Sexual Health

Question 1

Multiple missed COCP pill week 3. No sexual intercourse. What do you advise?

Answer 1

Take the last missed pill, finish the pack and start a new pack immediately.
Use barrier contraception for 7 days.

Question 2

Multiple missed pills, COCP week 1. What do you advise?

Answer 2

Emergency contraception if UPSI in last 7 days.
Take last missed pill, and continue taking pills as normal from there.
Barrier contraception for 7 days.

Question 3

Multiple missed COCP week 2. What do you advise?

Answer 3

Take most recent missed pill. Continue as normal.

Barrier contraception for 7 days.

Question 4

How long post-partum must a woman be for COCP to be prescribed if she is BF?

Answer 4

6 weeks

Question 5

At what stage post partum is it possible to insert an IUD?

Answer 5

<48 hours

>4 weeks

Question 6

What method of contraception is suitable for a woman who is 3 weeks post partum and is breast feeding?

Answer 6

Progesterone only pill

Question 7

Important factors to ask about in history taking when deciding on contraception

Answer 7

PMHx
Migraine with aura
BMI >35
Breast cancer
Liver disease
VTE
Vascular disease
Congenital heart disease
Breast feeding
HTN (>140-160 contraindicated) 

FHx
VTE

SOCIAL

• Smoking (COCP contraindicated >35)
• Drinking
• Lifestyle e.g. occupation, what works best
• Concerns e.g. weight gain, acne

OTHER

• PID/possible STI
• Possibility of pregnancy

Question 8

Mechanism of action of combined contraception

How long do they start working?

Answer 8

Prevent ovulation by suppressing LH and FSH to prevent oestrogen release. (+ thickens cervical mucus).

1st 5 days of period = immediately
Otherwise = takes 7 days

Question 9

Missed pill rules for COCP

Answer 9

Miss 1 = doesn’t really matter (unless 1st in pack)

Miss 2 or more:

1st week = DANGER WEEK: high risk. Emergency contraception, condoms for 7 days.

2nd week = medium risk. condoms for 7 days.

3rd week = medium risk. Condoms for 7 days + miss pill free break.

Question 10

Mechanism of action of progestogen only contraception

Answer 10

Inhibits ovulation + thickens cervical mucus + prevents endometrial proliferation

Question 11

Missed pill rules for progesterone only pill

Answer 11

Missed = >24 hours

Any missed pill - use condoms for 48 hours

Question 12

SEs specific to depot injection

Answer 12

Reduced bone mineral density
Weight gain
Delayed return to fertility (6-9 months)

Question 13

Which contraceptive method is associated with a delayed return to fertility?

Answer 13

Depot injection

Question 14

Mechanism of action of IUS coil

Answer 14

Prevents endometrial proliferation

Thickens cervical mucus

Question 15

Mechanism of action of IUD coil

Answer 15

Spermicide

Prevents implantation

Question 16

Coil counselling: E and 6Ps

Answer 16

Expulsion rate (5%)
Pregnancy
Perforation
PID (swabs/sexual history)
Periods (IUD = heavier, IUS = lighter/stop)
Progestrogenic SEs (rare - acne, mood etc)
Procedure (explain and consent form)

Question 17

How many days after miscarriage can you become pregnant?

Answer 17

5

Question 18

How to work out ovulation date?

Answer 18

Ovulation = 14 days before period (luteal phase is fixed)

Work out normal cycle length and LMP

Question 19

How long after ovulation can implantation take place?

Answer 19

5 days

Question 20

Mechanism of action of EllaOne (ulipristal)

Answer 20

Selective progesterone receptor modulator (SPERM)

Works on progesterone receptors - can’t be used within 5 days of other hormonal contraception: receptors already involved so it will be less effective.
Won’t disrupt existing pregnancy

Question 21

When can Ulipristal be used?

Answer 21

120 hours after sex (5 days)

Will only work before ovulation

Question 22

MOA of levonelle (levonorgestrel) and when can it be used?

Answer 22

Delays/inhibits ovulation
Will only work before ovulation
72 hours (3 days) after sex

Won’t disrupt existing pregnancy

Question 23

Contraceptives affected by other enzyme inducer medications

Answer 23

Combined pill
Progesterone only pill
Implant
Oral emergency contraception

Question 24

What are the Fraser guidelines for giving contraception to U16?

Answer 24

UnProtected Sex Is Silly

Understand?
Parents - can they be persuaded to tell them?
Sex continues with/without contraceptive treatment?
Interest - best interest to give
Suffer - they would suffer without it

Question 25

When should you restart contraception after taking EllaOne/Levonelle?

Answer 25

``` EllaOne = COCP 5 days, POP 7 days (condoms 12 days) Levonelle = immediately (condoms 7 days) ```

Question 26

Screening for HIV risk

Answer 26

``` IVDU MSM Abroad Paid for sex Contact with HIV ```

Question 27

How to diagnose HIV

Answer 27

P24 antigen will be present 2-4 weeks after infection. HIV antibody will be present 4-8 weeks after infection (100% effective after 12 weeks) Serology --> ELISA test: more accurate. Tests for ANTIGEN (18 - 45 days (2-6 week) window) Point of care test --> instant results - shows ANTIGEN (from 2-4 weeks - 99% will be positive at 12 weeks after infection). If <4 weeks still do the test, but get them back for another. If high risk advise tests 3-6 monthly.

Question 28

How to prevent HIV transmission.

Answer 28

Condoms PrEP - pre-exposure prophylaxis. Give before, during and after sex with HIV+ve partner. Daily or just when needed. Very effective, test regularly. PEP - post-exposure prophylaxis. Taken within 72 hours (ideally 24), for 28 days.

Question 29

HIV treatment plan | What about in pregnancy?

Answer 29

HAART (highly active antiretroviral therapy) - reduces viral load to undetectable level, which means minimal transmission risk. Lots of drug interactions! Take care - liverpool drug interaction checker. When used in pregnancy = reduces transmission risk to <1%.

Question 30

Hep B Serology results and what do they mean?

Answer 30

``` HbeAg = highly infective HbsAg = current HbcAb = current / cleared HbsAb = cleared/ vaccinated (safe) ```

Question 31

What cells move to the ectocervix in an ectropion?

Answer 31

Columnar epithelial cells

Question 32

Treatment for chlamydia

Answer 32

doxycycline 7 day 100mg TDS

Question 33

Treatment for BV

Answer 33

Metronidazole 5-7 days

Question 34

What will be seen under the microscope if BV is present?

Answer 34

Clue cells

Question 35

Candida treatment

Answer 35

Clotrimazole pessary + fluconazole PO | pregnancy = JUST pessary

Question 36

Trichomonas treatment

Answer 36

Metronidazole PO 2g STAT dose + Metronidazole 5/7

Question 37

Gonorrhoea treatment

Answer 37

Ceftriazone 1g IM single dose

Question 38

Anogenital herpes treatment

Answer 38

Acyclovir

Question 39

syphillis treatment

Answer 39

Benzathine penicillin IM weekly for 3 weeks

Question 40

What will be seen on wet mount microscopy for TV?

Answer 40

Flagellated unicellular organisms

Question 41

UK MEC4 criteria for CI of COCP

Answer 41

``` Age >35 and smoking >15 a day Migraine with aura Personal history of VTE Personal history of stroke/MI Antiphospholipid syndrome Breastfeeding at <6 weeks PP Uncontrolled hypertension Current breast cancer Major surgery with prolonged immobilisation ```

Question 42

How long after taking leveonelle does one need to wait to restart regular contraception?

Answer 42

immediately

Question 43

How long after taking ellaone does one need to wait to restart regular contraception?

Answer 43

``` COCP = 5 days POP = 7 days ```

Question 44

Management of lichen sclerosis

Answer 44

Topical steroids and emollients