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Sexual Health Flashcards

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1
Q

What test can be done to assess for ovulation and how is the timing of this worked out if the patient doesn’t have a regular menstrual cycle.

A

21 day progesterone level test

If a patient doesn’t have a regular cycle. Subtract 7 days from when the period will start. This will give you the 7 day post ovulation - in which progesterone should be high.
*remember luteal phase is more consistent than follicular phase

*normal level is >25picommol.

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2
Q

What are the most common causes of anovulation?

A

PCOS

Hypothalamic amenorrhea
- physiological stress stops GnRH being released

Endocrine disorders

  • Hypothyroidism
  • Hyper-prolactinomas
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3
Q

List 6 main types of contraception:

A
  1. Barrier - condoms
  2. Pill
    - combined
    - Progesterone only
  3. Implant
    - last 3 years
  4. Injection
    - every 3 months
    - long acting progesterone
  5. intrauterine
    - Copper
    - Mirena
    * Mirena up to 5 years use
  6. Sterilisation
    Female - Clips on tubes or Tubal ligation

Male - Vasectomy

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4
Q

What are some risk factors for STIs?

A

Not using Barrier protection

<25 years of age

High number of sexual partners

New sexual partners

Men who have sex with men

Commercial sex workers

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5
Q

Why should two condoms not be used at once?

A

More like to tear

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6
Q

Following a positive screen for chlamydia, when should a person be retested?

A

3-6 months later

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7
Q

What are some of the clinical signs of chlamydia?

A

Cervicitis
Cervical contact bleeding
PID
Reactive arthritis*

Typical symptoms:

  • Lower abdominal pain
  • Dyspareunia
  • Dysuria
  • Intermenstrual bleeding
  • Post-coital bleeding
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8
Q

What type of urine sample is required for STI testing in men?

A

First void urine

*not MSSU

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9
Q

What is the treatment for chlamydia? how long should one abstain from sex and what else should be done?

A

Doxycycline or Azithromycin

Pregnant:
- Erythromycin

7 days no sex - even with condom.

Contact tracing

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10
Q

What is the management of Gonorrhoea?

A

Referral to sexual health clinic.

Ceftriaxone 500mg STAT
+
Azithromycin 1G STAT

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11
Q

What are the Urogenital complications of Gonorrhoea?

A

Females:

  • PID
  • Bartholin’s cyst
  • Endometritis

Male:

  • Epididymitis
  • Infection of penile glands (Tyson’s glands)
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12
Q

What are the symptoms of primary HSV and what are the complications?

A 
Malaise with flu like symptoms. 
Lymphadenopathy 
Stinging/ tingling sensation in genital area 
Vesicle formation in genitals 
Dysuria

Complications:

  • Urinary retention
  • Constipation
  • Aseptic meningitis
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13
Q

What is the cause of genital warts and what is the treatment?

A

HPV

Treatment:

  • Podophyllotoxin cream
  • Imiquimod
  • Cryotherapy
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14
Q

What is the vaccine against HPV?

A

HPV vaccine against:

  • 6
  • 11
  • 16
  • 18

Administered to all girls at school
+
Men who have sex with men <45 years old

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15
Q

What in the clinical history and symptoms can help differentiate between bacterial vaginosis and Trichomonas vaginalis?

A

Discharge:
BV: grey and watery

TV: Frothy and Yellow

Symptoms:
BV: Usually asymptomatic

TV: Dysuria

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16
Q

What investigations should be done into vaginal discharge?

A

Vaginal pH

High Vaginal swab / HVS

Pregnancy test 
(retained products of conception can cause discharge)

Chlamydia and gonorrhoea swab
+/-
urethral/ rectal and pharyngeal swab

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17
Q

What are the Emergency contraception options? and which is the most effective contraception?

A

Copper IUD
- most effective

Levonorgestrel

Ulipristal Acetate (progesterone receptor modulator)

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18
Q

When is a copper IUD effective for Emergancy contraception till?

A

Up to 5 days following the unprotective sex
or
5 days after ovulation (day 19 in normal cycle)

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19
Q

When can ulipristal acetate be used up till for Emergancy contraception?

A

Up to 120 hours

Inhibits or delays ovulation

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20
Q

How long after unprotected sex is levonorgestrel effective?

A

72 hours

1.5mg given.
Dose should be 3mg (Doubled) if:
- BMI >26
- On liver enzyme inducing medication

Inhibits ovulation - delaying or preventing follicular rupture.

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21
Q

What are the grounds of a termination?

A

An abortion can only be carried out if 2 or more doctors agree that the pregnancy should be terminated on 1 or more grounds.
These include:
• Continuance of pregnancy would involve risk to the life of the pregnant woman greater than if continued.

* Termination is necessary to prevent grave physical or mental injury of the pregnant woman 
* Pregnancy has not exceeded 24 weeks and the continuance of pregnancy would not involve greater risk to pregnant woman both physically and mentally 
* Pregnancy has not exceeded 24 weeks and the continuance of pregnancy would not involve greater risk to the family of the pregnant woman both physically and mentally

That there is a sufficient risk if the child was born it would suffer such severe mental or physical handicaps

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22
Q

What pre-abortion investigations are needed?

A

Bloods:

  • FBC
  • Blood grouping
  • Kleihaur test
  • Rh Negative will need prophylactic anti D

Orifices:

  • STI screen
  • cervical cytology

Baby:
- gestational age

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23
Q

What are the medical options for abortion?

A
  • Mifepristone (progesterone antagonists)
    24-48 hours later given:
  • Misoprostol (prostaglandin)

**used most successfully <7 weeks but can be used late 1st trimester

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24
Q

What are the surgical options for a late abortion (2nd trimester)

A

Dilation and evacuation

  • cervical dilation
  • surgical removal of fetus
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25
What type of surgical abortion can be performed in 1st trimester?
<7 weeks: - manual vacuum aspiration 7-14 weeks: - suction or vacuum aspiration achieved by manual or electrical pump *follow up of hCG is needed
26
What are the complications of abortion?
Retained products of conception - prophylactic antibiotics +/- surgical removal Failure of abortion Post abortion infection - pre- STI screen/ prophylactic antibiotics Trauma to genital tract Psychological sequalae
27
What is the screening programme for cervical cancer?
25 - 64 years old. - 25 - 49: every 3 years - 50 - 64: every 5 years. **liquid cytology is conducted CIN 1 - observe CIN 1 + High grade HPV - colposcopy CIN >2 - referral for colposcopy
28
When is the best time to take a cervical smear?
Mid - menstrual cycle
29
What is the management of a woman with an abnormal smear?
*high grade HPV + Dyskarosis ``` Colposcopy + Acetic acid. +/- Punch biopsy ``` Options are: - see and treat - punch biopsy and treat later
30
What is follow up after treatment of CIN?
Test of cure - 6 month smear for HPV testing if normal - discharge onto normal screening if abnormal - refer back to colposcopy
31
Women post partum can be protected from pregnancy naturally depending on what? what is this called? and what is the criteria to make it effective?
Breast feeding exclusively protects from pregnancy. Called: Lactational Amenorrhoea Method (LAM) - Exclusively breast feeding (>85%) - Amenorrhoeic - <6 months post- partum
32
After birth when is the mother at risk of becoming pregnant again?
21 days post partum
33
How long following an abortion will a urinary pregnancy test remain high for?
4 weeks
34
Which cancer is the combined oral contraceptive pill protective against?
Endometrial and ovarian
35
Where is the rod inserted into?
Non dominant arm - Sub dermally | 1/3rd up.
36
When starting the combined oral contraceptive, when in the cycle is a woman safe from pregnancy?
If started in the first 5 days of the cycle she is safe. | If started afterwards she will need to use barrier protection for 7 days
37
What are the complications of IUCs?
Lost threads Abnormal bleeding Ectopic pregnancy Actinomyces infection and PID **PID infection true for first 20 days then returns to normal thereafter
38
What are the contraindications to the COCP?
Previous VTE Thrombophilia disease BMI >35 Smokes >15 a day + >35 years old Arterial disease Migraine with aura Breast cancer Rifampicin use
39
If the progesterone only pill is started after the 1st day of menstrual cycle, how long does it take to work? how to does this compare to the COCP?
2 days COCP = 7 days
40
At what age would you refer to social services for underage sex?
Under 13
41
How long does contraceptive cover need to be given for women when menopausal?
<50 years and menopausal (over 1 year since last period) - 2 years of contraception >50 years and menopausal - 1 year of contraception
42
How long does the implant work for, how does it work and what are some common side effects?
3 years. Progesterone: - stops ovulation - thickens cervical mucus - thins lining of womb Side effects: - no periods - irregular bleeding - unpredictable bleeding
43
What is the injection that can be used and name some side effects:
Given every 13 weeks./ 3 months Uses progesterone. Side effects: - stop periods, irregular bleeding - weight gain - Osteoporosis - can take up to 1 year to start ovulating again
44
Contrast the difference between the IUD copper device and the progesterone device:
Copper: - non- hormonal - can be used as emergency contraception - can cause heavier bleeds to begin with - last 5-10 years Progesterone: - hormonal - lasts for 3-5 years - lighter and less painful periods - abnormal bleeding
45
Other than the contraindications to the COCP what other factor must you consider when prescribing it?
RIsk of pregnancy - contraindicated if pregnant *hence why not used as emergency contraception
46
HIghlight the differenceis between Fraser guidelines and Gillick's compotence:
Frasers: concerned with contraception Gillicks: concerned with treatment of any medical condition
47
What are the aspects to Fraser's guidelines?
Understanding Parental involvement - encourage them to speak to parents Sexual activity - is it going to occur even without contraception Suffering - mental and physical well being suffer? Interests - is it in their interest?
48
Which act governs abortion in the UK mainland, and what is needed for an abortion to take place?
1967 abortion act *need 2 doctors to sign it off and to be on the medical grounds for the patient
49
Which act limits the abortion to 24 weeks? and what are some caveats to this?
The human fertilisation and embryology Act 1990 abortion can take place later if there is: - serious deformity - life threatening risk to mother
50
Do partners of the pregnant women have any legal rights over the abortion?
no.
51
How many women by the age of 45 have had an abortion?
1 in 3
52
In scotland what are the time frames for an abortion?
Medical up to 18 weeks - home (< 10weeks) - >10 weeks inpatient Surgical up to 13 weeks If >18 weeks then need to be referred to England via British Pregnancy Advisory Service (BPAS)
53
Highlight the medical procedure of abortion:
- Mifepristone - progesterone antagonist followed 24-48 hours by - Misoprostol - to promote uterine expulsion *starts within 2-3 hours *painful *completed within 24 hours
54
What things need to be considered other than gestational age in an abortion?
Contraception - needed 5 days following procedure Antibiotics? Anti D prophylaxis - if mother Rh - and: - < 10 weeks medical not needed > 10 weeks medical needed Surgical Cervical screening STI screening Gender based violence
55
List some abortion complications and their management:
Failure to end pregnancy Retained products of conception - additional dose of misoprostol - surgical wash out Infection / endometritis - broad spectrum Abx +/- Sepsis 6 if septic Uterine perforation - laparotomy/ laparoscopy procedure Cervical tear **these can account for symptoms of bleeding, abdo pain etc following an abortion and must be investigated for.
56
What are some contraindications to medical abortion? and surgical abortion?
``` Medical: Corticosteroid use Adrenal disease Hypertension High Cholesterol Sickle cell ``` Surgical: BMI 40 BMI 35 + comorbidities Anaesthesia
57
What is the major side effect of the intrauterine copper device?
Heavy bleeding with cramping
58
What are the antibody screening tests for syphilis and how does it relate to treatment?
Group specific antigens - TPHA (Treponema pallidum haemagglutinin antigen) * remains positive even after treatment Non-specific antigens - VDRL - RPR * changes to negative following treatment
59
How long following insertion of a IUS or rod is protection effective?
7 days
60
How would you advise someone who missed taken their COCP?
If one pill has been missed then: - take the missed pill immediately, even if it means taking two pills in one day If more than one pill has been missed then: - Take the last missed pill immediately, even if it means taking two pills in one day + Barrier protection for 7 days *if she had unprotected sex during the first 1-7 days of the cycle and missed more than 1 pill then Emergancy contraception is also needed.
61
What would you advise if someone misses their POP?
Out with 3 hours of normally taking it. Take the missed pill immediately, even if it means taken 2 in one day. + Barrier protection for 48 hours +/- Emergancy contraception if she had unprotected sex in that time
62
What is the progesterone only injection known as and how is provided?
DMPA Sub cut or IM
63
What are the two unique side effects to progesterone injection?
Weight gain Osteoporosis Long time to recovery of normal cycle
64
What is the contraindication to the progesterone implant and injection?
Active breast cancer
65
What tests / should be done in women prior to implanting the coil?
Tests: - STI screen in those at risk BP and HR monitored before and after Examination: - bimanual examination to assess for the position of the uterus
66
What advice should be given to females prior to removal of coils?
Refrain from sex or use condoms for least 7 days prior# *due to the risk of ectopic
67
What disease is the copper IUD contraindicated in?
Wilson's disease
68
What things need to be considered when giving the emergency contraception?
BMI of patient Malabsorption (including D&V) Enzyme inducers/ inhibitors
69
If you have to give ulipristal acetate as Emergancy contraception how long should you wait before restarting COCP or POP?
5 days
70
What contraception is considered safe during breast feeding?
POP Rod Copper coil IUD *all except oestrogen
71
If levongestrol is taken and the patient vomits within 3 hours what should she do?
Take a second dose | - if vomiting within 3 hours
72
When is COCP contraindicated following pregnancy?
< 6 weeks postpartum
73
What are some of the relative and absolute contraindications to the COCP?
UKMEC3 (relative) - >35 years old and smoking <15 cigarettes - Controlled HTN - family history of DVTs - Immobile (wheelchair use) - BRCA1/ BRCA2 mutation UKMEC 4 (absolute) - >35 years old and smoking >15 cigarettes - Migraine with aura - DVTs - Breast cancer - Ischemic heart disease - Major surgery with immbolity - Postpatum <6 weeks - Breast feeding
74
What advice should be given to females starting the pill?
Hypertension - need regular BP monitoring DVT advice - to seek immediate help if they haves symptoms of DVT If they develop migraines to seek help D&V - may need additional cover due to lack of absorption Missed pill advice Drug interactions which may reduce efficacy of the pill: - St John's wort - Ridampicin - Anti-epileptics - phenytoin Doesn't protect against STIs
75
What are some advantages and disadvantages of the COCP?
Advantages; - Effective 99% - Easy to use - Reduced risk of ovarian and endometrial cancer - Doesn't interfere with sex Disadvantages: - Increased risk of cervical and breast cancer - Increased risk of stroke - increased risk of heart disease - Temporary side effects N&V, breast tenderness
76
What advice can be given for those trying to conceive?
Optimise BMI Regular vaginal sex Stop smoking Don't try and time with ovulation - causes unwanted stress
77
Which drug can cause ovarian hyperstimulation and what are the symptoms?
Clomiphene and GnRH N&V Abdominal pain (follicular cyst formation) Ascites Pleural effusions
78
How can pre-menstrual syndrome be treated?
Lifestyle New- generation COCP SSRIs if severe
79
What test can be conducted to assess ovarian reserve?
Anti- Mullerian Hormone
80
When testing someone for an STI - what other infections are routinely investigated for as well?
Chlamydia Gonorrhoea Syphilis HIV Hep B

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