Module 1 : Fertility and sexual health Flashcards by Rebekah M

Trichomonas

Signs (4)

Offensive, yellow/green, frothy discharge
Vulvovaginitis
Strawberry Cervix
pH >4.5
Asymptomatic usually in men, may cause urethritis

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Trichomonas
Ix
Treatment

Ix - microscopy shows motile trophozoites

Tx - Oral metronidazole 5-7 days or 2g STAT

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Bacterial Vaginosis
Amsels Criteria (4)

3 of 4 for diagnosis
Thin white homogenous discharge
Clue cells on microscopy
pH >4.5
Positive wiff test - fishy with potassium hydroxide

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BV - Organism

Garderella Vaginalis overgrowth - leads to fall in lactic acid producing aerobic lactobacilli

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BV
Tx
Cure rate, Relapse rate

Oral metronidazole 5-7 days

70-80% cure, >50% relapse in 3 months

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BV risks in pregnancy

Increased risk of..
Preterm labour
Low birth weight
Late miscarriage
Chorioamnionitis

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Candida

Signs (4)

Cottage cheese, non offensive
Itch
Vulvitis - superficial dyspareunia, dysuria
Vulval erythema, fissuring, satellite lesions

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Risk factors for Candida

DM, steroids, Abx, pregnancy, immunosuppression

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Treatment for Candida

Local - clotrimazole pessary 500mg PV
Oral - Itraconzaole, Fluconazole
Pregnancy - oral CONTRAINDICATED

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Recurrent Candida

Definition and Management

4 or more episodes per year
Do HVS to confirm, bloods ? DM, exclude lichen sclerosus
Induction: Fluconazole every 3 days for 3 doses
Maintenance: Fluconazole weekly 6 months

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HPV strains
Genital Warts
Cervical Ca

Genital Warts 6,11

Cervical Ca 16,18

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Cervical screening ages

25-49 3 yearly
50-64 5 yearly
Can be delayed 3 months post partum

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HPV negative screen

Return to recall unless on treat till cure, untreated CIN1 or follow up

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HPV positive and cytology normal

Repeat at 12 months

if -ve routine
if +ve repeat again in 12 months and if + again COLPOSCOPY

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HPV positive cytology abnormal

Colposcopy

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Cervical smear inadequate sample

Repeat in 3 months

2x inadequate go to COLPOSCOPY

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Risk factors for Cervical Ca

HPV 16,18,33
Smoking
HIV
Many sexual partners
High parity
COCP

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How do HPV 16 and 18 work

16 - produces E6 oncogene which inhibits p53 tumour suppressor
18 - produces E7 oncogene which inhibits RB suppressor

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FIGO Cervical Ca

Confined to cervix
Less than 7mm wide
A1 = <3mm deep
A2 = 3-5mm deep

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FIGO Cervical Ca

Confined to cervix
Visible or larger than 7mm
B1 = <4cm diameter
B2 = >4cm diameter

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FIGO Cervical Ca

Study These Flashcards

Beyond cervix but not to pelvic wall
A = upper 2/3 vagina
B = parametrial involvement

FIGO Cervical Ca

III

Study These Flashcards

Extension of tumour beyond cervix and to pelvic wall
A = lower 1/3 vagina
B = pelvic side wall
Any tumour causing hydronephrosis or non functioning kidney

FIGO Cervical Ca

Study These Flashcards

Extension of tumour beyond pelvis or involvement of bladder or rectum
A = bladder/rectum
B = distal sites to pelvis

How long after birth before women require contraception?

Study These Flashcards

21 days

Lactational Amenorrhoea Method

Lactational amenorrhoea method (LAM) is 98% effective providing the woman is fully breast-feeding (no supplementary feeds), amenorrhoeic and < 6 months post-partum

Risks of pregnancy again within 12 months of birth

An inter-pregnancy interval of less than 12 months between childbirth and conceiving again is associated with an increased risk of preterm birth, low birthweight and small for gestational age babies

Breastfeeding: POP

Progestogen only pill (POP) the FSRH advise 'postpartum women (breastfeeding and non-breastfeeding) can start the POP at any time postpartum.' after day 21 additional contraception should be used for the first 2 days a small amount of progestogen enters breast milk but this is not harmful to the infant

Breastfeeding: COCP

Combined oral contraceptive pill (COC) absolutely contraindicated - UKMEC 4 - if breast feeding < 6 weeks post-partum UKMEC 2 - if breast feeding 6 weeks - 6 months postpartum* the COC may reduce breast milk production in lactating mothers may be started from day 21 - this will provide immediate contraception after day 21 additional contraception should be used for the first 7 days

Postpartum insertion of coils

The intrauterine device or intrauterine system can be inserted within 48 hours of childbirth or after 4 weeks.

Smoking cessation in pregnant women

Nicotine replacement patches CONTRAINDICATED - varenicline and bupropion

How long after female sterilisation do you need to use contraception?

Until next period

First line contraception for women taking phenytoin,carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine....

IUD, IUS, Depo Provera - UKMEC 1 Implant, UKMEC 2 and COCP/POP UKMEC 3

First line contraception for lamotrigine:

UKMEC 1: POP, implant, Depo-Provera, IUD, IUS | UKMEC 3: the COCP

Causes of acute liver failure

paracetamol overdose alcohol viral hepatitis (usually A or B) acute fatty liver of pregnancy

Acute fatty liver of pregnancy - when to think of this

Jaundice following abdominal pain and pruritus during pregnancy think acute fatty liver of pregnancy

Syphilis in pregnancy - complications (7)

``` saddle nose sensorineural deafness encephalopathy limb abnormalities It can also result in miscarriages, stillbirths and early neonatal death. ```

Management of syphilis

intramuscular benzathine penicillin is the first-line management alternatives: doxycycline

Reaction to syphilis management

Jarisch-Herxheimer reaction is sometimes seen following treatment fever, rash, tachycardia after the first dose of antibiotic in contrast to anaphylaxis, there is no wheeze or hypotension it is thought to be due to the release of endotoxins following bacterial death and typically occurs within a few hours of treatment No treatment is needed other than antipyretics if required

Return to fertility: IUS

No delay

Return to fertility: Implant

Within 2 weeks

Return to fertility: Depo Provera

3-6months

Features of AntiPhospholipid Sydrome

``` venous/arterial thrombosis recurrent fetal loss livedo reticularis thrombocytopenia prolonged APTT other features: pre-eclampsia, pulmonary hypertension ```

Test for Anti Phospholipid Syndrome

Anti-cardiolipin syndrome

Primary and Secondary Management of Antiphosphoipid Syndrome

Management - based on EULAR guidelines primary thromboprophylaxis low-dose aspirin secondary thromboprophylaxis initial venous thromboembolic events: lifelong warfarin with a target INR of 2-3 recurrent venous thromboembolic events: lifelong warfarin; if occurred whilst taking warfarin then consider adding low-dose aspirin, increase target INR to 3-4 arterial thrombosis should be treated with lifelong warfarin with target INR 2-3

Time till effective (if not 1st day of period): IUD

instant

Time till effective (if not 1st day of period): COCP

7 days

Time till effective (if not 1st day of period): POP

2 days

Time till effective (if not 1st day of period): Depo

7 days

Time till effective (if not 1st day of period): IUS

7 days

Time till effective (if not 1st day of period): Implant

7 days

Module 1 : Fertility and sexual health Flashcards

(50 cards)