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Reproduction/Sexual Health > Week 2 > Flashcards

Week 2 Flashcards

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1
Q

Contact tracing in chlamydia

A

Male urethral - past 4 weeks
Any other infection - past 6 months

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2
Q

Contact tracing in gonorrhoea

A

Male urethral - past 2 weeks
Any other infection - past 3 months

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3
Q

When is contact tracing not req?

A

Warts (asymptomatic)
Herpes (asymptomatic)
Thrush (not STI)
BV (not STI)

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4
Q

Vax available for STI

A

Hep B/A
HPV
Mpox

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5
Q

PEP

A

3 antiretrovirals
Within 72H
28 days total

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6
Q

Hep B PEP

A

HBV vax up to 7 days
OR Immunoglobulin in vax non-responders

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7
Q

Contraception involving prevention of ovulation

A

Suppression of FSH/LH
Most common type e.g. COCP, implant
Emergency contraception delays ovulation

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8
Q

Contraception involving prevention of fertilisation

A

Mechanical/surgical barrier
External - condoms, diaphragm, spermicides
Internal - tubal ligation, vasectomy
Hormonal - mirena coil, causes hostile cervical mucous effect to reduce sperm penetration
Negative effect on tubal motility e.g. POP, CHC

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9
Q

Contraception involving prevention of implantation

A

Hormonal creating hostile thin endometrium
IUDs causing local endo inflam reaction and toxicity to sperm/ova (this is secondary mech of copper coil, esp in emergency)

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10
Q

Contraception which thickens cervical mucous

A

LNG-IUD,
DMPA, POP,
SDI

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11
Q

Contraception causing endometrial change

A

Cu- and LNGIUD, SDI,
DMPA, POP,
CHC

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12
Q

What is LARC?

A

Long-acting reversible contraception

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13
Q

5 most effective contraceptive methods

A

Subdermal implant
Vasectomy
IUS (mirena)
Female sterilisation
IUD (copper)

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14
Q

Non-contraceptive benefits of hormonal contraception

A

DECREASE IN:
 Period pain
 Heavy menstrual bleeding
 Irregular PV bleeding (mainly CHC, LNG-IUD and DMPA)
 Ovulation pain (if ov supp)
 PMS (mainly CHC)
 Cyclical breast tenderness
 Ovarian cysts (if ov supp)
 Endometriosis
 Ovarian cancer (if ov supp)
 Acne or hirsutism (CHC only)
 Perimenopausal symptoms (CHC only)

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15
Q

Contraindications of coils

A

Submucosal fibroids
Uterine malformation etc

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16
Q

How is copper bearing IUD used as emergency contraception?

A

Up to 5 days after sex or 5 days after earliest estimated day of ovulation
Copper coil causes direct toxicity to sperm and egg and prevents implantation

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17
Q

Use of mirena coil other than contraception

A

Treatment of heavy period
HRT
Therapeutic use in endometriosis, hyperplasia

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18
Q

Describe SDI and its main side effect

A

Most effective, safe, lasts 3 years
Low stable level of hormones - less hormonal side effects
Main SE - prolonged PV bleeding
Bleeding may be cervicitis/endometritis from STI, preg complication, cancer/polyp
Bleeding can be controlled by additional COC

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19
Q

How to take COCP?

A

Start in first 5 days of period
OR
At any time in cycle when prob sure not pregnant, plus condoms for 7 days

Take daily for 21 days and then 7 day break

Some can be taken continuously with no interval

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20
Q

Factors affecting effectiveness of CHC

A

Impaired absorption
– GI conditions (COC)
Increased metabolism
– Liver enzyme induction or
drug interaction
Patch
– less effective >90kg

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21
Q

Main risks of CHC

A
  1. Venous thrombosis
    - depends on dose, but more common with other RFs present, prescribe with lowest risk
  2. Arterial disease
    - incr risk of MI esp with smokers/incr BP, incr ischaemic stroke, check BP initially and annually
  3. Adverse effects on some cancers
    - WHILE USING, RETURNS TO BASELINE AFTER 10Y: incr risk of breast cancer while using esp with BRACA mutation, small incr in cervical cancer
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22
Q

Why is CHC contraindicated in migraine with aura?

A

Increases risk of ischaemic stroke

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23
Q

Benefit of CHC in cancer

A

Reductio in ovarian cancer and endometrial cancer

Benefit can last decades after stopping CHC

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24
Q

Non-contraceptive benefits of CHC

A

Acne reduction
Less bleeding
Fewer functional ovarian cysts
Improvements with PMS and PCOS

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25
Side effects of CHC
Nausea Bleeding Spots Breast tenderness Weight gain Mood swings Pretty much anything you can think of
26
Mode of action of desogestrel PO methods
Inhibition of ovulation Start day 1-5 of period or anytime if reasonably certain not pregnant plus condoms for 7 days (2 days if POP) Now available OTC
27
Risk and side effects of POP
Small risk of breast cancer All similar to COCP plus anything you can think of
28
Mode of action of depo provera/sayana press
Suppression of FSH Lowers estradiol
29
Side effects of depot contraception
Nausea WG (more likely if <18 or BMI >30) Bleeding Spots Headache Small incr risk of breast and cervical cancer Caution in terms of bone health with under 18s and over 50s
30
How is vasectomy performed and complications?
Local/gen anaesthetic NO SCALPEL Comps include: pain, infection, inefficacy, bleeding/haematoma Failure is usually due to early non compliance and late semen analysis
31
4 types of female sterilisation
Removal Band Clip Essure
32
3 main emergency contraceptive methods
Levonorgestrel (levonelle) - progesterone, 72h afterwards, delays ov, OTC, 60-80% effective Ulipristal acetate (ella one) - progesterone receptor mod, 120h afterwards, delays ov, LH surge, OTC, 60-80% effective IUD - 5 days after sex or 5 days after ovulation, 99% effective
33
Describe microbio of neisseria gonnorhoeae
Gm- diplococci Screen with PCR Grown on chcocolate agar Causes urithritis, cervicitis, disseminated disease, PID, pharyngitis, proctitis
34
Management of gonorrhoea
1G Ceftriaxone IM, NOT ciprofloxacin 500mg oral unless sensitivity known 2nd line: cefixine 400mg oral + azithromycin 2G Treatment failure is usually in pharynx infection where there is limited penetration of antibios
35
Describe clinical pres of chlamydia trachomatis
Increased vaginal discharge, post-coital bleeding, dysuria, dyspareunia, rectal pain Complications: PID, salpingitis, endometritis, tubal infertility, ectopic pregnancy, perihepatitis, reactive arthritis
36
Testing and treatment of chlamydia
Test with NAAT Manage: 100mg BD doxycycline 1 week or azithromycin 1g stat followed by 2 days 50mg
37
Describe lymphogranuloma venereum
Caused by serovar L2 (and L1/L3) Presents as outbreaks of chlamydia Clinical: Painless ulcers and/or haemorrhagic proctitis, pharyngitis, lymphadenopathy (often unilateral)
38
Anaerobic bacterial causing infections which are not STIs
Gardnerella vaginalis Prevotells sp. Mobiluncus sp. Atopobium sp. Most commonly causing BV Test with gram stain Manage with metronidazole oral/gel or clindamycin cream
39
Describe pres, testing ad treatment of mycoplasma genitaleum
Pres: PID and urethritis Not stainable as lacking cell wall, usually NAAT Treatment: doxycycline/moxyfloxacin
40
Describe pres/testing of ureaplasma
Sexually transmitted and then becomes part of normal genital flora Pres: urethritis, epididymitis, prostatitis Test with PCR or liquid culture for sensitivity
41
Describe cause of syphilis
Trponema pallidum whichis a spirochate Sex, blood transfusion, pregnancy
42
How is syphilis tested for?
PCR from lesion sample Treponemal serology - Test 1: treponemal IgG and IgM - Test 2 if test 1 positive: specific Treponema pallidum assay & RPR (Rapid plasma reagin)/VDRL
43
Clinical pres of syphilis
Primary: chancre (painless ulcers on genitals) Secondary: rash incl palms and soles, mucous pathes, condyloma lata, hepatitis, splenomegaly, glomerulonephritis Latent after 3-12 weeks Late/tertiary disease: neuro/cardio/gummatous syphilis
44
Management of syphilis
Benzathine penicillin OR penicillin relative or doxy or azithromycin or erythromycin
45
Pres of HSV as STIs
Most asymptomatic HSV-1 mainly transmitted via oral-to-oral contact => “cold sores” HSV-2 mainly sexually transmitted => genital herpes with lesions
46
Complications of HSV
Increases risk of HIV transmission 3x Severe disease in immunocompromised people - Frequent recurrences - HSV-1 – keratitis - HSV-1 – encephalitis - HSV-2 - Meningoencephalitis - Dissemintated infection Neonatal herpes
47
Management of HSV
Aciclovir 400mg 3x daily for 5 days Prevention incl vaccine is much better than treatment
48
How does HPV present as a sexual health concern?
HPV 16 and 18 => 70% of cervical cancers HPV 6 and 11 => genital warts
49
Describe Mpox
Causes vesicles similar to HSV, can be severe disease Outpreaks of pox-like disease, ongoing since May 2022 globally Smallpox vaccine up to 85% effective in prevention ARV available for severe disease
50
How can varicella zoster be differentiated from HSV?
PCR
51
Complications of varicella zoster
Complications of primary infection: - Pneumonia - Encephalitis - Pregnancy: fetal injury Complications of recurrent infection: - Lasting nerve damage - Visual impairment
52
Mangaement of varicella zoster
Aciclovir in severe casess Live attenuated vaccine available
53
Pres and management of yeast infection
GM pos fungi, mostly candida albicans Pres: range of infections incl vulvovaginal candidiasis Manage: topical or systemic antifungals
54
Pres, testing and management of trichomonas vaginalis
Unicellular protozoa, ST Pres: Discharge with vulval itching, dysuria, Prostatitis, may cause preterm delivery Testing: micro from vaginal swab, NAAT, point of care test Manage: metronidazole 400mg BD and partner notification
55
Hx urethral symptoms to ask for
Duration of sxs Colour/amount Other urinary sxs Testicular sxs Systemic sxs Sexual hx (history of STIs)
56
Presentation of cystitis
Dysuria Frequency Urgency Nocturia Haematuria Suprapubic pain Systemic Usually due to gut bacteria
57
Presentation of urethritis
Dysuria Discharge No bladder Sx Nil systemic Usually caused by: Chlamydia Gonorrhoea Non-specific urethritis
58
Presentation of dermatitis
“External dysuria” Discomfort +/- itch Rash or ulcers Usually caused by: Candidiasis Trichomoniasis Herpes simplex Dermatoses
59
Investigations for urethritis
Clinical Examination Urethral swab for Gram stain and microscopy Urethral swab for gonorrhoea culture and sensitivities First void urine, Throat and rectal swabs for chlamydia and gonorrhoea NAAT Blood for syphilis and HIV
60
Diagnosis of urethritis on microscopy
More than 5 polymorphs on high powered field Gm- intracellular diplococci = gonnococcal urethritis None of above = non-gonococcal urethritis
61
Complications of gonnorhoea
Lower gen tract - bartholinitis, tysonitis Upper gen tract - endomitritis, PID Disseminated - skin lesions, septic arthritis
62
Most common cause of non-specific urtheritis
Chlamydia
63
Deep dyspareunia suggests?
Upper genital tract infection
64
Cervical excitation/motion tenderness?
Pain on touch or movement of cervix
65
Symptomatic sampling of discharge
Cervical microscopy (gram stain) Vaginal microscopy (gram stain and wet prep) and pH (narrow range) Amies swab (HVS culture and sensitivity) if recurrent/persistent, unknown cause, preg/PP, PID
66
When is diag and treatment of PID considered?
sexually active woman who has - recent onset, lower abdominal pain - associated with local tenderness on bimanual vaginal examination - pregnancy excluded - no other cause for the pain
67
Presentation of chlamydia
SYMPTOMS Urethral discharge (milky) Irregular bleeding (PCB/IMB) (this is red flag) Abdominal pain Dysuria SIGNS Urethritis Cervicitis Epididymo-orchitis Proctitis (LGV)
68
Complications of chlamydia
PID Ectopic pregnancy Reactive arthritis Conjunctivitis Fitz Hugh-Curtis (perihepatitis)
69
Management of PID
Ceftriaxone 1G IM Doxycycline 100mg BD x 2 weeks Metronidazole 400 mg BD x 2 weeks
70
Management of BV
Reassure Metronidazole 400mg bd 5/7 Topical clindamycin 2% cream or metronidazole 0.75% gel pH gels from pharmacy for prevention of recurrence If persistent cnsider suppressive therapy (metro) Worsening/recurring advice
71
Management of candidiasis
Reassure Clotrimazole 500mg pessary OR Fluconazole 150mg stat Clotrimazole 1% cream for external symptoms x2 weeks Worsening/recurring advice Consider HIV test if recurrent
72
Why can sex trigger BV?
Semen can incr pH of vagina
73
Findings of BV on exam
Genital mucosae normal Film of grey/white homogenous discharge at introitus and around cervix Normal cervis
74
RFs for candidiasis
Diabetes mellitus SGLT2i (Type 2 DM) Recent antibiotic use Immunosuppression
75
How is HSV transmitted?
close contact of oral or genital tract with an individual who is shedding virus - mouth, anogenital, eyes virus travels along sensory nerves to dorsal root ganglion and remains inactive causes symptom distribution in nevrve root, can be asymptomatic reactivation more often in HSV 2
76
Presentation of primary HSV
Symptoms: Pain, dysuria, discharge, painful lymphadenopathy, systemic symptoms, rectal symptoms Signs: Erythema, vesicles/ulcers (scab), lymphadenopathy, cervicitis HSV 1 and 2 often present the same but HSV 2 most likely to be asymptomatic
77
Symptoms of recurrent HSV
Prodrome (tingling, itching, burning), localised vesicles/ulcers, heal with scab, lasts 5-10 days
78
Inv for herpes
Swab lesion for HSV 1 and 2 PCR Recommend a full STI screen (chlamydia, gonorrhoea, syphilis and HIV)
79
Acquiring primary herpes in last 6 weeks of pregnancy may lead to?
Neonatal herpes
80
Describe pres of primary syphilis
Incubation 10-90 days Painless chancre - mouth, vulval, tip of penis, anal Resolves in 3-6w without treatment
81
Describe pres of secondary syphilis
Incubation<2y Haematogenous and lympathic dissemination causing multi-system disease Systemic symptoms/fluey: - low grade fever - sore throat - headache - lymphadenopathy - rash (esp palms and soles) - wart like lesions in warm/moist areas (vulva, anus)
82
Inv for syphilis
Swab from lesion for treponema pallidum PCR Venous blood for syphilis IgG/IgM (EIA) - serology is not v specific but is best TPPA is confirmatory, then RPR to monitor disease prog Consider repeating STI screen if previously not definitive
83
ST causes of gential lumps
Genital warts (HPV) Molluscum contagiosum Monkeypox Scabies
84
Non-ST causes of genital lumps
Physiological Folliculitis Hydradenitis suppurativa Seborrhoeic keratoses Cancers Bartholin’s abscess Skin tags Lichen planus Pyoderma granuloma
85
Mnagaement of genital warts
Cryotherapy Topical podophylotoxin - Solution (0.5%) - Cream (0.15%) Imiquimod Cataphen Surgical - Electrocautery - Curette - Debulking
86
Is HPV persistent?
No not usually 70% DNA negative at 12m and 80% negative at 24m Persistence more common in immunosuppressed or people who smoke
87

Reproduction/Sexual Health (9 decks)

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