STIs and Contraception

Question 1

What are the components of a sexual history?

Answer 1

PC- dysuria, pain, itch, discharge, bleeding, systemic syx

BBV risk

Gynae history

Partners

Gender based violence

Question 2

What questions should you ask in the BBV risk section?

Answer 2

nationality of partner
IV drug use
Partner high risk HIV/Hep B/C?
Non professional tattoo/piercing
Paid for sex?

Question 3

What should you ask about in the gynae history?

Answer 3

assess pregnancy risk
last menstrual period
contraception
smear up to date
HPV vaccines

Question 4

What test is available for herpes simplex virus?

Answer 4

PCR test via swab

Question 5

What is the management of herpes?

Answer 5

aciclovir
saline bathing

Question 6

What is the latest time post exposure prophylaxis for HIV can be administered?

Answer 6

72 hours

Question 7

What is the length of course for post exposure prophylaxis?

Answer 7

28 days

Question 8

What agents are used for post prophylactic exposure?

Answer 8

truvada and raltegravir

Question 9

Patient presents to A&E with unprotected anal sex with another male. When would you test for HIV?

Answer 9

at 8 weeks

Question 10

Name one criteria for prescribing HIV pre exposure prophylaxis

Answer 10

MSM or transwoman who has had >2 partner in past 12 months or STI in past 12 months

Partner with HIV detectable viral load

Question 11

Which virus causes genital warts?

Answer 11

HPV 6 and 11

Question 12

What is the management of genital warts?

Answer 12

Imiquimod
Cryotherapy
Podophyllotoxin

Question 13

What is the most common cause of abnormal discharge?

Answer 13

bacterial vaginosis

Question 14

What is normal vaginal pH?

Answer 14

4-4.5

Question 15

What is the pH of someone with bacterial vaginosis?

Answer 15

> 4.5

Question 16

How is bacterial vaginosis diagnosed?

Answer 16

Thin homogenous discharge
High pH
Miscroscopy

Question 17

What is the name of the criteria to diagnose bacterial vaginosis?

Answer 17

Amsel’s criteria

Question 18

Which cells can be seen on microscopy in bacterial vaginosis?

Answer 18

clue cells

Question 19

What is the most common causative agent of candida?

Answer 19

candida albicans

Question 20

How is candida diagnosed?

Answer 20

history and macroscopic appearance
pH <5
miscroscopy

Question 21

What is the management of uncomplicated candida?

Answer 21

pessary or cream clotrimazole
fluconazole

Question 22

Name two indicator conditions for HIV

Answer 22

thrombocytopaenia
recurrent shingles
recurrent bacterial pneumonia
dementia
any STIs

Question 23

What are the stages of syphilis infection?

Answer 23

primary lesion (chancre)
secondary lesion (Rash)
latent serology
tertiary syphilis (CDV, neuo)

Question 24

How many days after giving birth do you need contraception?

Answer 24

21 days

Question 25

How many days after an abortion to you require contraception?

Answer 25

5 days

Question 26

When do you need to use contraception until?

Answer 26

45-50 and 2 years amenorrhoea (with no OCP use) 50 and 1 year amenorrhoea until 55 years old

Question 27

How long does it take to exclude pregnancy following unprotected sex?

Answer 27

3 weeks/21 days

Question 28

Name three contraception options where there are no user failures

Answer 28

copper IUD Female and male sterilisation Levonorgestrel releasing intrauterine system progestogen only implant

Question 29

List three side effects of hormonal contraception

Answer 29

irregular bleeding headache mood swings acne weight gain breast tenderness vaginal dryness greasy skin/hair chloasma

Question 30

What is chloasma?

Answer 30

=melasma (facial pigmentation)

Question 31

What is the MOA of the implant?

Answer 31

prevents ovulation

Question 32

What is the MOA of the hormonal intrauterine device?

Answer 32

progestogen- thins endometrium and thickens mucus 10% inhibition of ovulation

Question 33

What is the lifespan of IUS?

Answer 33

3-5 years

Question 34

What are the disadvantages of IUS?

Answer 34

minor medical procedure to insert- can be painful risk of vaginal bleeding/spotting 3-6 months after small chance of infection

Question 35

What is the MOA of the IUD/copper coil?

Answer 35

copper kills sperm, stops implantation, mucus thicker

Question 36

Name two disadvantages of the IUD

Answer 36

painful heaver bleeding perforation and expulsion risk infection risk

Question 37

What is the MOA of progestogen injection?

Answer 37

prevents ovulation

Question 38

Name two disadvantages of progestogen injection?

Answer 38

every 3 months delay in return to fertility weight gain erratic bleeding

Question 39

What are the two options for progestogen only injection?

Answer 39

depo provera sayana press- sub cut injection (Self-administered)

Question 40

Which OCP can be used in migraines?

Answer 40

progestogen only pill

Question 41

Name one example of progestogen only pill?

Answer 41

desogestrel

Question 42

Which contraceptive methods reduce the risk of endometrial and ovarian cancer?

Answer 42

progestogen only pill and injection

Question 43

What is the MOA of the combined hormonal pill?

Answer 43

prevents ovulation

Question 44

Which contraceptive method is associated with increased risk of breast and cervical cancer?

Answer 44

combined OCP

Question 45

List three contraindications for combined hormonal contraception

Answer 45

CDV disease VTE risk factors migraine with aura cancer- breast/liver post-natal

Question 46

Female missed one pill. What advice do you give them?

Answer 46

no condoms needed, no emergency contraception. Take the last missed pill and continue the pack (2 in one day)

Question 47

Female misses three pills in a row. What do you advise them?

Answer 47

need to ask where in the pack (for any >2 pills)

Question 48

Female misses two pills in the first week. What advice do you give her?

Answer 48

condoms for 7 days emergency contraception might be needed- seek advice

Question 49

Female misses three pills in the second week. Advice?

Answer 49

Use condoms for 7 days NO EC needed carry on taking pills as usual

Question 50

Female misses 4 pills in week 3. Advice?

Answer 50

condoms for 7 days and no EC needed. Start next packet of pills without a break

Question 51

How do you assess Fraser competency?

Answer 51

Is the child mature and intelligent enough to understand the nature and implications of the treatment proposed? Is it impossible to persuade the child to tell their parents, or let the Doctor tell them? Are they likely to begin or continue having sexual intercourse with or without contraception? Are their physical or mental health likely to suffer unless they get the advice or treatment? Is the advice or treatment in their best interest?

Question 52

List two options for emergency contraception

Answer 52

Cu IUD Ulipristal acetate EC Levonorgstrel EC

Question 53

What is the time frame of Cu IUD?

Answer 53

within 5 days of unprotected sex

Question 54

When can Cu IUD be inserted?

Answer 54

A copper IUD can be inserted up to 5 days after unprotected intercourse or 5 days after the calculated ovulation day or anytime in the cycle if a high sensitivity pregnancy test is negative.

Question 55

Patient needs emergency contraception 4 days after they had unprotected sex. Which EC method can they not opt for?

Answer 55

can't do levonorgestrel (within 72 hours)

Question 56

List three unacceptable risks wherein the combined OCP cannot be prescribed/considered

Answer 56

UKMEC4: - >35 years old and smoker of > 15 cigarettes per day - migraine with aura - Personal history of deep vein thrombosis or pulmonary embolism - Personal history of stroke or ischaemic heart disease - Uncontrolled hypertension - Breast cancer - Recent major surgery with prolonged immobilisation - Breast feeding and < 6 weeks postpartum earliest expected day of ovulation

Question 57

Aside from contraception, name three other indications for the COCP

Answer 57

aids heavy menstrual bleeding dysmennorhoea symptoms of endometriosis treatment of PCOS menopausal symptoms may improve acne reduction in benign ovarian cysts and tumours

Question 58

Which cancers does COCP reduce the risk of?

Answer 58

endometrial and ovarian cancer colorectal cancer

Question 59

Name two contraindications for COCP

Answer 59

high BMI smoking VTE IHD migraines hypertension stroke hx liver disease

Question 60

How does the COCP prevent pregnancy

Answer 60

inhibits ovulation thickens cervical mucus thins endometrium