Sexual Health Workshop [completed]

Question 1

What is the causative organism for chlamydia?

Answer 1

Chlamydia trachomatis (gram positive)

Question 2

What population is chlamydia prevalent in?

Answer 2

Sexually active people under 25

Question 3

Are people with chlamydia often symptomatic or asymptomatic?

Answer 3

Asymptomatic

Question 4

What are some symptoms that men may experience if they have chlamydia?

Answer 4

Pain when urinating (dysuria) caused by urethritis
Discharge
Testicular pain and swelling
Fever
Perineal fullness due to prostatis
Pain and discharge from anus

Question 5

What are some symptoms that women may experience if they have chlamydia?

Answer 5

Pain on urination
Pus in the urine
Lower abdominal pain
Fever
Dyspareunia - pain during sex
Bleeding between periods or after sex
Changes in vaginal discharge
Pain and discharge from anus

Question 6

What signs may be found on examination of men with chlamydia?

Answer 6

Testicular tenderness
Mucoid/mucopurulent discharge

Question 7

What signs may be found on examination of women with chlamydia?

Answer 7

Friable inflamed cervix with a follicular/cobblestone appearance
Cervix bleeds on contact/cervical excitation
Discharge
Pelvic tenderness on palpitation

Question 8

What are some ways to diagnose chlamydia?

Answer 8

Cell culture
Antigen detection/enzyme immunoassays
Nucleid Acid Amplification Test (HIGHEST SENSITIVITY)
Serology
Swab is vulvovaginal, cervical, urethral, or rectal.
Or men may have first-catch urine sample.

Question 9

What is the first line treatment for chlamydia?

Answer 9

ORAL
Doxycycline 100mg bd for 7 days OR azithromycin 1g on day 1 then 500mg od for 2 days

Question 10

What addition counselling should be given to patients with chlamydia?

Answer 10

NO SEX until doxycline course completed or 7 days after azithromycin
Test for other STIs
Partner notification
Follow up
Use of barrier methods of contraception

Question 11

Which partners should be notified in chlamydia?

Answer 11

Partners from
4 weeks back: symptomatic men
6 months back: women and asymptomatic men

Question 12

What are the health implications of not treating chlamydia?

Answer 12

Pelvic inflammatory disease
Infertility
Ectopic pregnancy
Ophthalmia neonatorum - if passed on to neonate
Issues with Labour and delivery
Urethral stricture and scarring in men
Reiter’s syndrome (reactive arthritis)

Question 13

When will the symptoms of chlamydia be relieved?

Answer 13

2-4 weeks - improvements seen after a few days

Question 14

What is the causative organism for Gonorrhoea?

Answer 14

Neisseria gonorrhoeae (gram negative)

Question 15

What population is gonorrhoea prevalent in?

Answer 15

Young people under the age of 25.

Question 16

What percentage of men with gonorrhoea are symptomatic?

Answer 16

90/95%

Question 17

What symptoms may men with gonorrhoea experience?

Answer 17

mucopurulent/purulent urethral discharge
dysuria
balanitis
epididymal tenderness and swelling

Question 18

What percentage of women with gonorrhoea have no symptoms?

Answer 18

50%

Question 19

What symptoms may women with gonorrhoea experience?

Answer 19

Mucopurulent discharge/increase in discharge
Easily induced bleeding
Bleeding between periods
Cystitis/dysuria
Pelvic/lower abdominal pain

Question 20

What sign may be found on examination of men with gonorrhoea?

Answer 20

Epididymal tenderness - pain on palpation of the testes

Question 21

How is gonnorhea diagnosed?

Answer 21

Swab taken of vagina, cervix or penis –> presence of Neisseria gonorrhoeae detected through cell culture or Nucleic Acid Amplification test

Question 22

What is the first line treatment for gonnorhea?

Answer 22

Oral ciprofloxacin 500mg as a single dose if susceptibility is known OR
Ceftriaxone 1g IM if susceptibility is not known

Question 23

What additional counselling should be given to patients with gonnorhea?

Answer 23

Avoid sexual activity until 7 days after they and any partners have treatment
Partner notification
Test for other STIs
Advice on safe sex - e.g. barrier methods such as condoms and dental dams
Follow up and test of cure is recommended

Question 24

Which partners should be notified in gonorrhoea?

Answer 24

All partners from the last 3 months or TWO WEEKS in symptomatic men

Question 25

What are the health implications of not treating gonorrhoea?

Answer 25

Epididymo-orchitis - painful condition of testicles Spread to womb - PID can lead to infertility and pain

Question 26

What is the national chlamydia screening programme? Who is eligible?

Answer 26

Anyone who is sexually active, aged 15-24 and has a womb and ovaries may be invited Anyone can go to a pharmacy or gum clinic and ask for a test

Question 27

What is provided in a chlamydia screening kit?

Answer 27

Blood test Urine test (men) Vaginal Rectal

Question 28

What is an IUD?

Answer 28

Copper coil inserted into the uterus - copper stops egg implanting or being fertilised Can cause heavy bleeds and uncomfortable to put in >99% effective Lasts a long time (5-10 years) Fertility goes back to normal as soon as its taken out can also be used as emergency contraception if over 5 days

Question 29

What is a diaphragm or cap?

Answer 29

silicon discs put inside vagina just before intercourse to stop the sperm entering the womb 92-96% effective if used correctly Caps are smaller diaphragms

Question 30

What are progestogen only pills (POPs)

Answer 30

Contain progestogens such as levenorgestrol, norethistone, desogestrel Prevents egg release over 99% effective if used correctly

Question 31

What are lovima and Hana?

Answer 31

POPs - contain desogestrel 75mcg and can be supplied as P medicines

Question 32

What are some contraindications for Lovima and Hana?

Answer 32

Active thrombosis Active or history of liver disease or liver cancer Active or suspected sex-steroid sensitive cancer - breast, uterine or ovarian Undiagnosed vaginal bleeding Pregnancy Allergic to ingredients such as lactose, soya, or peanut (soybean oil in lovima)

Question 33

When is the best time to take the POP?

Answer 33

Days 1 to 5 of cycle (Day 1 = first day of period)

Question 34

If you start a POP after day 5, why do you still have to use other methods of contraception?

Answer 34

Protection only starts after taking for 2 days

Question 35

What is the window to take a missed POP?

Answer 35

3 hours except desogestrol which is 12 hours

Question 36

Is there a seven day pill free period with POPs

Answer 36

No

Question 37

what drugs can affect efficacy of CHCs and POPs when they are taken orally ?

Answer 37

Enzyme inducers - carbamazepine, eslicarbazepine acetate, efavirenz, nevirapine, oxcarbazepine, phenytoin, phenobarbital, primidone, rifabutin, rifampicin, ritonavir, St John's wort, and topiramate

Question 38

If combined oral contraceptives are used correctly do condoms need to be used during the pill free period?

Answer 38

No

Question 39

What are some side effects of CHCs?

Answer 39

depression weight gain mood swings changes in libido headches THROMBOSIS CANCER

Question 40

What is natural family planning?

Answer 40

Tracking the menstrual cycle to see when most fertile and not having sec during this 6 day window. Can be figured out using basal temperature, changes in mucus and ovulation test but need to know cycle really well. If done correctly then 91-99% effective

Question 41

What is the implant?

Answer 41

Small plastic rod inserted under the skin of the arm that releases progestogen Lasts for 3 years 99% effective if replaced as needed. Can make periods lighter but can also make them heavier

Question 42

What is male sterilistion?

Answer 42

Vasectomy - sperm ducts are sealed, blocked or cut so sperm is not released on ejaculation Over 99% effective Not always reversible if you change your mind