1 Gp - Seco 3

Front 1

Risk factors for Chlamydia infection

Back 1

-age<25
-new or multiple sexual partner in the past yr
---new partner is more important than the # of partners
-lack of consistent use of condoms

Front 2

Danger of not treating Chlamydia

Back 2

-spread infection, re-infection of spontaneously resolved partner
-10-40% of infected women develop PID
---sig. % of cases being asymptomatic or have mild, atypical symptoms
---PID can result in:
-tubal factor infertility
-ectopic pregnancy
-chronic pelvic pain
---Risk of PID & reproductive sequelae incr with each recurrence of C. trachomatis infection

Front 3

Chlamydia investigation

Back 3

WOMEN:
Sample of Choice:
-cervical swab
-vulvo-vaginal swab (sens. 90-95%); can be taken by pat/health worker

Urine samples - if speculum exam is not possible:
-variable sens. (65-100%)
-FVU (first voided urine specimen)
-pat should hold urine for1-2hr before giving a FVU specimen

MEN:
-FVU is as good as urethral swab
-again hold 1-2hr before giving FVU

Front 4

Management of Chlamydia

Back 4

Med:
-azythromycin 1g stat;
-doxycycline 100mg bd for 7d, contraind in pregnancy; or
-erythromycin 500mg bd for 10-14d

Advice:
-avoid intercourse (incl. oral) until pat's and their partner(s) have completed tx (or wait 7d for azithromycin)
-advice re appropriate action if using hormonal contraceptives also required

Further investigation:
-all pat's dx'd with C. trachomatis should be screened for other STI's
--incl. HIV test, and where indicated HepB screening and vaccination
-if pat is within the window period for HIV and syphylis, these could be repeated at an appropriate time interval
-all contacts of C. trachomatis should be offered the same screening tests

Front 5

Some Chlamydia info for the pat's to know

Back 5

-Chlamydia is primarily sexually transmited
-if asymptomatic, there is evidence that it could have persisted for mo's or yrs
-it is often asymptomatic in both men and women

Front 6

Primary and Secondary Dysmenorrhea

Back 6

PRIMARY:
---onset at menarche
-Onset: within 6-12mo after menarche
-lower abd/pelvic pain begins with onset of menses & lasts 8-72hrs
-low back pain
-med/ant thigh pain
-headache
-GI: DNV

SECONDARY:
---endometriosis, adenomyosis, unknown cause
-Onset: 20's/30's after relatively painless menstrual cycles in the past
-lower abd/pelvic pain during times other than menses
-heavy menstrual flow or irreg. bleeding
-infertility
-dyspareunia
-vaginal discharge
-pain unrelieved by NSAIDs

Front 7

Primary & Secondary Dysmenorrhea can be distinguished by means of a thorough hx.

Important Info includes...

Back 7

DAVO
-age at menarche
-abN vaginal bleed or discharge
-dyspareunia
-obstetric hx

Essential to assess PID risk factors ("MUSP") - prev hx of:
-PID
-STI
-multiple sex partners
-unprotected sex

"so, apart from DAVO, you MUSP assess PID risk"

Front 8

Physical Exam for Primary & Secondary Dysmenorrhea

Back 8

Abdominal & Pelvic exam

PRIMARY - may have:
-lower abd tenderness
-uterine tenderness
-OR normal pelvic exam
(cervical stenosis may contribute to retrograde menstrual flow)

SECONDARY:
-cervical motion tenderness
-palpable uterine mass or masses
-adnexal tenderness or palpable mass or masses
-vaginal or cervical discharge
-visible vaginal pathology (mucosal tears, masses, prolapse)
---NB: normal abd&pelvic exams don't rule out pathology. U/S or other imaging modalities may be warranted if highly suspicious of secondary dysmenorrhea.

Front 9

Management of Dysmenorrhea

Back 9

1st line: NSAIDs
-reduce PG production via COX inhiibiton
-if taken early&sufficient dose, v. effective in alleviating dysmenorrhea (2/3 women)
-v. effective when:
--taken before onset of menses --continued thru day 2

e.g.
-Ibuprofen 400mg PO q4-6h; max 3.2g/d
-Naproxen 500mg PO followed by 250mg q6-8h; max 1.25g/d
-Diclonefac 25mg bid/tid; if well tolerated, incr by 25/50mg weekly until controlled or 150-200mg PO is reached

Other:
-OC, which block monthly ovulation & decr menstrual flow, resulting in low uterine PG, may also relieve symptoms (1 trial: 65%)

Front 10

Patient whose symptoms aren't relieved by NSAIDs are ...

Back 10

more likely to have underlying pelvic pathology such as endometriosis.

Front 11

1990 Repeal of s. 3 of Contraception, Sterilisation and abortion Act 1977 means...

Back 11

there is no restriction on giving contraceptive advice or prescribing contraception to age<16 without consent from their parents
--the test of requiring consent centers on pat's competence to give consent rather than age
--protects the confidentiality of children/young people in regard to highly personal&sensitive advice & tx.
---it's often wise to advise a child/young person to discuss the issue with their parents -> chance to explroe family relationships and allow pat to discuss any concerns
----care must be taken on exploring because these enquiries may be threatening/intrusive)

Front 12

Advice for women going on the contraceptive pill for the first time

Back 12

-should continue to use condoms until the pill become effective
-7d rule: during a course of antibiotics and after 7d, use another contraception e.g. condom or don't have sex