Home
This site is intended for healthcare professionals
Advertisement
Share
Advertisement
Advertisement
 
 
 

Description

Join us for our "Road to Finals” series, delivered by MedTic teaching, where we will cover 10 MCQs over 1 hour. The content is aligned with the UKMLA curriculum. Sign up for our session every Thursday at 7pm.

This session will focus on STIs and contraception!

March

  • 6th - Cardiology
  • 13th - Respiratory
  • 20th - GI & Liver
  • 27th - GI - bowel

April

  • 3rd - Endocrine
  • 10th - Renal
  • 17th - Urology
  • 24th - General Surgery

May

  • 1st - MSK
  • 8th - Rheumatology & Dermatology
  • 15th - Ophthalmology
  • 22nd - Neurology
  • 29th - Psychiatry

June

  • 5th - Paediatrics (1)
  • 12th - Paediatrics (2)
  • 19th - Obstetrics & Gynaecology
  • 26th - GUM & Contraception

Follow us on Medall or join our mailing list to be the first to hear about our finals and careers series!

Website: medticteaching.com

Linktree: https://linktr.ee/medtic.teaching

Similar communities

View all

Similar events and on demand videos

Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

STIs &Contraception 26 June 2025, Dr Milena Nossen, Dr Sophia HwaiLearningOutcomes ● Sexually transmitted infections: Diagnosis, treatment, prevention ● HIV/AIDS: Testing, management, and ART ● Hepatitis B and C: Screening, diagnosis, and management ● Contraception: Emergency, hormonal, IUD, sterilization ● Adverse effects of contraception ● Patient counselling for STI prevention and contraception Question 1 A 25-year-old woman who is 16 weeks pregnant presents to her GP with mild lower abdominal discomfort and increased vaginal discharge. She denies any urinary symptoms. A high vaginal swab is taken, and nucleic acid amplification tests (NAATs) return positive for Chlamydia trachomatis. She reports no known drug allergies. Which is the most appropriate antibiotic to prescribe? A. Azithromycin 1g stat dose B. Doxycycline 100mg twice daily for 7 days C. Erythromycin 500mg four times daily for 7 days D. Amoxicillin 500mg three times daily for 7 days E. Ciprofloxacin 500mg twice daily for 7 days Question 1 A 25-year-old woman who is 16 weeks pregnant presents to her GP with mild lower abdominal discomfort and increased vaginal discharge. She denies any urinary symptoms. A high vaginal swab is taken, and nucleic acid amplification tests (NAATs) return positive for Chlamydia trachomatis. She reports no known drug allergies. Which is the most appropriate antibiotic to prescribe? A. Azithromycin 1g stat dose B. Doxycycline 100mg twice daily for 7 days C. Erythromycin 500mg four times daily for 7 days D. Amoxicillin 500mg three times daily for 7 days E. Ciprofloxacin 500mg twice daily for 7 daysChlamydiaChlamydia-Symptoms Asymptomatic (70% women, 50% men) Urethral: dysuria, urethral discharge (often white), epididymitis Vaginal: dysuria, PV discharge, PV bleeding, PID Rectal: asymptomatic or proctitis (discharge, bleeding, pain) Oral: asymptomaticChlamydia-Testing Men: first-void urine (NAAT) Woman: vulvovaginal swab (NAAT) Window period 2 weeks Gram-stained dry slide (urethral discharge) ->shows non-gonococcal urethritisChlamydia-Treatment Doxycycline 100mg BD for 7 days 2ndline azithromycin, erythromycin, amoxicillin Counselling, partner notification Men: 4 weeks before symptoms Women/ asymptomatic men: 6 months Abstain from sex for 7 days No TOC needed if 1 line treatment Test will remain +ve for 6 weeksQuestion 2 A 29-year-old man presents at the sexual health clinic with a 2-day history of green, penile discharge and dysuria. He is otherwise well, has no significant medical history and does not take any medications. He is sexually active and has had 5 female partners in the last 3 months, for which he uses condoms sporadically. His last encounter was 7 days ago. Examination is significant for erythema around the urethral meatus and green discharge on the tip of the penis. What is the most likely diagnosis? A. Chlamydia B. Gonorrhoea C. Urinary tract infection D. Urethritis E. SyphilisQuestion 2 A 29-year-old man presents at the sexual health clinic with a 2-day history of green, penile discharge and dysuria. He is otherwise well, has no significant medical history and does not take any medications. He is sexually active and has had 5 female partners in the last 3 months, for which he uses condoms sporadically. His last encounter was 7 days ago. Examination is significant for erythema around the urethral meatus and green discharge on the tip of the penis. What is the most likely diagnosis? A. Chlamydia B. Gonorrhoea C. Urinary tract infection D. Urethritis E. SyphilisGonorrhoeaGonorrhoea–Symptoms Urethral: dysuria, urethral discharge Vaginal: PV discharge, PV bleeding Rectal: asymptomatic or proctitis (discharge, bleeding, pain) Oral: asymptomatic Disseminated infection Tenosynovitis, migratory polyarthritis, dermatitis Septic arthritis, endocarditis, perihepatitisGonorrhoea-Testing Men: first-void urine (NAAT) Women: vulvovaginal swab (NAAT) Window period 2 weeks Gram-stained dry slide (urethral discharge) ->might show gram-negative intracellular diplococci Gonorrhoea-Treatment 1. Send culture from infection site (urethral, endocervical, rectal, oral swab) 2. Ceftriaxone 1g IM stat OR ciprofloxacin 500mg PO stat (if sensitivities known) a) 2nd line: oral cefixime 400mg STAT + oral azithromycin 2g STAT 3. Partner notification, counselling 4. Abstain from sex for 7 days 5. TOC after 2 weeks Question 3 A 28-year-old man presents to his GP with a 2-week history of fever, sore throat, and a non-itchy maculopapular rash on his trunk and limbs. He returned from a backpacking trip across Southeast Asia four weeks ago. He also reports malaise, myalgia, and mouth ulcers. On examination, he has cervical lymphadenopathy. Blood tests are unremarkable. What is the most likely diagnosis? A. Infectious mononucleosis (glandular fever) B. Secondary syphilis C. HIV seroconversion illness D. Dengue fever E. Streptococcal pharyngitis Question 3 A 28-year-old man presents to his GP with a 2-week history of fever, sore throat, and a non-itchy maculopapular rash on his trunk and limbs. He returned from a backpacking trip across Southeast Asia four weeks ago. He also reports malaise, myalgia, and mouth ulcers. On examination, he has cervical lymphadenopathy. Blood tests are unremarkable. What is the most likely diagnosis? A. Infectious mononucleosis (glandular fever) B. Secondary syphilis C. HIV seroconversion illness D. Dengue fever E. Streptococcal pharyngitisHIVHIV-Transmission via body fluids – blood, semen, vaginal fluid, rectal fluid, breast milk During sex, mother-to-child, blood exposure (needlestick, transfusion)HIV-Symptoms Incubation period 2 - 4 weeks on average 60-80% symptomatic ○ sore throat ○ lymphadenopathy ○ malaise, myalgia, arthralgia ○ diarrhoea ○ maculopapular rash ○ mouth ulcers ○ rarely meningoencephalitisHIV-Testing Who to test? ○ Symptomatic patients ○ Patients taking PrEP ○ HIV contacts, SA victims ○ Everyone who consents to it in sexual health ○ Opt-out testing in EDs since 2022 ○ Routine in pregnancy / blood donations ○ BASHH condition indicator, eg Kaposi sarcoma Window period 4 generation tests: 45 days HIV 1/2 Antibody and HIV p24 Antigen testing HIV RNA viral load – particularly in acute infection and infants <18 monthsHIV-Treatment 1. Partner notification & counselling 2. Refer to HIV clinic 3. Baseline testing 1. Health checks – FBC, U&Es, LFTs, lipids, HbA1c 2. HIV – resistance, viral load, CD4 count etc. 4. Commence ART immediately 1. 2x NRTI + INI, PI or NNRTI 5. f/u in HIV clinic regularly Question 4 A 25-year-old woman presents to her general practitioner with a painless genital ulcer that appeared one week ago. She reports a new sexual partner and inconsistent use of barrier contraception. On examination, there is a single, firm, non-tender ulcer on her labia majora and non-tender inguinal lymphadenopathy. Serological testing shows a positive treponemal-specific enzyme immunoassay (TP-EIA) test. What is the most appropriate next investigation to confirm active syphilis infection? A. Repeat the treponemal-specific TP-EIA test B. Order a non-treponemal test (e.g., VDRL) C. Arrange HIV serology testing D. Perform dark-field microscopy on the lesion E. Request PCR testing for Treponema pallidum DNA Question 4 A 25-year-old woman presents to her general practitioner with a painless genital ulcer that appeared one week ago. She reports a new sexual partner and inconsistent use of barrier contraception. On examination, there is a single, firm, non-tender ulcer on her labia majora and non-tender inguinal lymphadenopathy. Serological testing shows a positive treponemal-specific enzyme immunoassay (TP-EIA) test. What is the most appropriate next investigation to confirm active syphilis infection? A. Repeat the treponemal-specific TP-EIA test B. Order a non-treponemal test (e.g., VDRL) C. Arrange HIV serology testing D. Perform dark-field microscopy on the lesion E. Request PCR testing for Treponema pallidum DNASyphilisSyphilis Primary (9 -90 days) Secondary (6 weeks – 6 months) Tertiary (20+ years) Chancre Fevers, lymphadenopathy Cardiovascular Local, non-tender lymphadenopathy Rash on trunk, palms, soles Neurological Buccal, ‘snail track’ ulcers Gummatous Condylomata lataSyphilis-testing Non-treponemal tests o E.g. RPR, VDRL Non-treponemal Treponemal Interpretation o Not specific – false positives positive negative Active syphilis o Pregnancy, SLE, TB, HIV, infection malaria, leprosy o Becomes –ve after treatment positive negative False positive syphilis Treponemal-specific tests negative positive Treated syphilis o e.g. TP-EIA, TPHA o More expensive but specific for syphilis o Remains +ve Question 5 A 35-year-old man attends the GP clinic for a routine health check. He is asymptomatic and has no significant past medical history. He mentions he is planning to travel abroad for work and wants to ensure his vaccinations are up to date. Blood tests reveal the following Hepatitis B serology results: - HBsAg: positive - Anti-HBc IgM: negative - Anti-HBc IgG: positive - Anti-HBs: negative Which of the following is the most likely interpretation of his Hepatitis B serology results? A. He has acute Hepatitis B infection. B. He is chronically infected with Hepatitis B. C. He is immune to Hepatitis B due to vaccination. D. He is immune to Hepatitis B due to past infection. E. He has resolved a past Hepatitis B infection and is a carrier. Question 5 A 35-year-old man attends the GP clinic for a routine health check. He is asymptomatic and has no significant past medical history. He mentions he is planning to travel abroad for work and wants to ensure his vaccinations are up to date. Blood tests reveal the following Hepatitis B serology results: - HBsAg: positive - Anti-HBc IgM: negative - Anti-HBc IgG: positive - Anti-HBs: negative Which of the following is the most likely interpretation of his Hepatitis B serology results? A. He has acute Hepatitis B infection. B. He is chronically infected with Hepatitis B. C. He is immune to Hepatitis B due to vaccination. D. He is immune to Hepatitis B due to past infection. E. He has resolved a past Hepatitis B infection and is a carrier.HepatitisHepatitis B Spread via blood/ other fluids HBsAg: indicates current infection – either acute or Incubation period 6-20 weeks chronic (if > 6months) Fever, jaundice, deranged LFTs HbeAg – marker of replication, infectivity Management: 1 pegylated interferon-alpha or other antivirals Anti-HBc IgM: in acute infection Complications: chronic hepatitis, liver failure, Anti-HBc IgG: in chronic infection (persists hepatocellular carcinoma, >6months) glomerulonephritis, polyarteritis nodosa, cryoglobulinaemia Anti-HBs: indicates immunity by vaccination OR Vaccine routinely given in babies and high exposure – negative in chronic infection risk groupsHepatitis Hepatitis C Hepatitis D Transmission via blood, <5% risk while Via blood and fluids, requires hepatitis B surface intercourse antigen Incubation period 6-9 weeks Either co-infection or superinfection 30% symptomatic (jaundice, LFTs, fatigue, Treatment: interferon arthralgia) No vaccine available – but hep B vaccine is Complications: 55-85% develop chronic effectively protection hepatitis C Arthritis, arthralgia, Sjogren’s, cirrhosis, hepatocellular ca, cryoglobulinameia, glomerulonephritis No vaccine availableHepatitis Hepatitis A Hepatitis E Faecal-oral spread Faecal-oral spread Incubation period 2-4 weeks 3-8 weeks Self-limiting, usually harmless Similar disease to hepatitis A Flu-like symptoms, RUQ pain, tender Severe disease, 20% mortality in pregnant hepatomegaly, jaundice, deranged LFTs women Vaccine only given to at risk groups (high Vaccine in development risk areas, MSM, IV drug users, chronic liver disease) Question 6 A 25-year-old woman presents to the sexual health clinic complaining of painful genital sores. She reports that over the past three days she has developed multiple small ulcers on her vulva, which are very painful. She also reports dysuria (painful urination). She is sexually active and has had two new sexual partners in the last six months. On examination, there are multiple small, shallow ulcers on her labia majora and minora, with surrounding erythema. There is no inguinal lymphadenopathy. She is otherwise well, but feels a bit under the weather. What is the most likely diagnosis? A. Genital herpes simplex virus infection B. Primary syphilis C. Chancroid D. Lymphogranuloma venereum E. Behçet’s disease Question 6 A 25-year-old woman presents to the sexual health clinic complaining of painful genital sores. She reports that over the past three days she has developed multiple small ulcers on her vulva, which are very painful. She also reports dysuria (painful urination). She is sexually active and has had two new sexual partners in the last six months. On examination, there are multiple small, shallow ulcers on her labia majora and minora, with surrounding erythema. There is no inguinal lymphadenopathy. She is otherwise well, but feels a bit under the weather. What is the most likely diagnosis? A. Genital herpes simplex virus infection B. Primary syphilis C. Chancroid D. Lymphogranuloma venereum E. Behçet’s diseaseGenital HerpesGenital herpes simplex-symptoms Prodrome – flu-like symptoms, tingling/itching/burning sensation Small, painful blisters or ulcers in genital area Dysuria/ difficulty opening bowels Tender lymphadenopathy Will resolve on their own after several days to weeks Genital herpes simplex-management In pregnancy: 1. HSV 1/2 swab 2. Treat clinically – 5-day course 400mg acyclovir TDS Known diagnosis or 1 /2st ndtrimester o Consider regular aciclovir until 3. Saline bathing, analgesia, topical anaesthetics delivery 22 (if risks for premature) or 32 and offer vaginal delivery 4. Patient education 3 trimester o Consider aciclovir until delivery. Consider c-section, especially if within 6 weeks of deliveryContraception Question 7 A 23-year-old woman presents to the clinic, requesting for emergency contraception. She had sex with her regular partner 101 hrs ago, but the condom broke. She is currently on day 21 of a 28-day cycle. She has not had any other UPSIs in this current cycle. She does not have any medical conditions and takes no regular medications. Her BP is 117/78 and she weighs 68kg. She is not keen for an invasive procedures but agrees to try hormonal contraception. Which of the following options is most suitable? A. Levonorgestrel today and commence POP today B. Levonorgestrel today and start POP after 5 days C. Ulipristal today and commence POP after 5 days D. Ulipristal today and commence POP today E. Advise that oral EC are unlikely to be effective if taken after ovulation Question 7 A 23-year-old woman presents to the clinic, requesting for emergency contraception. She had sex with her regular partner 101 hrs ago, but the condom broke. She is currently on day 21 of a 28-day cycle. She has not had any other UPSIs in this current cycle. She does not have any medical conditions and takes no regular medications. Her BP is 117/78 and she weighs 68kg. She is not keen for an invasive procedures but agrees to try hormonal contraception. Which of the following options is most suitable? A. Levonorgestrel today and commence POP today B. Levonorgestrel today and start POP after 5 days C. Ulipristal today and commence POP after 5 days D. Ulipristal today and commence POP today E. Advise that oral EC are unlikely to be effective if taken after ovulationEmergency ContraceptionEmergencyContraception Copper IUD Ulipristal (EllaOne) Levonorgestrel Most effective – 99% Selective progesterone receptor Inhibits ovulation & inhibits modulator – inhibits ovulation implantation Inserted up to 5 days after UPSI or 5 days post likely ovulation date Up to 120 hours post UPSI Up to 72 hours – efficacy decreases with time Can be used for long-term Can be used multiple times in same contraception cycle Can be used multiple times in same Reduces hormonal contraception cycle effectiveness – wait 5 days Does not affect hormonal Caution in severe asthma/ enzyme contraception inducers Double dose if BMI > 26 or weight > Delay breastfeeding for 1 week 70kg or enzyme inducerEmergencyContraception Copper IUD Ulipristal (EllaOne) Levonorgestrel Most effective – 99% Selective progesterone receptor Inhibits ovulation & inhibits modulator – inhibits ovulation implantation Inserted up to 5 days after UPSI or 5 days post likely ovulation date Up to 120 hours post UPSI Up to 72 hours – efficacy decreases with time Can be used for long-term Can be used multiple times in same contraception cycle Can be used multiple times in same Reduces hormonal contraception cycle effectiveness – wait 5 days Does not affect hormonal Caution in severe asthma/ enzyme contraception inducers Double dose if BMI > 26 or weight > Delay breastfeeding for 1 week 70kg or enzyme inducerEmergencyContraception Copper IUD Ulipristal (EllaOne) Levonorgestrel Most effective – 99% Selective progesterone receptor Inhibits ovulation & inhibits modulator – inhibits ovulation implantation Inserted up to 5 days after UPSI or 5 days post likely ovulation date Up to 120 hours post UPSI Up to 72 hours – efficacy decreases with time Can be used for long-term Can be used multiple times in same contraception cycle Can be used multiple times in same Reduces hormonal contraception cycle effectiveness – wait 5 days Does not affect hormonal Caution in severe asthma/ enzyme contraception inducers Double dose if BMI > 26 or weight > Delay breastfeeding for 1 week 70kg or enzyme inducerEmergencyContraception Column textEmergencyContraception Column text Question 8 A 28-year-old woman attends your GP practice for a routine follow-up 6 weeks after insertion of a copper intrauterine device (IUD). She reports that she has not felt the threads recently and is concerned about whether the device is still in place. She has not experienced any abdominal pain, vaginal bleeding, or signs of infection. On examination, you are unable to visualise the IUD threads on speculum examination. A pregnancy test is negative. What is the most appropriate next step in management? A. Reassure her and advise to check for threads again in one month B. Arrange a pelvic ultrasound scan to locate the IUD C. Insert a new IUD immediately D. Advise use of barrier contraception and review in three months E. Refer for abdominal and pelvic X-ray to locate the IUD Question 8 A 28-year-old woman attends your GP practice for a routine follow-up 6 weeks after insertion of a copper intrauterine device (IUD). She reports that she has not felt the threads recently and is concerned about whether the device is still in place. She has not experienced any abdominal pain, vaginal bleeding, or signs of infection. On examination, you are unable to visualise the IUD threads on speculum examination. A pregnancy test is negative. What is the most appropriate next step in management? A. Reassure her and advise to check for threads again in one month B. Arrange a pelvic ultrasound scan to locate the IUD C. Insert a new IUD immediately D. Advise use of barrier contraception and review in three months E. Refer for abdominal and pelvic X-ray to locate the IUDIUD/ IUSIntra-uterine device IUD IUS Releases cupper ions -> decreased Levonorgestrel -> prevents sperm motility and survival endometrial proliferation and causes cervical mucus thickening For 5 or 10 years For 3,5 or 8 years Immediately effective Effective after 7 days Side effects: heavier, longer, more painful periods Side effects: initial irregular bleeding, later lighter, less painful periods or amenorrhoea Complications: uterine perforation (0.2%), ectopic pregnancies, infection, risk of expulsion 1 in 20Intra-uterine device IUD IUS Releases cupper ions -> decreased Levonorgestrel -> prevents sperm motility and survival endometrial proliferation and causes cervical mucus thickening For 5 or 10 years For 3,5 or 8 years Immediately effective Effective after 7 days Side effects: heavier, longer, more painful periods Side effects: initial irregular bleeding, later lighter, less painful periods or amenorrhoea Complications: uterine perforation (0.2%), ectopic pregnancies, infection, risk of expulsion 1 in 20 Question 9 A 32-year-old woman comes to the contraception, requesting for a repeat of her usual form of contraception, Depo-Provera. She has been on the depot injection for 1 year and her last dose was 15 weeks and 2 days ago. She has been amenorrhoeic since commencing the injections. She had unprotected sex at 13+3 and at 14+4 weeks after her last dose. Her PMH is significant for epilepsy, for which she takes lamotrigine. What is the best course of action on this appointment? A. Administer the depot injection today, no further action required B. Book another appointment for 3 weeks time and offer bridging contraception with POP C. Book another appointment for 3 weeks time and advise to abstain from sex until then D. Administer the depot injection today and provide emergency contraception E. Perform a urinary pregnancy test and administer the depot injection if it is negative Question 9 A 32-year-old woman comes to the contraception, requesting for a repeat of her usual form of contraception, Depo-Provera. She has been on the depot injection for 1 year and her last dose was 15 weeks and 2 days ago. She has been amenorrhoeic since commencing the injections. She had unprotected sex at 13+3 and at 14+4 weeks after her last dose. Her PMH is significant for epilepsy, for which she takes lamotrigine. What is the best course of action on this appointment? A. Administer the depot injection today, no further action required B. Book another appointment for 3 weeks time and offer bridging contraception with POP C. Book another appointment for 3 weeks time and advise to abstain from sex until then D. Administer the depot injection today and provide emergency contraception E. Perform a urinary pregnancy test and administer the depot injection if it is negativeDepot injectionDepot injection Medroxyprogesterone acetate MOA: Inhibits ovulation, thickens cervical mucus Administration: every 12-13 weeks, effective for 14 weeks Side effects: amenorrhoea, irregular bleeding, weight gain, delayed return to fertility, increased risk of osteoporosis Contraindications: breast cancer Cautions: high BMI, osteoporosis Question 10 A 27-year-old woman is looking to start on contraception. She has read up on the different options and would like to try the combined oral contraceptive pill. Which of the following is the strongest contraindication to her starting the COCP? A. PMHx of ovarian cancer B. Blood pressure on visit 135/87 C. Mother had a PE aged 52 D. History of migraine with aura, 5 years ago E. 5 weeks post-partum and breastfeeding Question 10 A 27-year-old woman is looking to start on contraception. She has read up on the different options and would like to try the combined oral contraceptive pill. Which of the following is the strongest contraindication to her starting the COCP? A. PMHx of ovarian cancer B. Blood pressure on visit 135/87 C. Mother had a PE aged 52 D. History of migraine with aura, 5 years ago E. 5 weeks post-partum and breastfeedingCombined oral contraceptive pillCombined oral contraceptive pill Contains oestrogen/ progesterone MOA: inhibits ovulation Taken daily for 21 days, followed by 7 days break Advantages: makes periods regular, lighter, less painful. Reduced risk of ovarian, endometrial and colorectal cancer. May benefit ovarian cysts, benign breast disease, acne vulgaris, PID Disadvantages: user-dependent, increased risk of VTE, stroke, breast, cervical cancer Temporary side effects: headache, nausea, breast tendernessCombined oral contraceptive pill Contraindications: UKMEC 3 BMI >35, immobility, FHx of VTEs <45yrs, >35 yrs & smoking <15 UKMEC 4 Migraine with aura, hx of VTE, breastfeeding <6weeks, >35 yrs & smoking >15 SEEYOUNEXT https://linktr.ee/medtic.teaching THURSDAY! Sign up to our next session on MedAll Take part in our research survey See all our upcoming events www.medticteaching.com | Email: medticteaching@gmail.com | Youtube @medtic | Instagram @medtic.teaching | Tiktok @medticteaching