STIs + contraception Flashcards
(106 cards)
1
Q
list the methods of contraception and their prevalence
A
combined oral pill- 25% progesterone pill - 5% implant/ jag - 3% intrauterine methods - 6% sterilised - 28%
2
Q
are ny methods of contraception 100% effective
A
no
vasectomy then implant
3
Q
what is the most serious side effect of the COC
A
venousthromboemoblism - DVT/ PE
3x
4
Q
what method of contraception can have a good effect on acne
A
combined oral contraceptive
5
Q
what does effectiveness of contraception depend on
A
user failure
breastfeeding
frequency of intercourse
age
6
Q
how do contraceptive clinical trials present their failure rates
A
pearl index
life table analysis
7
Q
if used correctly, what percentage of effectiveness are most methods of contraception
A
99%
8
Q
what methods of contraception have the same typical and perfect use
A
coil
implant
(inside body )
9
Q
what 2 hormones are contained in the combined oral contraceptive pill/ pesky/ ring
A
oestrogen - ethinyl oestoradiol
progesterone - synthetic progesterone
10
Q
how is the COCP normally taken (levonorgestrel)
A
21 days on , 1 week off
(new evidence for tailored regimes - 3 months on, 1 week off)
(takes 7 days to become effective at start - condoms)
11
Q
what is the mode of action of the COCP
A
prevents ovulation
negative feedback of hypothalamus - non GnRH, no FSH/ LSH, no surge
alters endometrium - inadequate for implantation
12
Q
what diseases does COCP reduce
A
ovarian cycsts ovarian/ endometrial cancer benign breast disease RA colon cancer osteoporosis
13
Q
what examples of progesterone only methods of contraception are there
A
pill
injection
implant
hormonal coil
14
Q
how is the pop pill taken (degosterel)
A
within 3 hours same time every day without a pill free interval
15
Q
what is the mode of action of progesterone methods of contraception
A
makes cervical mucus impenetrable by sperm
16
Q
how is the DepoProvera injection given
A
150mg intramuscular into upper outer quadrant of buttock every 12 weeks
(aqueous solution of crystals of the progesterone deoinedroxyprogesterone acetate)
17
Q
what is a disadvantage of the depoprovera injection
A
delay in return of fertility
18
Q
how does the subnormal implant work
A
inhibits ovulation (progesterone negative feedback) effect on cervical mucus inhabiting sperm entry
19
Q
what is the structure of the subnormal implant
A
measures 4cm , 2mm diameter
covered in rate controlling membrane made form EVA
68mg of progesterone etonogestrel
20
Q
what are the 2 types of long active reversible contraceptives
A
copper coil hormone coil (levagastro) - mirena, kyleena, jaydess
21
Q
what is the 1st line contraception for heavy menstraul bleeding
A
levagastro - hormonal coil
mirena, kyleena, jaydess
22
Q
how does the copper coil work
A
copper is toxic to sperm - prevents fertilisation
23
Q
what is the most effective method of emergency contraception
A
Cu- IUD
can be used up to day 19 of cycle or within 5 days of unprotected sex
24
Q
how long can the morning after pill be taken for after unprotected sex (levonorgestrel)
A
72 hours
most effective in 1st 24 hours
25
how long can the ella one pill be taken for after unprotected sex
120 hours
| can't start contraception for 5 days following
26
between what days of cycle is the greatest chance of getting pregnant
10-17 (20-30%)
| 2-3% chance of 1-9, 18-28 days
27
what might you ask someone before prescribing emergency contraception
stage of cycle/ last period
used recently
on contraception
STI check
28
what guidelines allow contraception to be prescribed to under 16s without parental permission
fraser guidelines/ gillicks competence
| if capacity - understand risks/ benefits
29
when do you have to notify a social worker of a couple's sexual activity
girl <13
| if partner >16 and girl <16 consider
30
what is the gold standard method of sterilisation
laparoscopic occlusion of tubes
31
what happens in a vasectomy
permanent division of vas deferens
32
what is a complication of a vasectomy
sperm granuloma - mass of degenerating spermatozoa surrounded by macrophages
33
when is abortion legal in UK
up to 24 weeks
| pregnancy viable at 22 weeks
34
when is surgical termination of pregnancy available till
12 weeks
35
how does the medical termination of pregnancy work
1st drug - switches off pregnancy hormones keeping uterus from contracting and allowing foetus to grow
2nd drug - 48 hours later prostaglandins initiate uterine contraception which opens servix and expels pregnancy
36
what are complications of termination of pregnancy
```
failure
haemorrhage
infection - up to 10%
prolonged bleeding
uterine perforation
```
37
what is the name of the act that allows termination of pregnancies to happen
abortion act 1967
38
what is a sexually transmitted infection
is an infection which is predominantly sexually transmitted - unlikely not to be
39
what is the difference between a STD and an STI
disease- what it causes e.g. virus
| infection - organsim
40
what groups have the highest prevalence of STIs
young adults and MSM
41
why is detection of STI's difficult
asymptomatic
42
what is the activity of identifying and informing sexual contacts of someone with an STI
partner tracing
43
who is in the MDT of STI control
doctors, nurses, health advisers, third sector organisations, politicians, public health staff, behavioural psychologists, educationalists and the public
44
what is a comennsal micro-organism
A micro-organism that derives food or other benfits from another organism without hurting or helping it.
45
what is a sexually transmitted disease
A disorder of structure or function caused by a sexually transmitted pathogen- ie shows symptoms; pelvic inflammatory disease, genital warts
46
in terms of oral, vaginal and anal sex, which is the highest to catch an STD
anal > vaginal > oral
47
what infections can be caught form genital contact only
pubi lice
scabies
warts
herpes
48
what are the 3 organisms of the VD act 1916
Syphilis (Treponema pallidum) Gonorrhea (Neisseria gonorhoeaa)
Chancroid (Haemophilus ducreyi)
49
what are 3 parasites that may cause STIs
Pthirus pubis Sarcoptes scabei
| Trichomonas vaginalis
50
list some features of an STI
They’re transmissible - must notify partner
Asymptomatic most of the time
All manageable but not always curable
Avoidable - primary prevention is education
51
what are outcomes of STIs
```
Fever/ malaise Rash
Lymphadenopathy -
Infertility
Cancer (cervical)
pregnancy mutations
```
52
what may be symptoms of STI's in males
```
urethral discharge,
dysuria,
genital skin problems,
testicular pain/ swelling,
peri-anal or anal symptoms in MSM.
```
53
what may be symptoms of STI's in females
```
unusual vaginal discharge,
vulval skin problems,
abdominal pain,
dyspareunia,
unusual vaginal bleeding (post-coital, intermenstrual).
```
54
what should you ask about sexual partners
sex of partner(s) type of contact (oral, vaginal, anal)
contraceptive method (properly used?)
type and duration of relationship
symptoms in partner(s) risk factors for HIV/hepatitis in partner(s)
whether partner(s) can be contacted.
STI history in all.
55
in an STI presentation, how far back should you ask about sexual partners
3 months
56
how would you examine a male for STIs
retract foreskin
inspect urethral meatus for discharge
scrotal contents/tender- ness/swelling (stand patient up).
57
how would you examine a female for STIs
vulval examination (lithotomy),
speculum of vagina/cervix,
bimanual examination for adnexal tenderness,
abdomen/pelvis for masses.
58
what organism causes gonorrhoea
Neisseria gonorrhoeae
59
what are the symptoms of gonorrhoea in males
10% of males have no symptoms though might have clinical signs if examined.
Thick, profuse yellow discharge, dysuria.
Rectal and pharyngeal infection often asymptomatic.
60
what are the symptoms of gonorrhoea in females
>50% have no symptoms.
| vaginal discharge, dysuria or intermenstrual/post-coital bleeding
61
what are complications of gonorrhoea
Men - Epididymitis
Women - Pelvic inflammatory disease, salpingitis, infertility
Bartholin's abscess. [Gonococcal ophthalmia neonatorum.]
Both - Acute monoarthritis usually elbow or shoulder.
Disseminated Gonococcal Infection: skin lesions - pustular with halo. (both v rare).
Increased HIV transmission.
62
what is the incubation period of gonorrhoea
5-6 days (2 days - 2 weeks)
63
is chlamydia or gonorrhoea more common
chlamydia
64
how is gonorrhoea diagnoses
Nucleic Acid Amplification Test (NAAT) on urine or swab from an exposed site – vagina, rectum, throat. Could be self-obtained or clinician-obtained.
Gram stained smear from urethra/cervix/rectum in symptomatic people.
Culture of swab-obtained specimen from an exposed site using highly selective lysed blood agar in a 5% CO2 environment. Should be done for all confirmed cases to assess antibiotic sensitivity.
65
how is a gonorrhoea infection followed up
Test of cure at 2 weeks and test of reinfection at 3 months
66
what is the treatment of gonorrhoea
Blind treatment with ceftriaxone 500mg im once plus Azithromycin 1g.
Can also treat according to antibiotic sensitivities. Complicated disease add doxycycline and metronidazole.
67
what is the causative organism of a chlamydia infection
Chlamydia trachomatis serovars D to K
68
what are symptoms of chlamydia in males
>70% asymptomatic. Slight watery discharge, dysuria, conjunctivitis
69
what are symptoms of chlamydia in females
>80% asymptomatic. Vaginal discharge, dysuria, intermenstrual/ post-coital bleeding, dyspareunia, conjunctivitis
70
what are complications of chlamydia
Men - Epidydimitis
Women - Pelvic Inflammatory Disease and hence ectopic pregnancy, pelvic pain and infertility
Both - Reactive arthritis/ Reiter’s syndrome – urethritis/cervicitis + conjunctivitis + arthritis
71
how is chlamydia diagnosed
First void urine in men.
Female swab from cervix, urethra, vulvovaginal. Swab rectum as appropriate.
All specimens tested using a NAAT – nucleic acid amplification test
72
how is chlamydia treated
Azithromycin 1g po once.
| Doxycycline 100mg bd 1 week
73
does a chlamydia infection need curative follow up testing
no
74
what is the causative organism in a herpes infection
Herpes Simplex Virus types 1 and 2
75
what are symptoms of herpes simplex
80% have no symptoms. The rest have recurring symptoms – monthly, annually. Burning/itching then blistering then tender ulceration.
Tender inguinal lymphadenopathy. Flu-like symptoms.
Dysuria, Neuralgic pain in back, pelvis and legs,
76
what are complications of herpes simplex
Autonomic neuropathy (urinary retention), neonatal infection, secondary infection.
77
what is the incubation period for herpes simplex
5 days - months
78
how is the diagnosis of herpes simplex made
Clinical impression.
| Swab from lesion tested using PCR.
79
what percentage of the UK population has herpes
15-20%
80
how is herpes treated
Aciclovir e.g. 400mg tds for 5 days
| Lidocaine ointment
81
how are infrequent recurrences of herpes simplex treated
Lidocaine ointment
| Aciclovir 1.2g once daily until symptoms gone (1-3 days)
82
how are frequent recurrences of herpes simplex treated
Aciclovir 400bd long term as suppression
83
what is the causative organism of a trichomoniasis infection
Trichomonas vaginalis
84
what are symptoms of trichomoniasis
```
Men – usually asymptomatic
Women – 10-30% asymptomatic
Profuse thin vaginal discharge – greenish, frothy & foul smelling.
Vulvitis
Itch.
```
85
what are complications of trichomoniasis
Miscarriage, preterm labour, low birth weight
86
how is trichomoniasis diagnosed
PCR on a vaginal swab – microscopy of wet preparation of vaginal discharge
Not on urine yet so no test for men
87
how is trichomoniasis treated
Metronidazole 400mg po bd for 5 days or 2g single dose
88
what causes anogenital warts
Human Papilloma Virus types 6 and 11
89
what are symptoms of anogenital warts
Lumps with a surface texture of a small cauliflower. Occasionally itching or bleeding especially if perianal or intraurethral.
90
what is the epidemiology of anogenital warts
>90% of UK population have a genital HPV infection at some point in their life. Only about 20% of those infected with a wart-causing strain of human papilloma virus get warts
91
why is the prevalence of anogenital warts expected to drop
quadrivalent HPV vaccine
92
how would you diagnose anogenital warts
Appearance.
| Biopsy if unusual – to exclude intraepithelial neoplasia
93
how are anogenital warts treated
Home treatments - Podophyllotoxin (brands warticon and condyline), imiquimod (brand Aldara)
cryotherapy
Bulky warts – diathermy, scissor removal
94
what is the causative organism of syphillis
Treponema pallidum subspecies pallidum
95
what is the difference between primary and secondary and tertiary stage symphillis
primary - local ulcer (chancre)
secondary - Rash, mucosal ulceration, neuro symptoms, patchy alopecia
tertiary - Neurological, cardiovascular or gummatous – skin lesion
96
what are complications of syphillsi
neurosyphilis – cranial nerve palsies are commonest, cardiac or aortal involvement.
congenital syphillis
97
what is the difference between early and late latent symphillsi
early < 2 years since caught
| late > 2 years since caught
98
how is syphillis diagnosed
Clinical signs
Serology for TP IgGEIA, TPPA and RPR
PCR on sample from an ulcer
99
how is early latent syphillis treated (< 2yrs)
Benzathine penicillin 2.4 MU IM once or Doxycycline 100mg bd po 2 weeks
100
how is late latent syphillis treated (>2yrs)
Benzathine penicillin 2.4MU IM weekly for 3 doses Doxycycline 100mg bd po 28 days
101
what is the incubation period of syphillis
9 to 90 days
102
what is the name given to a primary symphillis ulcer
chancre
103
what population of people have a high prevalence of syphillsi
people who exchange sex for drugs
104
what is the STI risk assessment for a man
¥ Have you ever had sexual contact with a man?
¥ Have you ever injected drugs?
¥ Sexual contact with - anyone who’s injected drugs? someone from outside the UK? (clarify)
¥ Medical treatment outside UK? (clarify)
¥ Involvement with sex industry. (had sex with prostitute)
105
what is the difference between client and provider referral of partner notification of STIs
client referral’ - Patient tells contacts
| ‘provider referral’ - NHS tells contact they have been in contact with someone with a sexual transmitted infection
106
what sexual history may be taken in a STI clinic
1. When did you last have sexual contact?
2. Casual contact vs ‘regular’ partner? - How long were you going out with them for
3. Were they male or female?
4. Asking about nature of sex act sometimes useful - may alter where you swab from
5. Did you use condoms?
6. Other contraception used
7. Nationality of contact
