Sexual Health Flashcards

Question

What are the approuches used to diagnose BV

Answer 1

1) gram stained vaginal smear, evaluated with the Hay/lson criteria or the Nugent criteria 2) amsels criteria

Answer 2

BV Grade 1 -normal - lactobacillus morphotypes predominate Grade 2- intermediate - mixed flora with some lactobacilli present but gardnerella or mobilunus morphotypes also present Deare 3 - BV- predominantly gardnerella and or mobiluncus morphotypes , few or absent lactobacilli Grade 0 - no bacteria Grade 4- gram positive cocci predominate

Answer 3

BV At least 3 of the 4 criteria are present for diagnosis of BC -thin, white, homogenous discharge - clue cells on microscopy of wel mount -ph of vag fluid >4.5 -release of a fishy odour on adding alkali (10% KOH)

Answer 4

Levonorgestrel (30 micrograms) Norethisterone (350mcg) Brand names- Norgestron Micronor Noriday Nor-QD

Answer 5

Desogestrel (75 mcg) Brand names Cerazette Cerelle Nacrez Aizea

Answer 6

The progesterone type

Answer 7

With in weeks of stopping

Answer 8

Use effective contraception until her first period post sterilization No increased risk of heavy period from sterilisation

Answer 9

Ulipristal is a SPRM - stops effects of progesterone and thus stops ovulation - works up to 120h post sex There is a risk that is can block progesterone in the COCP therefore if return to COCP post ulipristal, need 14 days of condoms / abstinence

Answer 10

With traditional POP 60% of cycles if inhibited New generation - inhibit ovulation in up to 97% of cycles

Answer 11

Perfect use - <1% Typical use- 8%

Answer 12

Relative contraindications to POP Currrent or previous ischemic heart disease Stroke Prev breast CA with no evidence of recurrence for 5 years Severe decompensated liver cirrhosis Benign or malignant liver tumors Systemic SLE with severe thrombocytopaenia and positive antiphosphplipd antibodies UK MEC 4- current breast CA

Answer 13

20% amenorrhoea 40% regular bleeding 40% irregular bleeding

Answer 14

Cervical smear and triple swabs

Answer 15

Given in deltoids or gluteal or lateral thigh Can be given up to and including the 5th day of the menstrual cycle with the need for extra protection If started at any other time , need barrier method for 7 days

Answer 16

Post TOP in 1st or 2nd trimester can be started but if over 5 days need barrier for 7 days Can be started anytime post-partum but if over 21 days post delivery need barrier method for 7 days

Answer 17

Use the missed pill rule if vomiting within 2 hours of taking the POP, take another pill asap and if continues to vomit used the missed pill rule : -traditional POP are missed if taken more than 3 hour late (>27h since previous pill - new generation same rule but 12 hours (>36h since last pill) - take missed pill as soon as remembered , take next pill at regular time so might take 2 pills in one day -**use barrier method in next 48 hours** - emergency contraception might be needed if SI occurred in the 48h after missed pill

Answer 18

Up to 2 weeks late and still be covered

Answer 19

Is Etonogestrel implant- has very low failure rate of less than 1 pregnancy per 1000 fitted implants over 3 years Vaginal bleeding patterns likely to chance while on implant **20% will be anenorrhoeic but up to 50% will have infrequent, frequent or prolonged bleeding and this is unlikely to settle with time** Dysmenorrhea may reduce wit time using the implant No evidence showing a delay in return to fertility after an etonogestrel implant is removed Complications with insertion are uncommon

Answer 20

Depo-Provera Sayana Press Noristerat

Answer 21

Nexplanon Norplant Jadelle

Answer 22

Copper IUDs TCu380s MiniTT 380 Slimline Nova-T380 Gynefix

Answer 23

Levonorgestrel IUS Mirena Skyla Jaydess Levosert

Answer 24

Amenorrhoea - likely with DMPA , more likely as time goes on Up to 50% of women stop SMPA by 1 year due to irregular bleeding DMPA may cause weight gain 2-3kg in over 1 year DMPA is not associated with acne or depression or headaches DMPA is associated with small amount of done density but returns to normal post stopping , no evidence it increases the risk of fractures

Answer 25

Inhibits ovulation by suppressing the LH and FSH via the hypothalamic pituitary ovarian axis

Answer 26

Inhibition of fertilization , copper is toxic to both sperm and ovum , inhibits sperm penetration through the cervical mucus due to increased copper content and inhibition of implantation due to inflammatory reaction on the endometrium

Answer 27

May be associated with reduction in the frequency of seizures in women with epilepsy

Answer 28

Yes and the dose interval does not need to be reduced

Answer 29

Inhibits implantation - due to its action on the endometrium causing endometrial atrophy and changes to the endometrial stroma Secondary effects include alteration of cervical mucus which reduces sperm penetration. -more than 75% of women using the LNG-IUS continue to ovulate and serum estradiol levels are not reduced

Answer 30

COCP - increases the clearance of lamotrigine so it can decrease serum levels and increase in seizures frequency

Answer 31

Post placenta delivery 10. Min post Within first 48h after vaginal birth Within 24h after vag birth Within first 48 h post uncomplicated CS

Answer 32

Less than 10 in 1000 over 5 years

Answer 33

Vag - up to 7 days Anus - 3 days Oral 2 days Toxicology screen will be sent from blood within 3 days of the assault and from urine with in 14 days of assault if a drug facilitated sexual assault is suspected

Answer 34

Copper ID - 120h - 5days-most reliable Levonorgestrel - Levonelle 1500, 30mg - 72h - 3d Ulipristal acetate- EllaOne - 120h

Answer 35

Pregnancy rate is <1% with few contraindications -aged, nulliparity, risk of STI and prev ectopic pregnancy are NOT contraindications to use -Cu IUD is effective imediatly

Answer 36

BMI>35 Smoking and age , >35 and smoking 15 per day or stopped smoking <1year ago Hypertension VTE- Fam Hx of VTE in 1st deg relative <45 yr, immobility unrelated to surgery Migraines without aura- stop cocp if develops Breasts- undiagnosed breast mass, carrier of known BRCA1, past cancer with no evidence of recurrence for 5 year

Answer 37

>35 year and >15 cigarettes / day HTN - >160 >96 Stroke Hx of TIA or cerebrovascular accident VTE- personal Hx of VTE, current VTE, known thrombogenic mutation - factor V Leiden IHD Pre existing migraine with aura at any age Current breast cancer Severe cirrhosis Liver adenoma Malignant liver tumors -hepatoma

Answer 38

SPRM- works by inhibiting or delaying ovulation Contraindications- hypersensitivity to UPA Pregnancy Severe asthma uncontrolled by oral glucocorticoids Liver disease Drugs that decrease gastric pH such as proton pump inhibitors and antacids may result in a decrease in the efficacy of the UPA, concomitant use is not recommended **liver enzyme-inducing drugs may also reduce its efficacy and this effect persists for 28 days afterwards**

Answer 39

All contraceptive methods can be started at the time of medical abortion except IUDs Can be inserted immediately after pregnancy is expelled

Answer 40

All contraceptive methods can be started at the time of procedure Including the IUD

Answer 41

Known or suspected ectopic Prev allergic reaction to mife or miso If woman has the below can use MISO nut not MIFE Severe uncontrolled asthma Chronic adrenal failure Inherited porphyria Extra precautions with : Long term steroids- mife is a glucocorticoid receptor antagonist , it might inhibit the action of steroid therapy and exacerbate the condition Anticogaulants Bleeding disorder Symptomatic anaemia **IUD in place- should be removed in advance of treatment, if can’t be removed important to confirm that its expelled during procedure - x ray if needed**

Answer 42

-mife 200mg PO, 24-48h before procedure Or -miso 400mcg SL, 1-2 h pre op Or -miso 400mcg vaginally, or baccalaureate 2-3h pre op

Answer 43

-combo of mife and miso using regimes same as pre 12w Or -osmotic dilators plus either mife or miso or with both mife and miso using above regimens in all cases

Answer 44

Osmotic dilator plus either mife or miso or both mife and miso using same as pre 12w regimens

Answer 45

Fluconazole 150mg stat If PO contraindicated, then topical Clotrimazole pessary 500mg stat OR Cltirmazile pessary 200mg Noce for 3 nights Econazole pessary 150mg single dose or 150mg noce for 3 nights Fenticonazole capsule intravaginally stat 600mg or 200mg intravaginally at night for 3 nights Itraconazole 200mg PO BD for one day PO Miconazole capsure 1200mg vaginally stat or 400 mg vaginally at night for 3 night Miconazole vag cream 2% , 5g vaginally at night for seven consecutive nights

Answer 46

Advice on saline bathing and topical an aesthetic to pee 5% lidocaine Aciclovir 400mg TDS for 5 day Valaciclovir 500 mg BD - 5 days Alternative Aciclovir 200mg five times daily - 5 days Famciclovir 250mg three times a day

Answer 47

Primary sites of infection are columns epithelium-lines mucous membranes of the urethra, endocervix, recutm, phyarynx and conjunctiva Mucopurulent discharge from cervix, vag, dysuria, male urethral discharge

Answer 48

IV ceftriaxone, metronidazole 500mg TDS and gent 3mg/kg

Answer 49

Can be in the conjunctiva and nasopharynx without genital infection If untreated infection can resolve spontaneously - 50% of infections spontaneously resolve approx 12 months from initial diagnosis

Answer 50

Fetocide with KCl, Po mife 200mg, 800mcg miso vag but a ally or sub L, followed by miso 400 mcg vaginally , buccally or subL every 3 h until abortion If mife not available same routine but no mife This is the regime at 12-24w of preg.

Answer 51

Mife 200mg, then 24-48h of miso 800mcg vaginal, buccal or sub L Of no expulsion of preg after 4h take another 400mcg miso , usually needed if over 9w, this is when the single dose of 800mcg gets less affective If no mife available take 800 of miso then 3hourly 400 miso until delivery

Answer 52

Miso 400 vag subL or buccal or 600 PO

Answer 53

Give MIFE 24-48h pre miso Or evac with antibiotics

Answer 54

Miso 400 every 3 hours If missed abortion **mife 200 24h-28 before miso** Or surgical mangement with antibiotics , vacuums aspiration pre 14w can be sued From 14-16w forceps removal of larger fetal parts may be required From 16w a dilation and evacuation may be performed , might need to use forceps, with vacuum aspiration

Answer 55

Even if high risk of HIV they can also have all IUS and IUDs without restriction There are some drug interactions with hormonal contraception and antiretrovirals

Answer 56

IUS and IUD after 2nd trimester abortion

Answer 57

HSV 1 - usual cause of oro labial herpes and is now the MC cause of genital herpes in the UK HSV2 now this virus type is more likely to cause recurrent anogenital symptoms Only 1/3rd of individual appear to develop symptoms at the time of acquisition of infection with HSV2 Virus becomes latent in the sensory ganglia after primary infections If asymptomatic HSV2 can shed from vag, anorectum, urethra and cervix

Answer 58

Variable symptoms 10-50% can be asymptomatic MC- vag discharge, vulval itching, dysuria, offensive odor, 70% - present vag discharge varying in consistency from thin to scanty to produce and thick - classic frothy yellow discharge occurs in 10-30% of women 2% of women have strawberry cx seen with naked eye

Answer 59

Oncogenic 16 and 18 - squamous cell CA of Cerv and anal and external genetalia squamous intraepithelial lesions ie VIN Ward types 11 and 16 MC - condylomata acuminata

Answer 60

Klebsiella granulomatis - gram neg Firm papule or subcutaneous nodule that later ulcerates 4types -**ulcerogranulomatous is the most common variant - non tender fleshy exuberant single or multiple beefy red ulcer that bleed readily when touched** -Hypertrophic or veroucous type and ulcer or growth with a raised irregular edge could look like a walnut -nectrotic usually a deep foul smelling ulcer causing tissue destruction - sclerotic with entities fibrous and scar tissue Genitals are affected 90% of cases and the inguinal area is 10%

Answer 61

Vuvlovaginal swab NAAT or by culture No test for Gono offers 100% sensitivity and specificity -microscopy - you can see the diplococci , has only 37 -50% and 20% sensitivity compared to the culture fro detecting go or from endocervical and female urethral smears respectively -microscopy of urethral or mental swab has good sens 90-95% in people with discharge from th epenile urethra ad is recommended to facilities immediate presumptive diagnosis in these individuals -NAATS sen >95% in people with symptomatic and asymptomatic infection therefore although NAATS are not list see for use at extra genital sites they are recommended - best in oropharyngeal and rectal sites - self vulvovaginal swabs are better than vulvovaginal

Answer 62

HVS + microscopy 1- gram stained vag smear evaluated with the HAY/Ison criteria (recommended by BASHHH) or the Nugent criteria 20 Amstel criteria See other cards

Answer 63

Vulvovaginal swab + culture NAATs are recommended as the preferred diagnostic method for genital herpes

Answer 64

HVS and NAAT (microscopy)

Answer 65

HSV and culture for recurrent for sensitivity as well! If primary infection do MICROSCOPY!

Answer 66

Metro 400mg BD for 7 d Or Metro 2g stat Or Vaginal metro 0.75% OD for 5 days OR Vag clindamycin cream 2% OD for 7 days Or tinidazole 2g stat Or clindamycin 300mg BD for 7days

Answer 67

Doxy 100mg BD for 7 days - not in preggo Or azithromycin 1g PO then 500mg OD for 2 days - IN PREG TOO Alternatives Erythromycin 500mg BD for 10-14d (level 4,C) Or Ofloxacin 200mg BD or 400mg OD for 7 days - not in preg

Answer 68

azithromycin 1g PO then 500mg OD for 2 days Or Erythromycin 500mg QDS for 7 days Or Erythromycin 500 BD for 14 d Or Amoxicillin 500 TDS for 7 d

Answer 69

If preggo If still symptomatic Where poor compliance is suspected

Answer 70

Ceftriaxone 1g IM stat If anti microbial susceptibility is known prior to treatment Ciprofloxacin 500mg PO STAT- high resistance to cipro 34%

Answer 71

PO metro 400 BD for 7d Or metro 2g stat

Sexual Health Flashcards

(102 cards)