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sexual health and contraception Flashcards

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1
Q

cause bacterial vaginosis

A

normal vaginal flora is disturbed, leading to a reduction in the numbers oflactobacillibacteria in the vagina, allowing growth of other microorganisms e.g. Gardnerella vaginalis,anaerobes and mycoplasmas. NOT AN STI

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2
Q

features BV

A

Offensive fishy smelling vaginal discharge, Not usually associated with soreness, itching or irritation, Thin, white/grey, homogenous vaginal discharge

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3
Q

mx BV

A

Metronidazole. This can be taken orally (400mg twice daily for 5-7 days, or a single dose of 2g) or as a gel applied directly to the vagina

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4
Q

cause of thrush

A

Candida albicans. This particular yeast-like fungus. NOT AN STI

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5
Q

featurs thrush

A

Itch, diacharge - white, curd-like and non-offensive, dysuria

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6
Q

mx thrush

A

intravaginal antifungal - clotrimazole or fenticonazole, Oral antifungal -fluconazole

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7
Q

cause trichomoniasis

A

protozoan - Trichomonas vaginalis

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8
Q

presentation trichomoniasis

A

F: Offensive vaginal odour, Abnormal vaginal discharge – thick/thin/frothy and yellow-green, Itchiness or soreness of the vulva, Dyspareunia, Dysuria, strawberry cervix
M: Urethral discharge, Dysuria,Urinary frequency,pain or itching around the foreskin

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9
Q

mx trichomoniasis

A

Metronidazole 2g orally in a single dose or
Metronidazole 400-500mg twice daily for 5-7 day

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10
Q

cause chlamydia

A

Bacterium:Chlamydia trachomatis - obligate intracellular gram negative bacterium

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11
Q

presentation chlamydia

A

F: dysuria, yellow/green vaginal discharge, Intermenstrual or postcoital bleeding, Deep dyspareunia, Lower abdominal pain
M: Urethritis (Dysuria, Urethral discharge),
Epididymo-orchitis (Testicular pain)

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12
Q

mx chlamydia

A

Doxycycline100mg twice daily for 7 days or
Azithromycin1g single dose
If CI: Erythromycin500mg twice daily for 10- 14days

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13
Q

cause gonorrhoea

A

Neisseria gonorrhoeae - Gram-negative diplococcus

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14
Q

presentation gonorrhoea

A

F: Altered/increased vaginal discharge (commonly thin, watery, green or yellow), Dysuria, Dyspareunia
Lower abdominal pain
M: Mucopurulent/purulent urethral discharge, Dysuria

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15
Q

mx gonorrhoea

A

intramuscularceftriaxone 1g

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16
Q

cause HIV

A

HIV is asingle strandedRNA retrovirus that infects and replicates with CD4 cells

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17
Q

presentation HIV

A
  1. Seroconversion Illness (flu – like)
  2. Symptomatic HIV (Weight loss, High temperatures, Diarrhoea, Frequent minor opportunistic infections, e.g. herpes zoster or candidiasis)
  3. AIDS defining illnesses (pnuemocystis jiroveci pneumonia, non-Hodgkin’slymphoma, and TB)
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18
Q

mx HIV

A

Highly active antiretroviral therapy(HAART) – combination of drugs

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19
Q

cause pubic lice

A

Phthirus pubis

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20
Q

presentation pubic lice

A

Intense itching

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21
Q

mx pubic lice

A

Insecticide (permethrin or malathion), wash clothes and bedding

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22
Q

reducing the risk of HIV transmission in pregnancy to baby

A

Antenatal antiretroviral therapyduring pregnancy and delivery
Avoidance of breastfeeding
Neonatal post-exposure prophylaxis

if followed and undetectable viral load CS not needed

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23
Q

cause of genital warts

A

HPV 6 and 11

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24
Q

presentation genital warts

A

warts affecting the penis, scrotum, vulva, inside the vagina, cervix, perianal skin or inside the anus. Usually painless, fleshy growths, soft or hard and can be singular or multiple. Occasionally warts may cause irritation or become inflamed

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25
mx genital warts
Topical: Podophyllotoxin (small warts), Imiquimod (larger, partly keratinised) Physical ablation: excision, cryotherapy
26
cause genital herpes
HSV 1 and 2
27
presentation genital herpes
Primary infection: Small red blisters around the genitals that are very painful and can form open sores, Vaginal or penile discharge, Flu-like symptoms, Itchy genitals Secondary/recurrent: burning and itching around the genitals, Painful red blisters around the genitals
28
mx genitala herpes
Primary infection =acyclovir Secondary= painkillers, petroleum jelly and ice packs, episodic acyclovir (when sx start)
29
cause syphilis
pirochete gram-negative bacterium -Treponema pallidum subspecies pallidum
30
presentation syphilis
Primary: papule will ulcerate into chancre (painless ulcer) Secondary: rash, fever, wt loss, arthralgia, lymphadenopathy Tertiary: gummatous, neurosyphilis, cardiovascular
31
mx syphilis
Early syphilis: Benzathine penicillin 2.4 MU IM single dose. Late syphilis: Benzathine penicillin 2.4 MU IM 3 doses at weekly intervals
32
cause balanitis
Vary - candidiasis, dermatitis, bacteria
33
presentation balanitis
inflammation of the glans penis
34
cause chancroid
tropical disease - Haemophilus ducreyi
35
presentation chancroid
painful genital ulcers associated with unilateral, painful inguinal lymph node enlargement. The ulcers typically have a sharply defined, ragged, undermined border.
36
mx chancroid
Azithromycin 1 gm orally in a single dose OR Ceftriaxone 250 mg IM in a single dose OR Ciprofloxacin 500 mg orally 2 times/day for 3 daysOR Erythromycin base 500 mg orally 3 times/day for 7 days
37
cause lymphogranuloma venerum
Chlamydia trachomati
38
presentation lymphogranuloma venerum
Stage 1: small painless pustule which later forms an ulcer stage 2: painful inguinal lymphadenopathy stage 3: proctocolitis
39
mx lymphogranuloma venerum
doxycycline.
40
Jarisch Herxheimer reaction 
with syphilis: an inflammatory response secondary to death of treponemes, and results in a flu-like illness within 24 hours of treatment. Supportive measures are all that is required, unless a patient has cardiovascular or neurosyphilis, in which case oral steroids should be administered prior to antibiotics to reduce the risk of an acute localised inflammatory reaction
41
hypoactive sexual desire disorder
Lack or loss of sexual desire, Absent/deficient sexual and erotic thoughts 
42
causes hypoactive sexual desire disorder
Chronic medical conditions – obesity, CVD, DM, anaemia. Hormonal disorders – androgen deficiency, hypothyroidism, hyperprolactinaemia, Addison’s disease. Post-pregnancy . Medications – OCP, oral HRT, tamoxifen, anti-depressants, anti-psychotics, beta blockers. Post-surgery – bilateral oopherectomy . Psychological problems – depression, anxiety, body image disorder, life/work stressors, history of abuse, relationship problems 
43
mx hypoactive sexuaal desire disorder
therapy, testosterone in M
44
causes erectile dysfunction
Chronic medical conditions – CVS, DM, neurological disease. Hormonal disorders – androgen deficiency, hyperprolactinaemia. Iatrogenic – post prostate surgery, prescribed medications (antihypertensives, SSRIs). Age. Ineffective sexual stimuli. Pain. Veno-occlusive disorder. ED can be an early sign of CVD and diabetes 
45
mx erectile dysfunction
sildenafil (viagra), tadalafil ,  intracavernosal injection, stimulating routines, therapy
46
vaginismus
Spasm of the pelvic floor muscles that surround the vagina
47
paraphilia
disorder of sexual preference
48
SE of hormone therapy fpr gender transition
Increased risk of thrombosis  Causes infertility – so important to council the person about storing their eggs/sperm before this happens (not available on NHS) Hormone therapy can cause weight gain (important to address this plus other cardiovascular RF)
49
how long live in gender role before hormone therapy
2y
50
CI to combined hormonal contraception
BMI greater than 35, Breast feeding, Smoking over the age of 35, Hypertension, History of or family history of venous thromboembolisms, Prolonged immobility due to surgery or disability, Diabetes mellitus with complications e.g. retinopathy, History of migraines with aura, Breast cancer or primary liver tumours
51
which contraceptive linked to osteoporosis
depo injection
52
MOA combined hormonal contraception
primarily to inhibit ovulation, progesterone also acts to inhibit proliferation of the endometrium, and increases the thickness of cervical mucus
53
MOA POP
Primarily to thicken the cervical mucus, also inhibits ovulation and thins cervical mucous
54
MOA progesterone implant
inhibit ovulation and also thicken cervical mucous and thin endometrium
55
MOA depo injection
inhibition of ovulation and the thickening of cervical mucus.
56
MOA IUD
Unfavourable environment and inhibiting implantation
57
MOA IUS
It thins the endometrium, and thickens cervical mucus
58
contrwception with no user failure
injection implant iud ius sterilisation
59
contraceptive injection
progesterone lasts 8-13w takes a while to regain fertility
60
implant
under skin in arm that releases progesterone lasts 3y
61
IUS
progesterone releasing works for 3-5y lighter and shorter and less painful periods, maybe irregular bleeding
62
IUD
copper can last 5-10y may have heavier or more painful periods
63
contraceptive methods with user failure
patch, ring, COCP, POP, condom, diaphragm, family plnning
64
contraceptoive patch
on skin and releases oestrogen and progesterone can make bleeds lighter
65
contraceptive vaginal ring
releases oestrogen and progesterone 1 ring stays in for 3w - self insert
66
COCP
oestrogen and progesterone reduces bleeding and pain
67
POP
progesterone only
68
condoms
protect against STIs
69
diaphragm with spermicide contraceptove
put in before sex need right size
70
emergency hormonal contracpetion
Levonorgestrel  (marketed as Levonelle One Step): Licensed for use within 72 hours of unprotected sex. Ulipristal acetate (EllaOne): Licensed for use within 120 hours of unprotected sex. The Intrauterine Device: must be inserted within 5 days of unprotected sex
71
CI ulipristal acetate
Diseases of malabsorption e.g. Crohn’s, Hypersensitivity to Ulipristal Acetate, Severe hepatic dysfunction, Enzyme inducing drugs e.g. rifampicin, Breast feeding – avoid breastfeeding for 7 days after taking UPA, Asthma insufficiently controlled by corticosteroids, Drugs increasing gastric pH e.g. omeprazole, ranitidine
72
CI copper IUD
Uterine fibroids with distortion of the uterine cavity, Documented or suspected pelvic inflammatory disease (PID), Documented or suspected STI (especially chlamydia or gonorrhoea)

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