Sexual health Flashcards
(121 cards)
1
Q
What is the failure rate for male condoms
A
Perfect use: 2%
Typical use: 16%
2
Q
What is the failure rate for female condoms
A
Perfect use: 5%
Typical use: 21%
3
Q
What is the failure rate for diaphragms
A
Perfect use: 6%
Typical use: 16%
4
Q
What is the failure rate for nulliparous cervical cap
A
Perfect use: 9%
Typical use: 16%
5
Q
What is the failure rate for parous cervical cap
A
Perfect use: 20%
Typical use: 32%
6
Q
What is the mechanism of action of the combined hormonal contraceptives
A
Inhibition of ovulation
Inhibition of endometrial thickening
Increased thickening of cervical mucus
7
Q
What happens in the pill-free break for COCP
A
Fall in hormone concentration
Degradation of endometrium
Menstrual bleeding
8
Q
What are monophasic pills of COCP
A
Every pill contains same amount of oestrogen and progesterone
Most common type
9
Q
What are phasic pills of COCP
A
Levels of oestrogen and progesterone change throughout cycle
Important to take pills in correct order
10
Q
What is the contraceptive transdermal patch
A
A method of combined hormonal contraception
Applied every 7 days for 3 weeks, then a 7 day break for withdrawal bleed
Can be put on arm/abdomen/buttock/back
11
Q
What is a contraceptive vaginal ring
A
A form or combined hormonal contraception
Plastic ring, inserted into vagina
Sits in vagina for 21 days, removed for 7 days
12
Q
Which cancers do combined hormonal contraceptives reduce the risk of
A
Ovarian
Uterine
Colon
13
Q
What are the contraindications for combined hormonal contraceptives
A
BMI >35
Breastfeeding
Smoking and age >35
Hypertension
Family history of VTE
Prolonged immobility
Diabetes with complications
Migraines with aura
Breast cancer
Primary liver tumour
14
Q
What is the failure rate for COCP
A
Perfect use: 0.3%
Typical use: 9%
15
Q
When is POP most commonly used
A
Where COCP is contraindicated
16
Q
What are the mechanisms of action of progesterone only contraceptives
A
Thickening of cervical mucus
Inhibition of ovulation
Thinning of endometrium
17
Q
What are the cancer risks associated with POP
A
Reduced risk of endometrial cancer
Increased risk of breast cancer
18
Q
What are the contraindications for POP use
A
Current/past breast cancer
Liver cirrhosis/tumour
Low efficacy in <70 kg
Stroke/coronary heart disease
19
Q
How do POP and progesterone implant affect periods
A
Irregular pattern
20
Q
What are the contraindications for progesterone implant
A
Pregnancy
Unexplained vaginal bleeding
Liver cirrhosis/tumour
History of breast cancer
Stroke/TIA whilst using implant
21
Q
How long do progesterone only injections last
A
Depo-provera - 12 weeks
- Deep IM injection
Others between 8 and 13 weeks
22
Q
What effects does the progesterone only injection have on fertility and periods
A
Up to a year for fertility to return
A few months for periods to return to normal
23
Q
What is the failure rate for POP
A
Perfect use: 0.3%
Typical use: 9%
24
Q
What is the effectiveness for progesterone only implant
A
Perfect use: 0.05%
Typical use: 0.05%
25
What is the effectiveness for progesterone only injection
Perfect use: 0.2%
Typical use: 6%
26
What is the mechanism of action of the intrauterine device
Copper coil
Makes uterus unfavourable to sperm
Causes endometrial inflammatory reaction (inhibiting implantation)
27
What is the mechanism of action of the intrauterine system
Levonorgestrel-releasing coil
Thins endometrium
Thickens cervical mucus
28
How long does if take for IUD/IUS to become effective
IUD
- Immediately
IUS
- Immediately if in first 7 days of cycle
- 7 days if not in first 7 days of cycle
29
What are the indications for IUD/IUS
IUD
- Emergency contraceptive
IUS
- 1st line for heavy menstrual periods
- 2nd line for dysmenorrhoea
30
What are the contraindications for IUD/IUS
Infection (history of PID, recent STI)
Current pregnancy - 4 weeks post-partum
Uterine structural abnormality
Current gynaecological malignancy
Current unexplained vaginal bleeding
31
What do IUD/IUS increase the risk of
Ectopic pregnancy
32
What are the 2 types of emergency contraceptive pill
Levonorgestrel
- Synthetic progesterone
- Delays ovulation by 5-7 days
- Within 72 hours of unprotected sex
Ulipristal acetate
- Progesterone receptor modulator
- Delays ovulation by 5-7 days
- Within 120 hours of unprotected sex
33
How soon after unprotected sex does an IUD need to be inserted as an emergency contraceptive
5 days
Lasts 5-10 years
34
What are the contraindications for levonorgestrel emergency contraceptive
No absolute contraindications
Efficacy reduced by
- Diseases of malabsorption
- Enzyme inducing drugs
35
What are the contraindications for ulipristal acetate emergency contraceptive
Diseases of malabsorption
Hypersensitivity to ulipristal acetate
Severe hepatic dysfunction
Enzyme-inducing drugs
Breastfeeding
Asthma insufficiently controlled by corticosteroids
Drugs increasing gastric pH
36
What are the contraindications for IUD as an emergency contraceptive
Uterine fibroids with distortion to uterine cavity
Documented/suspected PID
Documented/suspected STI
37
What follow up advice should be given to women taking emergency contraceptive
Seek help if vomiting within
- 2 hours for levonorgestrel
- 3 hours for ulipristal acetate
Effectiveness declines as time since intercourse increases
38
What is pelvic inflammatory disease
Infection of the upper genital tract in females
May involve the uterus, endometrium, fallopian tubes, and ovaries
Mostly in sexually active women 15-24
39
What are the most common causative organisms of pelvic inflammatory disease
Chlamydia trachomatis
Neisseria gonorrhoea
40
What are the risk factors for pelvic inflammatory disease
Sexually active
15-24
Recent partner change
Intercourse without barrier contraceptives
History of STIs
Personal history of PID
Instrumentation of cervix
41
What are the clinical features of pelvic inflammatory disease
May be asymptomatic
Lower abdominal pain
Deer dyspareunia
Menstrual abnormalities
Post-coital bleeding
Dysuria
Fever and N+V in severe cases
42
What would you find on vaginal examination in PID
Tenderness of uterus/adnexae
Cervical excitation
Palpable mass in lower abdomen
Abnormal vaginal discharge
43
What are the differential diagnoses for PID
Ectopic pregnancy
Ruptured ovarian cyst
Endometriosis
UTI
44
What investigations are needed for PID
Endocervical swab (for gonorrhoea and chlamydia)
High vaginal swab (for trichomonas vaginalis and bacterial vaginosis)
Full STI screen
Urine dip
Pregnancy test
Transvaginal ultrasound/laparoscopy if uncertain
45
What is the management for pelvic inflammatory disease
Antibiotics
- 14 days, broad spectrum, start immediately
Simple analgesia
Rest
Avoid sexual intercourse until partner also treated
All sexual partners from last 6 months to be tested
46
When should you admit someone to hospital with suspected PID
Pregnant
Severe symptoms (nausea, vomiting, high fever)
Signs of pelvic peritonitis
Unresponsive to oral antibiotics
Need for emergency surgery
47
What are the complications of pelvic inflammatory disease
Ectopic pregnancy
Infertility
Tubo-ovarian abscess
Chronic pelvic pain
Fitz-High-Curtis syndrome
48
What is chlamydia
Infection due to chlamydia trachomatis
Most common bacterial STI in the UK
49
What are the different types of chlamydia infection
Serotypes A-C
- Cause ocular infection
Serotypes D-K
- Cause classical genitourinary infection
Serotypes L1-L3
- Cause infection in MSM, get proctitis
50
How is chlamydia transmitted
Unprotected vaginal, anal or oral sex
Penetration not always necessary (can be through skin-skin contact)
If infected fluid enters eye, get chlamydial conjunctivitis
Vertical transmission during delivery
51
What are the risk factors for chlamydia
<25
Sexual partner positive for chlamydia
Recent change in sexual partner
Co-infection with another STI
Sexual intercourse without barrier contraceptive
52
What are the symptoms of chlamydia in women
Dysuria
Abnormal vaginal discharge
Intermenstrual bleeding
Post-coital bleeding
Deep dyspareunia
Lower abdominal pain
53
What are the signs of chlamydia in women
Cervicitis and contact bleeding
Mucopurulent endocervical discharge
Pelvic tenderness
Cervical excitation
54
What are the symptoms of chlamydia in men
Dysuria
Urethral discharge
Testicular pain
55
What are the signs of chlamydia in men
Epidydimal tenderness
Mucopurulent discharge
56
What investigations are needed for chlamydia
NAAT
Women
- Vulvo-vaginal swab, endocervical swab, first catch urine
Men
- First catch urine, urethral swab
Consider swab from rectum/eye/throat
Contact tracing
Full STI screen
57
What is the management for chlamydia
7 days doxycycline or azithromycin single dose
Avoid sexual intercourse until partner also treated
If <25, repeat test in 3 months
58
What are the complications of chlamydia infection
Women
- PID (perihepatitis, ectopic pregnancy, infertility)
Men
- Epididymo-orchitis, effects on fertility
59
What are the complications of chlamydia in pregnancy
Premature delivery
Low birth weight
Miscarriage
Stillbirth
Treat with antibiotics
60
What is gonorrhoea
Caused by Neisseria gonorrhoeae
Gram negative bacterium
Second most common STI in the UK
Mainly affects <25s and MSM
61
Which parts of the body can gonorrhoea infection affect
Uterus
Urethra
Cervix
Fallopian tubes
Ovaries
Testicles
Rectum
Throat
Eyes
62
What are the risk factors for gonorrhoea infection
<25
MSM
Living in high density urban area
Previous gonorrhoea infection
Multiple sexual partners
63
What are the signs of gonorrhoea in women
Altered vaginal discharge (thin, watery, yellow/green)
Dysuria
Dyspareunia
Lower abdominal pain
Intermenstrual bleeding
Post-coital bleeding
64
What are the signs of gonorrhoea infection in women
Mucopurulent endocervical discharge
Easily induced cervical bleeding
Pelvic tenderness
65
What are the symptoms of gonorrhoea in men
Mucopurulent urethral discharge
Dysuria
66
What are the signs of gonorrhoea in men
Mucopurulent urethral discharge
Epididymal tenderness
67
What are the investigations for gonorrhoea
NAAT
Female
- Endocervical/vaginal swab
- Microscopy and culture of swabs
Male
- First pass urine
- Microscopy and culture of urethral swab
Consider swabbing throat/rectum/eyes
68
What is the management for gonorrhoea
Empirical antibiotics whilst waiting for results
Single dose IM ceftriaxone once confirmed
Screen for other STIs
Avoid sexual intercourse until partner also treated
Test for cure at follow up appointment
69
What are the complications of gonorrhoea
Female
- PID (chronic pelvic pain, infertility, ectopic pregnancy)
Male
- Epididymo-orchitis, prostatitis
Gonococcal meningitis (admit to hospital if have systemic symptoms)
70
What are the effects of gonorrhoea in pregnancy
Increased risk of:
- Perinatal mortality
- Spontaneous abortion
- Preterm labour
- Early membrane rupture
Gonorrhoea conjunctivitis
Give prophylactic antibiotics in pregnancy
Urgent referral for newborns (prevent long term damage and blindness)
71
What is HIV
Single stranded RNA retrovirus
Affects CD4+ T cells
Without treatment, leads to AIDS
72
Who are the at risk groups for HIV in the UK
MSM
IV drug users
From high prevalence areas
Unprotected sex with someone from/travelled to Africa
73
What are the clinical features of HIV
Seroconversion illness
- Non-specific flu-like illness
- 2-6 weeks after exposure
Symptomatic HIV
- After latent phase (many years)
- Weight loss, fever, diarrhoea, frequent minor opportunistic infections
AIDS-defining illness
- Malignancies, pneumonia, TB
74
What are the investigations for HIV
Fourth-generation test
- ELISA
- Serum/saliva sample
- Reliable result in 4-6 weeks
Rapid test kit
- 30 mins
- Not very reliable
Contact tracing
75
What is the management for HIV
Highly active antiretroviral therapy (HAART)
- Aims to reduce viral load to an undetectable level
- Tablets of a combination of drug types
- Must take medication for the rest of their lives
Post-exposure prophylaxis
- Lowers risk of becoming infected after a contact
- Must start within 72 hours of an event
- 1 month course
76
What can be done in pregnancy to reduce the chances of vertical transmission
Antenatal antiretroviral therapy during pregnancy and delivery
Avoid breastfeeding
Neonatal post-exposure prophylaxis
Can have a vaginal birth as long as mother has an undetectable viral load
77
What is syphilis
Caused by Treponema pallidum
MSM most at risk
Incubation 2-3 weeks
Affects arteries
78
What are the modes of transmission of syphilis
Sexual contact
Through placenta
Infected blood products
79
What are the risk factors for syphilis
Unprotected sex
Multiple sexual partners
MSM
HIV infection
80
What are the clinical features of primary syphilis
Get a papule
Ulcerates to become a chancre (painless ulcer)
Chancres heal in 3-10 weeks (take 9-90 days to develop)
81
What are the clinical features of secondary syphilis
3 months post-infection
Skin rash (usually on hands/feet)
Fever, malaise, weight loss, headaches
Condylomata (plaques at moist areas of skin)
Painless lymphadenopathy
Silvery-grey mucous membrane lesions
82
What are the clinical features of tertiary syphilis
Many years after initial infection
Gummatous syphilis
- Granuloma formation in bones/skin/mucous membranes
Neurosyphilis
- Tabes dorsalis (ataxia, numb legs, absence of deep tendon reflexes...)
- Dementia
- Meningovascular complications (nerve palsies, stroke...)
- Argyll Robertson pupil (constricted and unresponsive to light)
Cardiovascular syphilis
- Aortic regurgitation
- Angina
- Dilation and calcification of ascending aorta
83
What are the investigations for syphilis
Dark ground microscopy of chancre fluid
PCR of swab from active lesions
Serology testing
Lumbar puncture (CSF antibody test for neurosyphilis)
84
What is the management for syphilis
Penicillin
Avoid sexual contact until treatment successful
Screen for other STIs
Follow up serology
85
What are the complications of syphilis in pregnancy
Miscarriage
Stillbirth
Pre-term labour
Congenital syphilis
Antenatal screening
Treat pregnancy women early
86
What causes genital warts
HPV infection
90% due to HPV 6 and HPV 11
Skin-skin contact
87
What are the risk factors for genital warts
Early age of first sexual intercourse
Multiple partners
Immunosuppression
Smoking
Persistent warts in diabetes
88
Where can genital warts appear
Penis
Scrotum
Vulva
Vagina
Cervix
Perianal skin
Anus
May enlarge or multiply in pregnancy
89
What are the differential diagnoses for genital warts
Vestibular papillomatosis
Molluscum contagiosum (viral infection causing firm raised papules on skin)
90
What investigations are needed for genital warts
Full STI screen
Biopsy atypical lesions
91
What is the management for genital warts
Most resolve spontaneously over time
Topical treatment
Physical ablation
Vaccination
92
What are genital herpes
Herpes simplex virus on genitals
Transmitted via skin-skin contact during vaginal/anal/oral sex
Can get flare ups
HSV 1 affects genitals, mouth and nose
HSV 2 affects just genitals
Can be spread to genitals via penetrative or oral sex with someone with a cold sore
Stays dormant in ganglia of nerves
93
What are the risk factors for genital herpes
Unprotected sexual contact
Multiple sexual partners
Oral sex with a partner with a cold sore
94
What are the clinical features of genital herpes
Primary infection
- Small, red blisters around genitals
- Vaginal/penile discharge
- Flu-like symptoms
- Itchy genitals
Secondary (recurrent) infection
- Each outbreak shorter and less severe than previous episode
- Burning and itching around genitals
- Painful red blisters around genitals
95
What are the differential diagnoses for genital herpes
Aphthous ulcers
Varicella-zoster virus
Trauma
Vestibulobullous disorders
Underlying diagnosis of HIV (>5 outbreaks per year)
96
What investigations are needed for genital herpes
Swab from open sores
97
What is the management for genital herpes
Primary infection
- Aciclovir
- Avoid sexual contact during outbreaks
Recurrent outbreaks
- Painkillers, ice packs
- Episodic treatment (take aciclovir as soon as symptoms start)
- Suppressive treatment (>6 outbreaks per year, take daily aciclovir)
Full STI screen
98
What are the signs of herpes infection in a neonate
Skin, mouth and eye herpes
Disseminated herpes (affects internal organs)
CNS herpes (can cause encephalitis)
99
When is herpes in pregnancy most dangerous
During 3rd trimester
100
What is trichomoniasis
Infection caused by Trichomonas vaginalis
Transmitted through unprotected vaginal intercourse
Can get vertical transmission at delivery
Increased risk of contracting HIV
Symptoms develop after 28 days
101
Which parts of the body does trichomoniasis affect
Female
- Urethra, vagina, paraurethral glands
Male
- Urethra, under foreskin
102
What are the risk factors for trichomoniasis
Multiple sexual partners
Unprotected sexual intercourse
History of other STIs
Older women
103
What are the symptoms of trichomoniasis in women
Offensive vaginal odour
Abnormal vaginal discharge (thick/thin, frothy, yellow/green)
Vulval itchiness or dryness
Dyspareunia
Dysuria
104
What are the signs of trichomoniasis in women
Abnormal vaginal discharge
Vulvitis
Vaginitis
Strawberry cervix
105
What are the symptoms of trichomoniasis in males
Urethral discharge
Dysuria
Urinary frequency
Pain/itching around foreskin
106
What are the signs of trichomoniasis in men
Urethral discharge
Balanoprosthitis (inflammation of glans penis)
107
What are the investigations for trichomoniasis
Female
- High vaginal swab
Male
- Urethral swab or first void urine sample
Full STI screen
Contact tracing
108
What is the management of trichomoniasis
Anti-protozoan antibiotics
Test sexual partners
Avoid sex until treatment complete (or 1 week after single dose treatment)
109
What are the risks of trichomoniasis in pregnancy
Premature labour
Low birth weight
Maternal post-partum sepsis
110
What is bacterial vaginosis
Disturbance to normal vaginal flora
Infection of lower genital tract in females
Reduced lactobacilli in vagina
111
What are the risk factors for bacterial vaginosis
New sexual partner
Multiple sexual partners
Receptive oral sex
Presence of an STI
Vaginal douching
Vaginal deodorants
Recent antibiotic use
Black ethnicity
Smoking
112
What are the clinical features of bacterial vaginosis
Offensive fishy smelling vaginal discharge
No soreness, itching, or irritation
Thin, grey-ish homogenous discharge
113
What are the differential diagnoses for bacterial vaginosis
Vaginal candidiasis
Trichomonas vaginalis
STIs
114
What are the investigations for bacterial vaginosis
High vaginal smear
KOH whiff test (rarely used)
115
What is the management of bacterial vaginosis
Metronidazole
Advise stop vaginal douching
Remove IUD if contributing
High rates of recurrence
116
What are the complications of bacterial vaginosis in pregnancy
Prematurity
Miscarriage
Chorioamnionitis
117
What is vulvovaginal candidiasis
Fungal infection of lower urinary tract
Thrush
Highest in 20-40s
Due to candida albicans
More likely in pregnancy (higher oestrogen)
118
What are the risk factors for vulvovaginal candidiasis
Pregnancy
Diabetes
Use of broad spectrum antibiotics
Use of corticosteroids
Immunosuppression
119
What are the clinical features of vulvovaginal candidiasis
Itchy vulva
Vaginal discharge
Dysuria
Erythema/swelling of vulva
Satellite lesions
120
What are the differential diagnoses for vulvovaginal candidiasis
Bacterial vaginosis
Trichomonas vaginalis
UTI
Contact dermatitis
Eczema
Psoriasis
121
What is the management for vulvovaginal candidiasis
Antifungals
Advise to seek further attention if not cleared in 14 days
