Met
78
Vaginal discharge
- Questions
Vaginal discharge
- Questions
1. Colour, blood
2. Consistency, odour
3.Itch/soreness
4. IMB/PCB
5. Dyspareunia
6. Rash/lesions
79
Vaginal secretion
- Vaginal
- Cervical
Vaginal secretion
- Vaginal
1. Candidiasis
2. Trichomoniasis
3. Gardnerella-associated
4. Bacteria (FB)
5. Postmenopausal vaginitis
- Cervical
1. Gonorrhoea
2. Non-specific
3. Herpes
4. Ectopy
5. Neoplasm eg. polyp
80
Vaginal discharge
- High VS
- Vulvlovaginal
- Endocervical
- Other
Vaginal discharge
- High vaginal swab
1. Culture
- T. vaginalis
- Candida
2. Wet mount
3. Gram stain
- Vulvlovaginal
1. NAAT
- N.gonorrhoeae
- C. trachomatis
- Endocervical
1. Gonorrhoea culture
- Other
1. Other organisms
2. HSV PCR cervix
81
Candidiasis
- Epidemiology
- Risk Factors
Candidiasis
- Epidemiology
1. 75% lifetime risk for women
- Risk Factors
1. Immunosuppression
2. High oestrogen
- pregnnacy
- luteal phase
- COCs
3. ABx
4. DM
5. Mucosal breakdown
- sex, dermatitis
6. Atopy
- Recurrent candidiasis
82
Candida
- Tests
Candida
- Tests
1. Clinical
- Normal pH
- Infection
2. Samples
- Vaginal Wall
+/- vulval swab
3. Gram staining
- 60% sensitive
- 90% albicans/5% glabrata
83
Candida
- Mx
Candida
- Mx
1. Antifungal
- Fluconazole
- Clotrimazole
+/- Hydrocortisone 1%
2. Recurrent
- >4 episodes per year
- Induction then maintenance
- Fluconazole every 72 hours then weekly
- Fluconazole weekly
84
BV
- Epidemiology
- Precipitants
BV
- Epidemiology
1. Most common discharge in child-bearing age
- Precipitants
1. Unprotected sex
2. Receptive oral
3. Douching
4. Menstruation
85
BV
- Diagnosis
BV
- Diagnosis
1. Hay-Ison criteria
- Posterior fornix gram
2. Amsel (3 of:)
- Characterisitc discharge
- Wet mount epithelial 'clue' cells
- Raised pH
- KOH "whiff test"
86
BV
- Mx
BV
- Mx
1. Metronidazole
- BD 5/7
2. Avoid precipitants
87
Trichomonas
- Sx
Trichomonas
- Discharge
1. Off-white, blood-staining
2. Putrid, frothy
3. Itch/soreness
4. Strawberry cervix
- contact bleedin
88
Trichomonas
- Ix
Trichomonas
1. Posterior fornix sample
2. Vulvo-vaginal swab
- self-taken
3. First void urine in men
- urethra swab
- centrifuged
3. Wet mount
- 70% sensitive compared to culture
89
Trichomonas
- Mx
Trichomonas
- Mx
1. Metronidazole
- 400mg BD 7/7
90
Male urethral discharge
- Investigations
Male urethral discharge
- Investigations
1. Exam
2. Gram stain
- urethra smear
3. Gonorrhoea culture
4. Urine NAAT
- NG and CT
5. Considere
- Micro of urine threads
- TV - wet smear
- MSU
- HSV PCR
91
Gonorrhoea
- Dx
Gonorrhoea
- Dx
1. Microscopy
- Urethral/cervical
2. NAAT
- >95% sensitivity
3. Culture
- After NAAT, for treatment
92
Gonorrhoea
- Mx
Gonorrhoea
- Mx
1. Ceftriaxone
- Susc not known
2. Cipro
- Susc known
3. Allergy
- Discuss with GUM
93
Non-specific Urethritis
- NSU
- Common agents
Non-specific Urethritis
- NSU
- STI pathogens
1. CT
2. Mycoplasma genitalium
3. Ureaplasma urealyticum
4. TV
5. HSV
6. HPV
94
Non specific urethritis
- Non STI
Non specific urethritis
- Non STI
- Infective
1. UTI
2. Adenovirus
3. Candida
- Non-infective
1. Drugs
2. Alcohol
3. Trauma/FB
95
Chlamydia
- Mx
Chlamydia
- Mx
1. Doxy
- BD 7/7
2. Azithro/erythro
96
Mycoplasma genitalium
- Microscopic appearance
- Presentation
Mycoplasma genitalium
- Microscopic appearance
1. Flask shaped
2. Small gram +ve
- Presentation
1. Urethritis, epididymitis, proctitis
2. PID, mucopurulent cervicitis
97
Mycoplasma genitalium
- Dx
Mycoplasma genitalium
- Dx
1. First void urine
2. Swab
- Self-taken vaginal
- Anal
3. NAATs
- detect resistance
98
Mycoplasma genitalium
- Mx
Mycoplasma genitalium
- Mx
- ABx (no cell wall)
1. Doxy 7/7 + Azithro 4/7
2. Moxifloxacin 7-10/7
- PID/Epididymitis
1. Moxifloxacin 14/7
99
POP
- Active ingredients?
1. Cerazette
2. Micronor
3. Noriday
4. Norgeston
POP
- Active ingredients?
1. Cerazette
- Desogestrel
2. Micronor & Noriday
- Norethisterone
3. Norgeston
- Levonorgestrel
100
LARC contraception
- Routes
LARC contraception
- Routes
1. Injections
2. Implants
3. Devices/systems
101
LARC contraception
- Injectables (POIC)
Progestogen-only Injectable
1. Depo Provera (IM)
- 12 wk
2. Sayana Press (SC)
- 13wk
102
LARC contraception
- LNG-IUS
Levonorgestrel-releasing IUS (LNG IUS)
1. Mirena
2. Kyleena
3. Jaydess
4. Levosert
103
Lactational Amenorrhea Method
- Effectiveness
Lactational Amenorrhea Method
- Effectiveness
1. 98% if all of:
- Fully breastfeeding
- No periods
- <6 mo postpartum
104
IUD vs IUS
- Fertilisation or implantation?
IUD vs IUS
- Fertilisation or implantation?
1. IUD
- Prevents fertilisation
2. IUS
- Prevents implantation
105
COCP vs POP
- Missed pills
- Clots
- Periods
- Acne
COCP vs POP
- Missed pills
1. Daily for POP (12hrs)
- Clots
2. Increased in COCP
- Periods
3. Lighter in COCP
- Changes in POP
- Acne
4. Can improve with COCP
106
1 Missed Pill?
1 Missed Pill?
1. Take the missed pill
2. Continue as normal
107
2 -7 missed pills
- Week 1
- Week 2
- Week 3
2 or more missed pills
- Week 1
1. Emergency contraception
2. Take last pill missed
3. 7 days contraception
4. Continue as normal
- Week 2
1. Take last missed pill
2. Extra contraception
3. Continue as normal
- Week 3
1. Take last missed pill
2. Skip break (dummy or pill-free)
108
8 or more missed pills
- COCP
8 or more missed pills
- COCP
1. Preg test
2. Emergency contraception
109
LARC
- Injection ADRs
LARC
- Injection ADRs
1. Bleeding
- Erratic then amenorrhoea
2. Weight gain
3. Fertility
- 1 year in delay
110
LARC
- Implant brand
- Length of activity
- Return of fertility
LARC
- Implant brand
1. Nexplanon
- Etonogestrel
- Length of activity
2. 3 years
3. Rapid return of fertility
111
Contraception
- EC methods
Contraception
- EC methods
1. LNG
3 days
2. UPA
5 days
3. IUD
5 days (UPSI or ovulation)
112
Emergency contraception
- Physiology
- Failure
Emergency contraception
- Physiology
1. Delays ovulation
- Failure
2. After ovulation
