Sexual Medicine

Question 1

What is bacterial vaginosis?

Answer 1

Caused by loss of healthy bacteria in the vagina, that normally secrete lactic acid to keep the pH low, meaning that the pH rises and other bacteria can grow
Not sexually transmitted

Question 2

What are the risk factors for bacterial vaginosis?

Answer 2

Excessive vaginal cleaning
Recent antibiotics
Smoking
Copper coil

Question 3

What is the presentation of bacterial vaginosis?

Answer 3

Fishy-smelling grey/white discharge
Half of women are asymptomatic
NOT typically associated with itching or pain

Question 4

What is the management of bacterial vaginosis?

Answer 4

Asymptomatic = no management
Metronidazole
Rule out other STis

Question 5

What is the most common causative organism of vaginal candidiasis?

Answer 5

Candida albicans

Question 6

What are the risk factors for thrush?

Answer 6

Increased oestrogen (pregnancy) (lower pre-puberty or post-menopause)
Poorly controlled diabetes
Immunosuppression
Broad-spectrum antibiotics

Question 7

What are the symptoms of vaginal candidiasis?

Answer 7

Thick, white discharge that does not typically smell
Vulval and vaginal itching

Question 8

What is the management of uncomplicated thrush?

Answer 8

Single dose intravaginal clotrimazole cream/pessary
Single dose of fluconazole

Question 9

What is the causative organism of chlamydia?

Answer 9

Chlamydia trachomatis

Question 10

What is the presentation of chlamydia in women?

Answer 10

Abnormal vaginal discharge
Pelvic pain
Abnormal vaginal bleeding
Dyspareunia
Dysuria

Question 11

What is the presentation of chlamydia in men?

Answer 11

Urethral discharge/discomfort
Dysuria
Epididymo-orchitis
Reactive arthritis

Question 12

How do you diagnose chlamydia?

Answer 12

NAAT (First catch urine sample or urethral swab)

Question 13

What is the management of chlamydia?

Answer 13

Doxycycline BD for 7 days

Doxycycline contradicted in pregnancy so consider azithromycin, erythromycin or amoxicillin

Question 14

What is the causative organism in gonorrhoea?

Answer 14

Neisseria gonorrhoeae

Question 15

What is the presentation of gonorrhoea in women?

Answer 15

Odourless purulent discharge, possibly green or yellow
Dysuria
Pelvic pain

Question 16

What is the presentation of gonorrhoea in men?

Answer 16

Odourless purulent discharge
Dysuria
Testicular pain or swelling

Question 17

What is the management of gonorrhoea?

Answer 17

Single dose IM ceftriaxone if sensitivities not known
Single dose oral ciprofloxacin if sensitivities known

Question 18

What is the presentation of trichomonas vaginalis infection?

Answer 18

Frothy, yellow-green, fishy smelling discharge
Itching
Dysuria
Dyspareunia
Balanitis
Cervicitis

Question 19

What is the management of trichomoniasis?

Answer 19

Refer to GUM
Metronidazole

Question 20

What is the presentation of genital herpes?

Answer 20

Ulcers/blistering lesions around genital area
Neuropathic pain
Flu-like symptoms
Dysuria
Inguinal lymphadeopathy

Question 21

What is the management of genital herpes?

Answer 21

Aciclovir
Paracetamol
Topical lidocaine

Question 22

What is the causative organism of syphilis?

Answer 22

Treponema pallidum

Question 23

What is the presentation of primary syphilis?

Answer 23

Painless genital ulcer (chancre), usually resolving over 3-8 weeks
Local lymphadeopathy

Question 24

What is the presentation of secondary syphilis?

Answer 24

Occurs after chancre has healed
Maculopapular rash
Condylomata lata (grey warts around genitals and anus)
Low-grade fever
Lymphadeopathy
Alopecia
Oral lesions

Question 25

What is the standard treatment for syphilis?

Answer 25

Single IM benzathin benzylpenicillin

Question 26

How long does an IUD (copper coil) take to become effective contraception?

Answer 26

Instantly

Question 27

How long does the POP take to become effective contraception?

Answer 27

2 days

Question 28

How long does an IUS (Mirena) take to become effective contraception?

Answer 28

7 days

Question 29

How long does the COCP take to become effective contraception?

Answer 29

7 days

Question 30

How long does the implant (Nexplanon) take to become effective contraception?

Answer 30

7 days

Question 31

How long does the contraceptive injection take to become effective?

Answer 31

7 days

Question 32

How does the COCP prevent pregnancy?

Answer 32

Preventing ovulation Thickening of cervical mucosa (progesterone) Inhibition of endometrial proliferation (progesterone)

Question 33

What are three common regimes for taking the COCP?

Answer 33

21 days on and 7 off 63 days on and 7 off (tricycling) Continuous use

Question 34

What are the side effects and risks of the COCP?

Answer 34

Unscheduled bleeding --> common in first 3 months but settles with time Breast pain/tenderness Mood changes Headaches Hypertension VTE Breast and cervical cancer MI and stroke

Question 35

What are the benefits of the COCP?

Answer 35

Effective contraception Rapid return of fertility Improvement in premenstrual symptoms, menorrhagia and dysmenorrhoea Reduced risk of endometrial, ovarian and colon cancers Reduced risk of benign ovarian cysts

Question 36

What are the UKMEC4 contraindications for taking the COCP?

Answer 36

Uncontrolled hypertension Migraine with aura History of VTE Age over 35 and smoking more than 15 per day Major surgery with prolonged immobility Vascular disease or stroke or ischaemic heart disease Liver cirrhosis/tumours SLE

Question 37

What is the UKMEC4 contraindication for taking the POP?

Answer 37

Active breast cancer

Question 38

How is the POP taken?

Answer 38

Continuously

Question 39

What are the side effects and risks of taking the POP?

Answer 39

Changes to bleeding schedule (1/3 have amenorrhoea or less regular bleeds, 1/3 have regular bleeds and 1/3 have unscheduled heavier or prolonged bleeds) Breast tenderness Headaches Acne Ovarian cysts Ectopic pregnancy Breast cancer

Question 40

What are the side effects and risks of the progesterone depot injection?

Answer 40

Weight gain (unique to injection) Acne Reduced libido Mood changes Headaches Flushes Hair loss Skin reactions Osteoporosis (unique to injection) Breast and cervical cancer

Question 41

How long does a contraceptive implant last before it needs replacing?

Answer 41

3 years

Question 42

How long after unprotected sex can the copper coil be used as emergency contraception?

Answer 42

5 days OR 5 days after estimated ovulation date

Question 43

How long after unprotected sex can levonorgestrel be used as emergency contraception?

Answer 43

Within 72 hours

Question 44

How long after unprotected sex can ulipristal be used as emergency contraception?

Answer 44

120 hours