Contraception

Question 1

Which contraception has longest return to fertility

Answer 1

Injectable progesterone

Question 2

Which contraception can decrease bone mineral density

Answer 2

Injectable progesterone.

Question 3

What to do if you have a patient with the implant who needs to take rifampicin

Answer 3

the FSRH advises that women should be advised to switch to a method unaffected by enzyme-inducing drugs or to use additional contraception until 28 days after stopping the treatment e.g. progesterone depot

Question 4

What to do if heavy bleeding with implant

Answer 4

Can px COCP concurrently

Question 5

What methods of contraception aren’t affected by enzyme inducers

Answer 5

Depot injection/ IUD/S

Question 6

Which emergency contraception affects the pill

Answer 6

Ulipristral (ellaOne) may decrease efficacy of oral contraception so wait 5 days after ellaone before restarting and use barrier in this time

Question 7

Which emergency contraception affects breastfeeding?

Answer 7

Breastfeeding should be delayed for 7 days after ellaone. For levornogestrel it doesn’t matter

Question 8

What could you offer if a woman presents more than 5 days after UPSI.

Answer 8

Could fit IUD up to 5d after expected day of ovulation

Question 9

Chlamydia management

Answer 9

Doxy for 7d.
or azithro 1g OD for 1 day then 500mg OD for 1 day. This is 1st line if pregnant.

Contact trace for last 6m for women and asymptomatic men.

If symptomatic men then 4 weeks

Question 10

How and when to test for chlamydia

Answer 10

2 weeks after exposure
NAAT
VVS for women
First void Urine for men

Question 11

Who is eligible for chlamydia screening?

Answer 11

all men and women 15-24 years

Question 12

Gonorrhoea incubation

Answer 12

2-5d

Question 13

Gonorrhoea management

Answer 13

single dose of IM ceftriaxone 1g

If sensitivities are known (and is sensitive to ciprofloxacin) then a single dose of oral ciprofloxacin 500mg should be given

if ceftriaxone is refused (e.g. needle-phobic) then
oral cefixime 400mg (single dose) + oral azithromycin 2g (single dose) should be used

Question 14

What to do if someone takes levornogestrel for EC then vomits

Answer 14

If within 3h repeat the dose

Question 15

Who can’t have PO contraception or emergency contraception

Answer 15

People who have had a gastric sleeve/bypass

Question 16

How to manage genital warts

Answer 16

multiple, non-keratinised warts: topical podophyllum
(imiquimod 2nd line)

solitary, keratinised warts: cryotherapy

Question 17

When would you do USS on someone with irregular vaginal bleeding on COCP/POP

Answer 17

Wait 3m then if ongoing USS

Question 18

What is lymphogranuloma venereum and how does it present

Answer 18

Caused by a chlamydia strain

Painless genital pustule → ulcer → painful inguinal lymphadenopathy → proctocolitis -

Question 19

When would you need to double dose of levornogestrel

Answer 19

IF BMI over 26 or >70kg

Question 20

What does Haemophilus ducreyi cause?

Answer 20

Chancroid
Chancroid usually presents with multiple v painful ulcers and this is how you can tell between this and lymphogranuloma venereum
(both cause painful lymphadenopathy)

Question 21

When would you do a high vaginal swab

Answer 21

If testing for thrush or BV