Sexual Health News letter December 2018

HIV testing 
  • HIV testing is at an end
  • Promoting regular testing amongst the most affected population groups
COCP
  • New guidance out from FSRH for COCP
  • In summary:

-  Less effective method of contraception

- Think of benefits such as helping to improve acne, HMB, endometriosis, PMS Etc.

- Stop at 50 years (MEC 3)

- Think of VTE risks – NE/LNG lowest, possibly Zoley, Qlaira as more natural Estrodiol

- Lower EE doses lower VTE risk o Extended regime likely more effective than traditional pill taking regime (21d & 7d break)

  •  21d with 4d break
  •  Continuous – never have a break (break through bleeding reduces with time)
  • 3/12 & 4d break
  •  Flexible extended – 21d, then when bleeding occurs 3-4d consecutively stop pill for 4d, rpt. Must have 21d after each 4d break
  • 21d ensures ovulation suppressed
  • Must be with Monophasic pills only, IDEALY 20mcg EE no higher than 30mcg EE

-  ‘A Danish database study suggests that children born to women who have used hormonal contraception (HC) in the three months prior to conception or in early pregnancy are at increased risk of developing childhood non-lymphoid leukaemia compared with children whose mothers have never used HC’ Please refer to FSRH statement below:

https://www.fsrh.org/news/ceu-response-topublished-study-on-maternal-use-of-hormonal/

Draft Gonorrhoea guidance
  • Currently in consultation stage
  •  Major change:

- Treatment is 1g stat of ceftriaxone only – if no available culture results

- If culture results: Ciprofloxacin 500mg PO STAT

- Treat only those contacts with positive results, from Asia-Pacific region (greater resistance), pharyngeal infection or not had a first line treatment

Chlamydia Treatment
  • Change in treatment for chlamydia and not LGV
  • First line Treatment is Doxycycline 100mg BD for 7d
  •  If unable to have this then Azithromycin 1g stat followed by 500mg OD 2/7
  • This is due to rising Mycoplasma Genitalium cases and the associated resistance issues
  • Only TOC required with rectal Chlamydia and LGV cases

Heavy Menstrual Bleeding
  •  Think of risks factors in such patients:

- Age (especially > 45) o Overweight (BMI > 30)

- PCOs o Persistent IMB o Infrequent HMB

- DM/ pre-DM

  •  These have higher levels of circulating Estrogen so we need to be more suspicious of malignancy
  •  RCOG have a tool kit to aid life for the busy GP:
  •  http://www.rcgp.org.uk/menstrualwellbeingtoolkit
  •  Remember NICE guidance on menopause and Menstrual disorders including HMB

NEWS

If there is any feedback or updates in particular you require do let me know.

Dr Sara Moran

Published on 6th December 2018