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reproduction > STIs + contraception > Flashcards

STIs + contraception Flashcards

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%
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2
Q

are ny methods of contraception 100% effective

A

no

vasectomy then implant

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3
Q

what is the most serious side effect of the COC

A

venousthromboemoblism - DVT/ PE

3x

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4
Q

what method of contraception can have a good effect on acne

A

combined oral contraceptive

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5
Q

what does effectiveness of contraception depend on

A

user failure
breastfeeding
frequency of intercourse
age

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6
Q

how do contraceptive clinical trials present their failure rates

A

pearl index

life table analysis

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7
Q

if used correctly, what percentage of effectiveness are most methods of contraception

A

99%

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8
Q

what methods of contraception have the same typical and perfect use

A

coil
implant
(inside body )

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9
Q

what 2 hormones are contained in the combined oral contraceptive pill/ pesky/ ring

A

oestrogen - ethinyl oestoradiol

progesterone - synthetic progesterone

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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)

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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

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12
Q

what diseases does COCP reduce

A 
ovarian cycsts
ovarian/ endometrial cancer 
benign breast disease
RA
colon cancer
osteoporosis
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13
Q

what examples of progesterone only methods of contraception are there

A

pill
injection
implant
hormonal coil

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14
Q

how is the pop pill taken (degosterel)

A

within 3 hours same time every day without a pill free interval

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15
Q

what is the mode of action of progesterone methods of contraception

A

makes cervical mucus impenetrable by sperm

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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)

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17
Q

what is a disadvantage of the depoprovera injection

A

delay in return of fertility

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18
Q

how does the subnormal implant work

A 
inhibits ovulation (progesterone negative feedback)
effect on cervical mucus inhabiting sperm entry
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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

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20
Q

what are the 2 types of long active reversible contraceptives

A 
copper coil 
hormone coil (levagastro) - mirena, kyleena, jaydess
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21
Q

what is the 1st line contraception for heavy menstraul bleeding

A

levagastro - hormonal coil

mirena, kyleena, jaydess

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22
Q

how does the copper coil work

A

copper is toxic to sperm - prevents fertilisation

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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

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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

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25
Q

how long can the ella one pill be taken for after unprotected sex

A

120 hours

can’t start contraception for 5 days following

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26
Q

between what days of cycle is the greatest chance of getting pregnant

A

10-17 (20-30%)

2-3% chance of 1-9, 18-28 days

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27
Q

what might you ask someone before prescribing emergency contraception

A

stage of cycle/ last period
used recently
on contraception
STI check

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28
Q

what guidelines allow contraception to be prescribed to under 16s without parental permission

A

fraser guidelines/ gillicks competence

if capacity - understand risks/ benefits

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29
Q

when do you have to notify a social worker of a couple’s sexual activity

A

girl <13

if partner >16 and girl <16 consider

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30
Q

what is the gold standard method of sterilisation

A

laparoscopic occlusion of tubes

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31
Q

what happens in a vasectomy

A

permanent division of vas deferens

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32
Q

what is a complication of a vasectomy

A

sperm granuloma - mass of degenerating spermatozoa surrounded by macrophages

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33
Q

when is abortion legal in UK

A

up to 24 weeks

pregnancy viable at 22 weeks

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34
Q

when is surgical termination of pregnancy available till

A

12 weeks

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35
Q

how does the medical termination of pregnancy work

A

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

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36
Q

what are complications of termination of pregnancy

A 
failure
haemorrhage 
infection - up to 10%
prolonged bleeding 
uterine perforation
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37
Q

what is the name of the act that allows termination of pregnancies to happen

A

abortion act 1967

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38
Q

what is a sexually transmitted infection

A

is an infection which is predominantly sexually transmitted - unlikely not to be

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39
Q

what is the difference between a STD and an STI

A

disease- what it causes e.g. virus

infection - organsim

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40
Q

what groups have the highest prevalence of STIs

A

young adults and MSM

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41
Q

why is detection of STI’s difficult

A

asymptomatic

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42
Q

what is the activity of identifying and informing sexual contacts of someone with an STI

A

partner tracing

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43
Q

who is in the MDT of STI control

A

doctors, nurses, health advisers, third sector organisations, politicians, public health staff, behavioural psychologists, educationalists and the public

44
Q

what is a comennsal micro-organism

A

A micro-organism that derives food or other benfits from another organism without hurting or helping it.

45
Q

what is a sexually transmitted disease

A

A disorder of structure or function caused by a sexually transmitted pathogen- ie shows symptoms; pelvic inflammatory disease, genital warts

46
Q

in terms of oral, vaginal and anal sex, which is the highest to catch an STD

A

anal > vaginal > oral

47
Q

what infections can be caught form genital contact only

A

pubi lice
scabies
warts
herpes

48
Q

what are the 3 organisms of the VD act 1916

A

Syphilis (Treponema pallidum) Gonorrhea (Neisseria gonorhoeaa)
Chancroid (Haemophilus ducreyi)

49
Q

what are 3 parasites that may cause STIs

A

Pthirus pubis Sarcoptes scabei

Trichomonas vaginalis

50
Q

list some features of an STI

A

They’re transmissible - must notify partner
Asymptomatic most of the time
All manageable but not always curable
Avoidable - primary prevention is education

51
Q

what are outcomes of STIs

A 
Fever/ malaise 					Rash
Lymphadenopathy			- 
Infertility 
Cancer (cervical) 
pregnancy mutations
52
Q

what may be symptoms of STI’s in males

A 
urethral discharge, 
dysuria, 
genital skin problems, 
testicular pain/ swelling, 
peri-anal or anal symptoms in MSM.
53
Q

what may be symptoms of STI’s in females

A 
unusual vaginal discharge, 
vulval skin problems, 
abdominal pain, 
dyspareunia,
 unusual vaginal bleeding (post-coital, intermenstrual).
54
Q

what should you ask about sexual partners

A

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
Q

in an STI presentation, how far back should you ask about sexual partners

A

3 months

56
Q

how would you examine a male for STIs

A

retract foreskin
inspect urethral meatus for discharge
scrotal contents/tender- ness/swelling (stand patient up).

57
Q

how would you examine a female for STIs

A

vulval examination (lithotomy),
speculum of vagina/cervix,
bimanual examination for adnexal tenderness,
abdomen/pelvis for masses.

58
Q

what organism causes gonorrhoea

A

Neisseria gonorrhoeae

59
Q

what are the symptoms of gonorrhoea in males

A

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
Q

what are the symptoms of gonorrhoea in females

A

> 50% have no symptoms.

vaginal discharge, dysuria or intermenstrual/post-coital bleeding

61
Q

what are complications of gonorrhoea

A

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
Q

what is the incubation period of gonorrhoea

A

5-6 days (2 days - 2 weeks)

63
Q

is chlamydia or gonorrhoea more common

A

chlamydia

64
Q

how is gonorrhoea diagnoses

A

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
Q

how is a gonorrhoea infection followed up

A

Test of cure at 2 weeks and test of reinfection at 3 months

66
Q

what is the treatment of gonorrhoea

A

Blind treatment with ceftriaxone 500mg im once plus Azithromycin 1g.
Can also treat according to antibiotic sensitivities. Complicated disease add doxycycline and metronidazole.

67
Q

what is the causative organism of a chlamydia infection

A

Chlamydia trachomatis serovars D to K

68
Q

what are symptoms of chlamydia in males

A

> 70% asymptomatic. Slight watery discharge, dysuria, conjunctivitis

69
Q

what are symptoms of chlamydia in females

A

> 80% asymptomatic. Vaginal discharge, dysuria, intermenstrual/ post-coital bleeding, dyspareunia, conjunctivitis

70
Q

what are complications of chlamydia

A

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
Q

how is chlamydia diagnosed

A

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
Q

how is chlamydia treated

A

Azithromycin 1g po once.

Doxycycline 100mg bd 1 week

73
Q

does a chlamydia infection need curative follow up testing

A

no

74
Q

what is the causative organism in a herpes infection

A

Herpes Simplex Virus types 1 and 2

75
Q

what are symptoms of herpes simplex

A

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
Q

what are complications of herpes simplex

A

Autonomic neuropathy (urinary retention), neonatal infection, secondary infection.

77
Q

what is the incubation period for herpes simplex

A

5 days - months

78
Q

how is the diagnosis of herpes simplex made

A

Clinical impression.

Swab from lesion tested using PCR.

79
Q

what percentage of the UK population has herpes

A

15-20%

80
Q

how is herpes treated

A

Aciclovir e.g. 400mg tds for 5 days

Lidocaine ointment

81
Q

how are infrequent recurrences of herpes simplex treated

A

Lidocaine ointment

Aciclovir 1.2g once daily until symptoms gone (1-3 days)

82
Q

how are frequent recurrences of herpes simplex treated

A

Aciclovir 400bd long term as suppression

83
Q

what is the causative organism of a trichomoniasis infection

A

Trichomonas vaginalis

84
Q

what are symptoms of trichomoniasis

A 
Men – usually asymptomatic
Women – 10-30% asymptomatic
Profuse thin vaginal discharge – greenish, frothy &amp; foul smelling. 
Vulvitis
Itch.
85
Q

what are complications of trichomoniasis

A

Miscarriage, preterm labour, low birth weight

86
Q

how is trichomoniasis diagnosed

A

PCR on a vaginal swab – microscopy of wet preparation of vaginal discharge
Not on urine yet so no test for men

87
Q

how is trichomoniasis treated

A

Metronidazole 400mg po bd for 5 days or 2g single dose

88
Q

what causes anogenital warts

A

Human Papilloma Virus types 6 and 11

89
Q

what are symptoms of anogenital warts

A

Lumps with a surface texture of a small cauliflower. Occasionally itching or bleeding especially if perianal or intraurethral.

90
Q

what is the epidemiology of anogenital warts

A

> 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
Q

why is the prevalence of anogenital warts expected to drop

A

quadrivalent HPV vaccine

92
Q

how would you diagnose anogenital warts

A

Appearance.

Biopsy if unusual – to exclude intraepithelial neoplasia

93
Q

how are anogenital warts treated

A

Home treatments - Podophyllotoxin (brands warticon and condyline), imiquimod (brand Aldara)
cryotherapy
Bulky warts – diathermy, scissor removal

94
Q

what is the causative organism of syphillis

A

Treponema pallidum subspecies pallidum

95
Q

what is the difference between primary and secondary and tertiary stage symphillis

A

primary - local ulcer (chancre)
secondary - Rash, mucosal ulceration, neuro symptoms, patchy alopecia
tertiary - Neurological, cardiovascular or gummatous – skin lesion

96
Q

what are complications of syphillsi

A

neurosyphilis – cranial nerve palsies are commonest, cardiac or aortal involvement.
congenital syphillis

97
Q

what is the difference between early and late latent symphillsi

A

early < 2 years since caught

late > 2 years since caught

98
Q

how is syphillis diagnosed

A

Clinical signs
Serology for TP IgGEIA, TPPA and RPR
PCR on sample from an ulcer

99
Q

how is early latent syphillis treated (< 2yrs)

A

Benzathine penicillin 2.4 MU IM once or Doxycycline 100mg bd po 2 weeks

100
Q

how is late latent syphillis treated (>2yrs)

A

Benzathine penicillin 2.4MU IM weekly for 3 doses Doxycycline 100mg bd po 28 days

101
Q

what is the incubation period of syphillis

A

9 to 90 days

102
Q

what is the name given to a primary symphillis ulcer

A

chancre

103
Q

what population of people have a high prevalence of syphillsi

A

people who exchange sex for drugs

104
Q

what is the STI risk assessment for a man

A

¥ 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
Q

what is the difference between client and provider referral of partner notification of STIs

A

client referral’ - Patient tells contacts

‘provider referral’ - NHS tells contact they have been in contact with someone with a sexual transmitted infection

106
Q

what sexual history may be taken in a STI clinic

A
  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

reproduction (6 decks)

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