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Flashcards in Safe sex and STDs Deck (26)

Teenager asking for contraception- history

1. General health

2. Gynaecological

3. Obstetric

4. Complete sexual history


6. Advice on safe sex

7. Contraception, including contraI


Examination and investigations

1. General->BP

2. Heart

3. Lungs

4. Abdomen

5. Vaginal

6. Endocervical swab for gonorrhea and chlamydia


Precautions for women taking the pill

1. Take same time every day

2. If miss one, take as soon as remember. Use barrier protection for 7 days of active pill

3. GIT upsets may result in ineffective cover->barrier contraception and 7 day rule

4. Broad-spectrum antibiotic may also affect pill absorption and result in contraceptive failure

5. Regular check-up of BP

6. Common and usual self limiting side effects include breast tenderness, nausea and headaches


Managing consult with +ve chlamydia

1. Chlamydia is a common infection

2. Sexually transmitted, but treatable

3. In women can be symptomless, but can cause infertility through salpingitis and subsequent tubal blokage

4. PID from chlamydia is a common cause of ill health

4. Azithromycin and r/v in 2 weeks with repeat swab


"Where did I get it (chlamydia) from"

1. Probably impossible to know

2. Common, needs treatment now

3. Should contact all sexual partners and let them know so they can be treated


Screening guidelines high risk asymptomatic

1. All sexually active young people 15-29 ++if 

under age 20 years

Aboriginal or Torres Strait Islander

inconsistent or no condom usage

recent change in sexual partner

2. Urine or swab for chlamydia, every 12 months.

3. Decision of other infections based on risk factors


Screening for asymptomatic MSM

++Risk when: unprotected anal sex, >10 partners in past 6 months, group sex, drugs during sex

1. Urine and rectal PCR for chlamydia

2. Throat and rectal for gonorrhea

3. Serology for HIV, syphillis, hepatitis A/B if not vaccinated

4. Offer hepatitis immunisations

5. Every 12 months, 3-6 monthly in high risk men


Screening sexual contacts from last 6 months of infected

1. Treat all contacts presumptively

2. Consider other infections based on risk assessment

3. Immunisations

4. If chlamydia, repeat for reinfection after 3 months


Screening for low risk asymptomatic requesting STI checkup

1. Urine PCR/genital PCR chlamydia

2. Serology for hepatitis B (if not immune), syphillis and HIV


Treatment of gonorrhea

Ceftriaxone 500mg in 2ml lignocaine IM


Treatment of chlamydia

Azithromycin 1g PO + 1g one week later


Causes of vaginal discharge

1. Physiological

2. Candida->thick, cottage cheese

3. Trichomonas->erythema, green, frothy

4. Gonorrhea->friable, mucus, purulent

5. Irritant, allergic, foreign body

6. Bacterial vaginosis->homogenous, thin, fishy


Management of STI

1. Primary prevention

2. Offer immunisations->hep B/A, Gardasil

3. Discuss STI risk factors

4. ALWAYS use condoms

5. Condoms not 100% effective

6. STI not treated until partner treated

7. Mandatory reporting


Treatment of genital warts

1. Advise transmission genital-skin contact

2. Usually transient, but cosmetic concerns

3. Wart types are low risk for cancer

4. Topical Imiquimod or podophyllotoxin

5. Cryotherapy


Treatment of bacterial vaginosis

Metronidazole 400mg PO BD for 5 days


Treatment of trichomonas

Metronidazole 2g PO as single dose


Treatment of candida

1. Vaginal imidazole (clotrimazole) or Nystatin vaginal cream

2. If intolerant to topical therapy Fluconazole 150mg PO as single dose


Management of genital herpes

1. Collect swab

2. Antiviral therapy if started within 72 hours of onset of symptoms

3. Initial Aciclovir

4. Episodic/recurrent

Analgesia, saline bath Aciclovir 800mg PO tds for 2 days

5. Suppressive therapy Aciclovir 40mmg BD, reassess at 6 month

6. Simple analgesia

7. SItz bath

8. Screen for other STI

9. Check pap smear


Treatment of chancre

Azithromycin 1g single dose


Treatment of donovanosis

Azithromycin 1g, once weekly for at least 4 weeks.


Treatment of syphillis

Procaine penicllin IM F/U to determine response


Stages of syphillis disease

1. Primary->painless ulcer

2. Secondary->flu like, myalgia, fever, MC rash, condylomata lata

3. Latent: Dormant in liver and spleen, endarteritis and periarteritis

4. Tertiary->neurosyphillis


HIV pre-test counselling

1. Determine reasons for wanting test now

2. Who's idea

3. Identify high risk activities ->MSM, highr isk partner, multiple, IVDU, STDs

4. Check their knowledge of transmission

5. Seroconversion illness symptoms

6. Stress confidentiality

7. Window period 3 months before test positive

8. Implications for positive/negative test

9. Procedure of venesection

10. How long for results

11. What is HIV

12. Anti-retroV treatment

13. Prognosis->incurable but management, near-normal LE

14. HIV is not AIDS

15. Lifestyle modification and protective behaviours

16. How would they cope with a positive result

17. Summarise

18. Still happy to have test


Explaining herpes to patient

1. Most (up to 75%) 1st-episode infections are picked up by an asymptomatic partner 

2. 1st-episode infections may be asymptomatic or, like in your case, cause painful ulcerating genital lesions

3. These tend to heal over 2 weeks and the medications we give will help to reduce the severity

4. Once it all heals this virus tends to remain dormant in your nerves

5. When your immune system is a bit down (ie. head-colds, menstruations or stress) this virus can "sneak out” and cause recurrent infections

6. These recurrent infections may be asymptomatic or cause an outbreak of similar lesions on your genitals but these are almost always milder than the 1st time

7. Sometimes the recurrence is preceded by a funny tingling or burning sensation on your genitals, which is known as the prodromal period

8.  It’s important to realise that you are infectious during the prodrome and when the lesions are present so it’s important to avoid all sexual contact until it has resolved

9. It’s also wise to always practise safe sex by encouraging any partners to wear a condom as you don’t always know when you are having a recurrence!


Woman has unprotected sex, presenting with discharge and concern about pregnancy

1. Common situation and there are solutions

2. History

LMP, Contraception->if recent cessation, cycle, bleeding etc->determine stage of cycle

When the intercourse happened, consensual, vaginal/oral/anal, number of partners

Symptoms of STD->burning, pain, discharge

Past history of STD/testing, pap smears

2. Full medical history, allergies, medications

3. Emergency contraception available->TC from pharmacist

4. Regimen 2 X levenorgestrel 750ug->take first one ASAP, second in 12 hours.

5. If w/i 72 hours= 75-85% effective at preventing, 2% of those who have had unprotected and have MAP will become pregnant.

6. Will not dislodge or abort an established, not teratogenic

6. Chance of pregnancy also dependent on stage of cycle

7. Insertion of IUCD w/i 5 days also option, failure rate of 1%->not choice in nulliparous with risk of STD

8. Exaplanation about the MAP

9. STD screen->vaginal examination, swabs high vaginal (chlamydia/trichomonas) and endocervical for gonorrhea and chlamydia. Serology for HIV, hep B, syphillis

10. F/U in 7 days.

11. Remind of importance of safe sex, use condoms always


Other advice about MAP

1. Period may be earlier, longer

2. If no period by expected date should have pregnancy test->if positive, return to discuss options

3. Future contraeption