WOMEN'S HEALTH - SEXUAL HEALTH + GUM Flashcards

Question

GONORRHOEA What is it caused by?

Answer 1

Neisseria gonorrhoea – gram -ve diplococcus

Answer 2

2–5d, spreads via contact with infected mucous secretions, often if co-existing STI

Answer 3

Asymptomatic 90% F, 50% M

Answer 4

Cervicitis (PV discharge, PCB, IMB, dyspareunia)

Answer 5

Urethral discharge, dysuria, testicular pain/swelling (epididymo-orchitis)

Answer 6

Asymptomatic but sometimes peri-anal pain

Answer 7

Odourless purulent, can be green/yellow

Answer 8

NAAT testing - M = first-void urine or urethral swab - W = endocervical, vulvo-vaginal or first-void urine - Pharyngeal/rectal swab in MSM or clinical indication Charcoal swab (endocervical or HVS) MC&S

Answer 9

- To screen for other STIs. - Reduces antibiotic resistance by matching to sensitivities

Answer 10

- Urethral strictures - Epididymo-orchitis + salpingitis (can lead to infertility)

Answer 11

- PID - Gonococcal arthritis (most common cause of septic arthritis in young adults) - Disseminated gonococcal infection as triad (tenosynovitis, migratory polyarthritis, dermatitis lesions can be maculopapular or vesicular)

Answer 12

- Ophthalmia neonatorum (gonococcal conjunctivitis) – medical emergency associated with sepsis, eye perforation + blindness.

Answer 13

- 1g single dose IM ceftriaxone (add PO ciprofloxacin 500mg but only if sensitive as high antibiotic resistance) - Follow-up test of cure with NAAT testing or cultures - Contact tracing, partner notification, contraceptive advice, ?safeguarding

Answer 14

- Loss of lactobacilli which are the main component of healthy vaginal flora - These bacteria produce lactic acid to keep vaginal pH low (3.5–4.5) - The acidic environment prevents other bacteria overgrowing so pH rises > alkaline environment > anaerobes overgrow

Answer 15

- Gardnerella vaginalis (#1), mycoplasma hominis, prevotella spp.

Answer 16

No but can increase risk of STIs, may co-exist with other infections like candidiasis, chlamydia + gonorrhoea.

Answer 17

- Multiple sexual partners - Excessive vaginal cleaning - Recent Abx - Smoking - IUD

Answer 18

Less frequent if COCP or effective condom usage

Answer 19

- Fishy-smelling watery grey or white PV discharge - Commonest cause of abnormal vaginal discharge in younger women - Itching, irritation + pain are not common.

Answer 20

- Speculum (not necessary if classic Sx + low STI risk) to visualise discharge + HVS to exclude other causes. - ?NAAT to screen for STIs

Answer 21

Amsel's (3/4) - Thin, white discharge (can present asymptomatically) - Vaginal pH using swab + pH paper >4.5 - Clue cells on cervical swab MC&S (endocervical or self-taken vaginal) - Positive whiff test (add potassium hydroxide to get very strong fishy odour)

Answer 22

- Cervical epithelial cells that have bacteria stuck inside them.

Answer 23

- Pregnancy related – miscarriage, preterm delivery, PROM, chorioamnionitis, LBW

Answer 24

- Asymptomatic usually resolves without Tx - PO metronidazole 5–7d to target anaerobic bacteria (avoid alcohol as can cause N+V + flushing) - Topical metronidazole or clindamycin are alternatives - Advice about avoiding excessive vaginal cleaning

Answer 25

- STI spread through sexual activity + lives in uretha of men + women as well as vagina in women

Answer 26

Contracting HIV by damaging vaginal mucosa BV, cervical cancer, PID pregnancy-related complications.

Answer 27

- Protozoan parasite, single-celled organism with flagella – trichomonas vaginalis - 4 flagella at front, 1 on back making it highly motile, attach to tissues + cause damage

Answer 28

- PV discharge classically offensive, frothy + yellow/green. - Vulvovaginitis, itching, dysuria + dyspareunia. - May cause urethritis + balanitis in men

Answer 29

- Speculum = strawberry cervix (colpitis macularis) due to cervicitis + tiny haemorrhages on surface of cervix due to infection

Answer 30

- Vaginal pH >4.5 - Charcoal swab for MC&S (HVS, urethral swab or first-catch urine). - Microscopy shows motile trophozoites + wet microscopy shows polymorphonuclear leukocytes

Answer 31

- Referral to GUM for Dx, Tx + contact tracing - PO metronidazole 5–7d (or stat 2g dose)

Answer 32

- Gets in through skin or mucous membranes, replicates + then disseminates

Answer 33

About 3 weeks

Answer 34

Treponema pallidum – spirochete (spiral-shaped) bacteria

Answer 35

- Oral, vaginal + anal sex with direct contact with infected area - Vertical transmission - IVDU, blood transfusions + other transplants (rare due to screening) - Biggest RF = MSM

Answer 36

- Primary - Secondary - Tertiary

Answer 37

- Involves painless ulcer (chancre) at the original site of infection. - Often genitals but may not be visible (cervix)

Answer 38

- Systemic Sx once chancre healed, particularly of mucous membranes, Sx often resolve after 6–12w + then becomes latent (asymptomatic but still infected) - Early latent is <2y since initial infection, late latent is >2y

Answer 39

- Occurs many years after the initial infection + can affect many organs, particularly with development of gummas + CV/neuro complications

Answer 40

- Painless genital chancre, resolves over 3–8w with clear base + serum, rounded edges - Local lymphadenopathy

Answer 41

- Systemic (low grade fever, lymphadenopathy). - Maculopapular rash (trunk, soles + palms). - Condylomata lata (grey wart-like lesions around genitals + anus). - Alopecia - Buccal 'snail track ulcers'

Answer 42

- Gummas (granulomatous lesions that can affect skin, organs + bones) - Aortic aneurysms - Neurosyphilis – tabes dorsalis (locomotor ataxia), paralysis, dementia, Argyll-Robertson (prositutes) pupil

Answer 43

"Accommodates but does not react" - Constricted pupil that accommodates when focusing on near object but does not react to light, often irregularly (small) shaped

Answer 44

- Treponemal tests (enzyme immunoassay or haemagglutination assay) - Samples from site of infection tested with dark field microscopy or PCR

Answer 45

- Specialist GUM (full STI screening, contact tracing, contraceptive information). - Single dose IM benzathine benzylpenicillin or PO doxycycline if allergic

Answer 46

- Jarisch-Herxheimer reaction within a few hours of treatment - Fever, rash + tachycardia thought to be due to release of endotoxins following bacterial death

Answer 47

- Herpes simplex virus (HSV) causes both cold sores + genital herpes

Answer 48

Virus becomes latent in associated sensory nerve ganglia, commonly trigeminal nerve ganglion in cold sores (initial contraction in childhood, reactivates in stress) or sacral nerve ganglia in genital herpes

Answer 49

- Direct contact with affected mucous membranes or viral shedding in mucous secretions, can be shed even when no Sx (more common in first 12m).

Answer 50

HSV-1 mostly cold sores - If genital, due to oro-genital sex (oral > genital) HSV-2 mostly genital herpes - STI but can cause lesions in mouth

Answer 51

- Can be asymptomatic or develop Sx when latent virus reactivated - Initial infection usually appears within 2w + lasts for 3w being more severe than recurrent episodes which resolve quicker.

Answer 52

- Multiple painful ulcers or blistering lesions affecting genital area - Neuropathic type pain (tingling, burning, shooting) - Flu Sx (fatigue, headaches, fever, myalgia) - Dysuria - Inguinal lymphadenopathy

Answer 53

- Aphthous ulcers (small painful oral sores) - Herpes keratitis (inflammation of the cornea = blue) - Herpetic whitlow (painful skin lesion on finger/thumb)

Answer 54

- Viral PCR swab from a lesion

Answer 55

- Neonatal HSV infection as high morbidity + mortality. - After initial infection woman will produce IgG that cross placenta to give foetus passive immunity + protect during labour + delivery

Answer 56

- Aciclovir during infection - Prophylactic aciclovir from 36w gestation onwards to reduce risk of genital lesions during labour + delivery - Asymptomatic at delivery can have vaginal if >6w from initial infection, if Sx then c-section

Answer 57

- Aciclovir during infection + immediate prophylactic aciclovir - C-section in all cases

Answer 58

- Occurs if woman known to have genital herpes before pregnancy - Low risk of neonatal infection even if lesions at delivery - Prophylactic aciclovir from 36w to reduce risk of Sx at delivery

Answer 59

- Specialist GUM Mx - Conservative (paracetamol, topical lidocaine 2% instillagel, clean with warm saltwater, topical vaseline, PO fluids, loose clothing, avoid sex). - Aciclovir may be used

Answer 60

- Sex, sharing sex toys or potentially oral. - Can be transmitted even if asymptomatic

Answer 61

- Human papilloma virus 6 + 11 - Can stay in skin + warts can develop again

Answer 62

- 2-5mm fleshy, slightly pigmented warts around vagina, penis or anus - Itching or bleeding from genitals or anus - Abnormal urine stream

Answer 63

- Clinical diagnosis (may use magnifying glass or colposcope) - Application of acetic acid/vinegar produces acetowhite changes of surface - Biopsy if atypical

Answer 64

- May increase in number, size or recur during pregnancy - Cryotherapy offered, usually can give birth vaginally

Answer 65

- Prophylaxis with HPV vaccine for 12–13y (may be given to MSM, trans men/women + sex workers) - Topical podophyllotoxin cream/lotion or cryotherapy. - GUM contact tracing, contraceptive advice

Answer 66

- Thrush – vaginal infection with a yeast of the Candida family - May colonise without causing Sx then progresses to infection with the right environment (during pregnancy/after Tx with Abx that alter vaginal flora)

Answer 67

- Candida albicans (#1)

Answer 68

Increased oestrogen (pregnancy, during menstrual years) poorly controlled DM, immunosuppression, broad spectrum Abx

Answer 69

- Thick, white discharge that does not smell (cottage cheese) - Vaginal + vulval itching, irritation or discomfort - Severe infection > erythema, fissures, oedema, dysuria, dyspareunia

Answer 70

- Tx often started empirically on clinical presentation - Vaginal pH <4.5 - Charcoal swab MC&S to confirm

Answer 71

- Anti-fungal cream/pessary (clotrimazole) or PO anti-fungal tablets (fluconazole) - Canesten duo is standard OTC Tx with single fluconazole tablet + cream - Recurrent infections with induction + maintenance regime of PO/PV anti-fungals

Answer 72

Clotrimazole in pregnancy as fluconazole can cause congenital abnormalities

Answer 73

- Can damage latex condoms + prevent spermicides from working so alternative contraception needed for 5d after

Answer 74

- Chronic inflammation dermatosis where elastic tissue becomes collagen

Answer 75

Lichen refers to a flat eruption that spreads.

Answer 76

Labia, perineum + perianal skin

Answer 77

Glans penis + foreskin

Answer 78

- Thought to be autoimmune as associated with other autoimmune conditions (T1DM, alopecia, hypothyroidism, vitiligo)

Answer 79

- 45–60y with vulval itching + skin changes - Soreness/pain (worse at night), skin tightness + superficial dyspareunia

Answer 80

- Painful erections - Dyspareunia - Urinary Sx - Soreness

Answer 81

- Koebner phenomenon where signs + Sx worse with friction to skin - Can be worse with tight, rubbing underwear, scratching + incontinence

Answer 82

- Porcelain-white in colour, shiny, tight, thin, slightly raised, ± papules or plaques - Hyperkeratosis if chronic scratching - Affects vulva + perianal areas but not perineum giving hourglass/8 shape - Biopsy if ?malignancy

Answer 83

- 5% risk of developing squamous cell carcinoma of the vulva. - May be pain + discomfort, sexual dysfunction, bleeding + narrowing of vaginal or urethral openings

Answer 84

- Cannot be cured by symptoms controlled - Potent topical steroids like clobetasol propionate 0.05% (Dermovate) giving long-term control + reduces risk of malignancy - Topical emollients

Answer 85

- RNA retrovirus that encodes reverse transcriptase - Binds to GP120 envelope glycoprotein to CD4 receptors which migrate to lymphoid tissue where virus replicates + produces billions of new virions - Reverse transcriptase makes single strand RNA > double stranded DNA + viral DNA is integrated to host cell's DNA with enzyme integrase + core viral proteins synthesised + cleaved by viral protease - These then released + in turn infect new CD4 cells

Answer 86

- HIV-1 is most common type - HIV-2 is rare outside West Africa

Answer 87

MSM, IVDU, commercial sex workers

Answer 88

- Unprotected anal, vaginal or oral sex (co-existing STIs can enhance transmission) - Vertical transmission (pregnancy, breastfeeding) - Mucous membranes, blood or open wound exposure to blood or bodily fluids (IVDU, needle-sticks, blood splashed in eye)

Answer 89

- Initial seroconversion 2–6w post infection (flu Sx with fever, malaise, myalgia, maculopapular rash) - Clinical latency with progressive CD4 loss (poor immunity but no Sx). - Early Sx HIV (rise in viral load + fall in CD4 count) where fever, night sweats, diarrhoea + opportunistic infections (HSV, herpes zoster) > AIDS-related complex

Answer 90

AIDS = Sx of immune deficiency and a CD4 count of <200

Answer 91

- All associated with end-stage HIV infection where CD4 count dropped to a level that allows opportunistic diseases to occur. - Kaposi's sarcoma, pneumocystis jiroveci pneumonia, cytomegalovirus, candidiasis (oesophageal or bronchial), lymphomas, TB

Answer 92

- Serum/salivary HIV enzyme-linked immunosorbent assay (ELISA) - Rapid point of care screening blood test for HIV antibodies - PCR testing

Answer 93

Can take 3m for HIV Ab detection so confirmatory assay after 3m.

Answer 94

Immunoassay kit provides rapid result but needs serological confirmation, repeat within 3m of exposure if initially negative.

Answer 95

P24 antigen tests directly for viral antigen in blood + can give +ve earlier in infection compared to antibody test, HIV RNA levels tests directly for number of viral copies in blood giving a viral load

Answer 96

- Monitoring CD4 count - Monitoring viral load

Answer 97

i) Destroyed by virus so lower = increased risk of opportunistic infection (<200 cells/mm^3 = AIDS, 500–1200 normal range)

Answer 98

Undetectable refers to viral load below labs recordable range (usually 50–100 copies/ml), may be in hundreds of thousands if untreated. Undetectable = untransmissable

Answer 99

- Normal vaginal delivery if viral load <50 copies/ml - Consider c-section if >50, but mandatory in >400 - IV zidovudine 4h before c-section - Neonatal PO zidovudine if maternal viral load <50 if not triple ART both for 4–6w - No breastfeeding

Answer 100

- Specialist HIV, infectious diseases + GUM clinics - Highly active anti-retrovirus therapy (HAART) with 2 NRTIs + third agent - Goal to achieve normal CD4 count + undetectable viral load

Answer 101

- Nucleoside reverse transcriptase inhibitors (NRTIs) - Protease inhibitors (PIs) - Integrase inhibitors (IIs) - Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Answer 102

i) Zidovudine, tenofovir, emtricitabine – inhibits synthesis of DNA by reverse transcriptase ii) Indinavir (end –navir) – acts competitively on HIV enzyme involved in production of functional viral proteins iii) Raltegravir (end –gravir) – inhibits insertion of HIV DNA to genome iv) Nevirapine – binds directly to + inhibits reverse transcriptase

Answer 103

- Given within 72h of exposure to HIV+ (sooner = better) - ART therapy = Truvada (emtricitabine + tenofovir) + raltegravir for 28d - HIV test done immediately + 3m after, should abstain for 3m

Answer 104

- Education about safe sex + condoms, less partners, regular tests. - Prophylactic co-trimoxazole if CD4 <200 to protect from PCP - Monitor blood lipids + CVD RFs as increased risk - Yearly smears for women - Vaccines up to date but avoid live vaccinations - Can conceive safely via techniques like sperm washing + IVF

Answer 105

Balanitis is inflammation of the glans penis and sometimes extends to the underside of the foreskin which is known as balanoposthitis

Answer 106

candidiasis dermatitis bacterial anaerobic lichen planus lichen sclerosis

Answer 107

candidiasis dermatitis bacterial anaerobic

Answer 108

lichen sclerosis plasma cell of balanitis of Zoon

Answer 109

- red, swollen, itchy and sore penis - pain when peeing - thick discharge from under foreskin - unpleasant smell - difficulty pulling back foreskin

Answer 110

- mostly clinical diagnosis - if infective a swab can be taken for microscopy

Answer 111

- gentle saline washes - ensuring to wash foreskin properly - 1% hydrocortisone for short period

Answer 112

topical clotrimazole for 2 weeks

Answer 113

flucloxacillin or clarithromycin if penicillin allergic

Answer 114

saline washing oral metronidazole

Answer 115

mild topical corticosteroids (hydrocortisone)

Answer 116

strong topical corticosteroids (clobetasol)

Answer 117

STI caused by serovars L1, L2 or L3 or chlamydia trachomatis

Answer 118

Painless genital ulcer Appears 3-12 days after infection May not be noticeable e.g. if occurs inside the vagina Inguinal lymphadenopathy Proctitis, rectal pain, rectal discharge (in rectal infections) Systemic symptoms such as fever and malaise

Answer 119

swab PCR to detect chlamydia trachomatis

Answer 120

Treatment is with antibiotics. Common regimes include: Oral doxycycline 100 mg twice daily for 21 days Oral tetracycline 2 g daily for 21 days Oral erythromycin 500 mg four times daily for 21 days

Answer 121

Chancroid is an infection of the genital skin caused by Haemophilus ducreyi. It typically produces a painful, potentially necrotic genital lesion. Associated symptoms include painful lymphadenopathy and bleeding on contact.

Answer 122

Haemophilus ducreyi Given its relatively high incidence in topical areas and Greenland, it is important to inquire in the history about recent travel.

Answer 123

A painful genital lesion which may bleed on contact Associated symptoms include painful lymphadenopathy

Answer 124

clinical diagnosis diagnosis can be confirmed using culture or PCR

Answer 125

The infection is treated using antibiotics (typically Ceftriaxone, Azithromycin or Ciprofloxacin)

Answer 126

UK Medical Eligibility Criteria to do with safe contraception use. - UKMEC1 = no restriction in use (minimal risk). - UKMEC2 = benefits generally outweigh the risks. - UKMEC3 = risks generally outweigh the benefits. - UKMEC4 = unacceptable risk, C/I.

Answer 127

- Abstinence is only 100% effective method. - Long-acting methods as not dependent on user to take regular action. - Effectiveness is expressed as perfect use + typical use as it can be user dependent.

Answer 128

- NFP (≥95%, 76%) - Condoms (98%, 82%) - COCP/POP (>99%, 91%) - PO-injection (>99%, 94%) - PO-implant, coils + sterilisation (>99% both)

Answer 129

i) Any hormonal contraception (use IUD or barrier methods). ii) Avoid IUS. iii) Avoid copper coil.

Answer 130

- Require contraception for 2y if <50y/o or 1 y if >50. - HRT does not prevent pregnancy. - COCP can be used up to age 50 + can treat perimenopausal Sx. - Injection stopped before 50 due to risk of osteoporosis.

Answer 131

- COCP + POP unaffected by age. - Implant good choice of long-acting reversible contraception (UKMEC1). - Injection UKMEC2 due to concerns about reduced BMD. - Coils UKMEC2 as higher rate of expulsion.

Answer 132

- Fertility not considered to return until 21d postnatally. - Lactational amenorrhoea is >98% effective for up to 6m after if women fully breastfeeding + amenorrhoeic. - POP + implant considered safe in breastfeeding + can start any time after birth.

Answer 133

- Woman monitors her menstrual cycle + only has sex when less fertile. - Requires 3–12m of cycles to predict fertile time, partner commitment. - 6d prior to ovulation (sperm live for 6d) to 2d after (ovum life) is fertile window.

Answer 134

- Provide a physical barrier to semen entering the uterus. - Only method that protect against STIs (but not 100%).

Answer 135

- Latex barrier around the penis, using oil-based lubricants can damage latex + make them more likely to tear. - Polyurethane condoms can be used in latex allergy.

Answer 136

- Silicone cups that fit over the cervix + prevent semen entering the uterus. - Woman fits them before having sex + leaves in place for at least 6h after sex. - Should be used with spermicide gel to further reduce risk of pregnancy. - 95% perfect use but little protection to STIs.

Answer 137

- Used during oral sex to provide barrier between mouth + vulva and the vagina or anus to prevent infections that spread via oral sex. - Chlamydia, gonorrhoea, HS1+2, HPV, E. coli, pubic lice, syphilis.

Answer 138

- Pill containing supraphysiological level of oestrogen (ethinylestradiol) AND progesterone (of varying types).

Answer 139

- Inhibits ovulation (primary mechanism). - –ve feedback on hypothalamus/pituitary so suppression of GnRH/LH/FSH so anovulation. - Progesterone thickens cervical mucus, inhibits proliferation of endometrium, reducing chance of successful implantation.

Answer 140

- Endometrial lining is maintained in a stable state so when the pill is stopped, the lining breaks down + sheds causing a withdrawal bleed. - This is not a menstrual period as it's not part of the natural menstrual cycle. - Unscheduled bleeding (spotting) may occur in extended use without a pill-free period.

Answer 141

- Monophasic contain the same amount of hormone in each pill, everyday formulations like microgynon, pack contains 7 inactive pills. - Multiphasic pills have varying amounts of hormones to match the normal cyclical changes more closely.

Answer 142

i) Pills with levonorgestrel or noresthisterone (microgynon or Leostrin) as lower VTE risk. ii) Pills containing drospirenone as anti-mineralocorticoid + anti-androgen activity can help Sx (esp. w/ continuous use). ii) Pills containing cyproterone acetate (co-cyprindiol) as anti-androgen effects but the oestrogenic effects give it higher VTE risk so usually stopped after 3m when Sx reduced.

Answer 143

- 21d on 7d off. - Tricycling 63d on (three packs), 7d off. - Continuous use without a pill-free period.

Answer 144

- Effective contraception, rapid return of fertility after stopping. - Improvement in PMS, menorrhagia + dysmenorrhoea (acne in some). - Reduced risk of endometrial, ovarian, colon cancer + benign ovarian cysts.

Answer 145

- Unscheduled bleeding common in first 3m. - Breast pain + tenderness. - Mood changes + depression. - Headaches, HTN, VTE. - Small raise in risk of breast + cervical cancer (risk normalises after 10y taking pill). - Small raise in risk of MI + stroke.

Answer 146

- Uncontrolled HTN. - Migraine with aura. - >35 smoking >15/day. - Major surgery with prolonged immobility (stop 4w before major surgery) - Hx of stroke, IHD, AF, VTE. - Active breast cancer. - Liver cirrhosis or tumours. - SLE + antiphospholipid syndrome. - Breastfeeding before 6w postpartum (UKMEC2 after).

Answer 147

- >35 smoking <15/day. - BMI >35kg/m^2. - Controlled HTN. - VTE FHx in 1st degree relatives. - Immobility. - Known carrier of BRCA1/2.

Answer 148

- Start on day 1 = immediate protection. - Start after day 5 = extra contraception for first 7d. - Can switch from traditional POP at any time but 7d extra contraception. - Can switch from desogestrel with no additional contraception as it inhibits ovulation.

Answer 149

- When the pill is >24h, D+V is managed as missed pill. - Take missed pill ASAP even if means 2 pills on same day, no extra protection required as long as back on track.

Answer 150

Take most recent missed pill ASAP even if means 2 pills on same day, extra contraception for 7d. - Day 1–7 + UPSI = emergency contraception. Day 8–14 + UPSI = ok. Day 15–21 + UPSI = next pack back-to-back so skip pill free period.

Answer 151

- Pill containing only progesterone, taken continuously with fewer contraindications + risks compared with the COCP.

Answer 152

Traditional POP (norgeston) – - Thickens cervical mucus. - Alters endometrium so less accepting of implantation. - Reduced ciliary action in fallopian tube. Desogestrel POP (Cerazette) – - Inhibits ovulation (main mechanism) + above.

Answer 153

- Start day 1–5 = immediate protection. - Other times = 48h additional contraception to allow cervical mucus to thicken enough to prevent entry of sperm. - Can switch between POPs with no extra contraception.

Answer 154

- Best time to change is days 1–7 of the hormone-free period after finishing the COCP pack as no additional contraception required. - Any other time requires 48h contraception.

Answer 155

- Active breast cancer.

Answer 156

- Unscheduled bleeding common in first 3m (if persists exclude other causes like STIs, pregnancy, cancer). - Changes to bleeding schedule one of primary adverse effects (40% regular bleeding, 40% irregular, prolonged or troublesome + 20% amenorrhoeic). - Breast tenderness, headaches + acne.

Answer 157

- Increased risk of ovarian cysts, small risk of ectopic pregnancy with traditional POP due to reduced ciliary action, minimal increased risk of breast cancer (returns to normal 10y after stopping).

Answer 158

- >3h in traditional POP is a missed pill. - >12h for desogestrel-POP is a missed pill.

Answer 159

- Depot medroxyprogesterone acetate. - Depo-Provera = IM. - Sayana press = s/c (can be self-injected). - Noristerat is alternative that contains noresthisterone + works for 8w so used as short-term interim contraception (e.g. after vasectomy).

Answer 160

- Inhibits ovulation by inhibiting FSH secretion by the pituitary gland + prevents development of follicles in the ovary. - Thickens cervical mucus + alters endometrium to make it less favourable for implantation.

Answer 161

- Day 1–5 = immediate protection. - > day 5 = 7d of contraception. - Injections every 12–13w, any longer = less effective.

Answer 162

Changes to bleeding schedule main issue - Bleeding often more irregular, heavier + last longer. - Usually temporary, >1y of regular use most become amenorrhoeic. - Exclude other causes of bleeding. - Can use COCP for 3m if problematic bleeding. - Short course (5d) of mefenamic acid can halt bleeding.

Answer 163

- Weight gain - Reduced BMD (oestrogen maintains BMD + mostly produced by follicles in ovaries) – Makes depot unsuitable for those >45 - Takes 12m for fertility to return after stopping

Answer 164

- Acne. - Reduced libido. - Mood issues (depression). - Headaches. - Alopecia. - Skin reactions at injection sites. - Small rise in breast/cervical cancer risk.

Answer 165

- UKMEC4 = active breast cancer. - UKMEC3 = IHD + stroke, unexplained vaginal bleeding, severe liver cirrhosis + liver cancer.

Answer 166

- Small flexible plastic rod placed in upper arm beneath skin + above s/c fat that slowly releases progesterone into circulation.

Answer 167

- Inhibits ovulation. - Thickens cervical mucus. - Alters endometrium to make it less accepting to implantation.

Answer 168

- Day 1–5 = immediate protection. - >Day 5 = 7d contraception. - Lasts 3y then needs replacing.

Answer 169

- Effective + reliable. - Can improve dysmenorrhoea + can make periods lighter or stop altogether. - No weight gain, effect on BMD, no VTE risk, no restrictions for obese patients.

Answer 170

- Problematic bleeding (20% amenorrhoeic, 25% frequent/prolonged bleeding, 33% infrequent, rest normal, can use COCP for 3m if problematic bleeding + no C/Is). - Can worsen acne, no STI protection.

Answer 171

- Can be bent/fractured or impalpable/deeply implanted needing extra contraception until located (USS/XR), may need specialist removal. - Very rarely can enter vessels + migrate through body to lungs.

Answer 172

- Active breast cancer.

Answer 173

- Device inserted into uterus to provide contraception offering long-acting reversible contraception.

Answer 174

- Screen for STIs before insertion. - Women seen 3–6w after insertion to check the threads. - Abstain from sex or use extra contraception for 7d before coil removed.

Answer 175

- Insertion risks (bleeding, pain on insertion [use NSAIDs], - vasovagal reactions, - uterine perforation, - PID + expulsion rate highest in first 3m.

Answer 176

- PID or infection, - immunosuppression, - pregnancy, - unexplained bleeding, - pelvic cancer, - uterine cavity distortion (fibroids).

Answer 177

- Licensed for 5–10y after insertion depending on device + can be used as emergency contraception. - Copper toxic to ovum + sperm, alters endometrium making it less favourable to implantation.

Answer 178

- Reliable contraception. - Insert at any time in cycle + immediate protection. - No hormones so safe in VTE risk of Hx or cancer. - May reduce risk of endometrial + cervical cancer.

Answer 179

- Procedure with risks for insertion/removal. - Can cause HMB/IMB which often settles. - Some women have pelvic pain. - No STI protection. - Increased risk of ectopic pregnancies. - Occasionally falls out.

Answer 180

- Mirena effective for 5y in contraception, 4y for HRT + licensed for menorrhagia. - Levosert effective for 5y + licensed for menorrhagia

Answer 181

- Progesterone component thickens cervical mucus. - Alters endometrium making less hospitable + inhibits ovulation in small # of women.

Answer 182

- Can make periods lighter or stop. - May improve dysmenorrhoea or pelvic pain related to endometriosis. - No effect on BMD, VTE, no restrictions in obese pts.

Answer 183

- Procedure with risks for insertion/removal. - Can cause spotting or irregular bleeding. - Some women experience pelvic pain. - No STI protection. - Increased risk of ectopic pregnancies. - Occasionally falls out. - Increased incidence of ovarian cysts. - Systemic absorption can lead to progesterone Sx (acne, headaches, breast tenderness).

Answer 184

- Irregular bleeding can occur particularly in first 6m. - Exclude causes (STI, pregnancy, cervical smears up to date). - COCP in addition for 3m can settle the bleeding.

Answer 185

- Actinomyces-like organisms (ALO). - No treatment unless Sx (pelvic pain, abnormal bleeding) ?removal.

Answer 186

- Copper IUD - PO Ulipristal acetate (ellaOne) - PO levonorgestrel (levonelle)

Answer 187

i) 99% regardless of time in cycle ii) <120h of UPSI or 120h after earliest estimated date of ovulation iii) Toxic to sperm + ovum so inhibits fertilisation + implantation. iv) Keep in until at least next period

Answer 188

Pros - Choice not affected by BMI, enzyme-inducing drugs or malabsorption. - Can leave in as long-term contraceptive Cons - PID (especially if STIs) - Normal risks with coil insertion

Answer 189

i) Single 30mg dose ii) Second most effective but decreases with time iii) <120h iv) Selective progesterone receptor modulator that inhibits ovulation v) Vomiting within 3h then repeat dose vi) Spotting + changes to next menstrual period, abdo/pelvic/back pain, mood changes, headaches, dizziness, breast tenderness

Answer 190

Pros - More effective than levonorgestrel - Can be used >1 in one cycle Cons - Avoid breastfeeding for 1w (express but discard) - Avoid in severe asthma - Wait 5d before starting COCP or POP with 7 or 2d extra contraception needed

Answer 191

i) Single 1.5mg dose (3mg if BMI >26kg/m^2) ii) Least effective of group 84% iii) <72h iv) Stops ovulation + inhibits implantation v) Spotting + changes to next menstrual period, diarrhoea, breast tenderness, dizziness, depressed mood

Answer 192

Pros - Safe during breastfeeding (Avoid for 8h to avoid infant exposure though). - COCP/POP can start instantly but with extra contraception for 7/2d - Use more than once in a menstrual cycle Cons - Less effective

Answer 193

- Permanent surgical interventions to prevent conception but does not protect against STIs. - Yes but the NHS does not provide reversal, these are private and have a low success rate.

Answer 194

- Laparoscopic under GA - Occlusion of tubes using "Filshie clips" or fallopian tubes can be tied + cut/removed altogether either as elective or during c-section. - Prevents ovum travelling along fallopian tube to the uterus + so sperm and ovum will not meet.

Answer 195

- 99% effective (1 in 200 failure rate). - Alternative contraception until next menstrual period as ovum may have already reached uterus during that cycle.

Answer 196

- Cutting the vas deferens, preventing sperm travelling from the testes to join the ejaculated fluid so prevents sperm being released into the vagina. - Relatively quick, less invasive and under LA.

Answer 197

- 99% effective (1 in 2000 failure rate). - Alternative contraception required for 2m after. - Test semen to confirm absence of sperm before it can be relied upon contraception, usually 12w after to allow clearance.

Answer 198

- Failure to conceive after 1 year of regular (2–3/7) unprotected sex.

Answer 199

After >1y or... - Female >35 - Menstrual disorder - Previous abdo/pelvic surgery - Previous PID/STI - Abnormal pelvic exam

Answer 200

- 40% factors in both partners - 30% male factors - Unexplained, ovulatory disorders, tubal damage. - Less commonly uterine/peritoneal disorders.

Answer 201

PCOS POI, pituitary tumours, hyperprolactinaemia, Turner syndrome, Sheehan's, previous radio/chemo

Answer 202

- Extremes of weight - Increasing age - Smoking - Alcohol/drug use

Answer 203

- STI screens (particularly chlamydia). - Ovulatory tests (mid-luteal progesterone levels, ovarian reserve testing) - TFTs + prolactin if clinical suspicion - Pelvic USS for PCOS or structural abnormalities - Karyotyping

Answer 204

- Indication of ovulation - 7d before end of cycle (usually day 21) - <16 = anovulation, >30 is ovular

Answer 205

- Serum FSH + LH on days 2–5 (high = poor ovarian reserve) - Anti-mullerian hormone (released by granulosa cells in growing follicles so falls as eggs depleted) - Antral follicle count on USS (Few suggest poor ovarian reserve)

Answer 206

- Hysterosalpingogram – no anaesthetic required, use in those with no risk factors. - Laparoscopy + dye test (gold standard) – use in those with risk factors

Answer 207

- Intercourse 2–3 a week, regular smear tests, check rubella status. - Take 0.4mg folic acid (or 5mg if high risk). - Healthy BMI, no alcohol, drugs or smoking, control any co-morbidities.

Answer 208

- Weight loss - Clomiphene (selective oestrogen receptor modulator on days 2–6 to inhibit oestrogen + cause more GnRH + so FSH + LH release) or letrozole (aromatase inhibitor) to stimulate ovulation. - Gonadotrophins to stimulate ovulation if resistant to clomiphene - Ovarian drilling may be used in PCOS

Answer 209

- Laparoscopy/tomy adhesiolysis + ablation or resection of endometriosis - Tubal catheterisation during HSG or selective salphingography

Answer 210

- Surgery to correct polyps, adhesions or structural deformities - IVF

Answer 211

After >1y or... - Previous genital pathology or urogenital surgery - Previous STI - Systemic illness - Abnormal genital exam

Answer 212

- Pre-testicular causes - Testicular causes - Post-testicular causes - Genetic/congenital causes of defective/absent sperm production - Azoospermia or teratozoospermia

Answer 213

Pituitary/hypothalamus pathology, suppression due to stress, chronic conditions, hyperprolactinaemia, Kallmann's

Answer 214

Klinefelter's, Y chromosome deletions

Answer 215

Semen analysis - Count >15m/ml - Motility >40% - Morphology >4% - Total >39 million - Repeat in 3m if abnormal

Answer 216

- FSH (increases in testicular failure) - Vasogram (inject dye to vas deferens + XR for obstruction), USS. - Testicular biopsy in azoospermia only if cryopreservation facilities. - CF screen, karyotyping (Klinefelters)

Answer 217

- Optimise weight - No alcohol/drugs/smoking - Control any co-morbidities - Avoid extreme heat near genitals - Looser fitting underwear - Avoid harmful chemicals in occupation - Zinc supplements

Answer 218

- Intrauterine insemination, IUI (collect + separate high-quality sperm + inject into uterus) - Intracytoplasmic sperm injection, ICSI (inject sperm directly into cytoplasm of egg + inject into uterus) - Surgical correction of an obstruction in the vas

Answer 219

- Surgical sperm recovery or donor insemination

Answer 220

- Ovulation induction - Stimulated intrauterine insemination, IUI - Donor insemination, egg or embryo - Host surrogacy (same-sex or if uterine pathology) - IVF (ICSI, surgical sperm recovery, embryo freezing, assisted hatching)

Answer 221

- Ovarian stimulation + collection of oocytes. - May have several embryos + may be frozen.

Answer 222

- Suppression of natural menstrual cycle - Ovarian stimulation to promote follicles developing. - Oocyte collection with a needle under TVS - Oocyte insemination (or ICSI especially if male factor infertility) - Embryo culture (2-5d until blastocyst) - Embryo transfer of highest quality embryos (usually 1, or 2 if >35y), may have cryopreservation - Pregnancy test performed around day 16 after egg collection - USS performed in early pregnancy (7w) to check for foetal heartbeat

Answer 223

- GnRH agonist like goserelin or GnRH antagonist like cetrorelix. - FSH initially then hCG 36h before collection - Progesterone via vaginal suppositories to mimic corpus luteum, placenta takes over after.

Answer 224

- Age is biggest factor - Cause of infertility - Previous pregnancies (increase likelihood) - Duration of infertility - # of previous attempts - Medical conditions + environmental factors

Answer 225

- Multiple pregnancy - Miscarriage + ectopics - Ovarian hyperstimulation syndrome - Bleeding + infection at egg collection - Failure

Answer 226

- Mild = abdo pain + vomiting - Mod = N+V + ascites on USS - Severe = ascites, oliguria - Critical = anuria, VTE, ARDS

Answer 227

- Younger age. - Lower BMI. - PCOS. - Higher antral follicle count.

Answer 228

- Activation of RAAS > high renin - Haematocrit raised as less fluid in intravascular space - USS + serum oestrogen (high = risk) – monitor these to identify those at risk.

Answer 229

- PO fluids - Monitor urine output - LMWH - Paracentesis for ascites - IV colloids

Answer 230

- Take pill ASAP but only 1 pill (even if >1 missed), - continue with next pill as usual (even if it means taking 2 on same day), - contraception for 48h.

Answer 231

Sex since missing pill or within 48h of restarting = emergency contraception.

Answer 232

Nexplanon used in UK, 68mg of etonogestrel, licensed 18–40y/o.

Answer 233

- ?expulsion, - ?pregnancy, - ?uterine perforation > USS or XR, hysteroscopy/laparoscopy as last line.

Answer 234

Can be inserted either within 48h of birth or >4w after birth (UKMEC1) but not between (UKMEC3).

Answer 235

- Up to day 7 = immediate protection. - >Day 7 = extra contraception for 7d

Answer 236

- 1 in 7 couples struggle to conceive naturally. - 80% of couples <40 conceive within a year + 50% of those remaining will within 2.

Answer 237

PID, sterilisation, Asherman's, fibroids, polyps, endometriosis, uterine deformity

Answer 238

Damage from mumps, undescended testes, trauma, cancer, radio/chemo

Answer 239

Retrograde ejaculation, scarring from epididymitis (chlamydia), absence of vas deferens (may be associated with cystic fibrosis, even carriers), damage to testicle or vas (trauma, surgery, cancer).

Answer 240

Steroid abuse, vasectomy

Answer 241

Testicular cancer

Answer 242

- Gonadotrophins if hypogonadotrophic hypogonadism, bromocriptine if hyperprolactinaemia + sexual dysfunction

Answer 243

- Increased vascular endothelial growth factor (VEGF) from granulosa cells increases vascular permeability so fluid leaks from intravascular>extravascular space (oedema, ascites + hypovolaemia). - Gonadotrophins to mature follicles.

WOMEN'S HEALTH - SEXUAL HEALTH + GUM Flashcards

(267 cards)