The big sexual health and

contraception quiz
100 Qs

Jess Parker
Signs and symptoms
Screening and testing
Management
Contraception
100 questions
Might not have time for them all…
Let me know what you find most tricky!

Won’t be covering HIV

Just for those that came to the session…
Partner tracing for Chlamydia:
● Men with urethral symptoms is 4 weeks!
● Asymptomatics, symptomatic females, and males with non-urethral symptoms is 6 months!

Missed COCPs:
● If 1 pill has been missed (or if new pack has been started 24-48 hours late) take missed pill, take next as usual – even if
taking 2 in 24 hours. Continue as usual. Emergency contraception not required
● If a new pack has been started more than 48 hours late (you’ve missed the first 2 pills)– take most recent missed pill even if
it means taking 2 in 24 hours. Avoid sex/use barrier method until 7 consecutive pills have been taken
● If 2 or more are missed during the 1st week– emergency contraception (if had unprotected sex in pill free period or in 1st week
of pill packet)
● If pills are missed in the 2nd week emergency contraception not required as long as pills in the last 7 days have been taken
correctly
● If 2 or more are missed in the 3rd week – start taking the next pack of pills without a break. If taking dummy/placebo pills
these should be discarded and the new pack started. Emergency contraception not required if pill free interval omitted. 

https://cks.nice.org.uk/contraception-combined-hormonal-method
Signs and symptoms
Q1. What is the most common STI in the UK?

A. Gonorrhoea
B. Chlamydia
C. Bacterial vaginosis
D. Trichomonas
Q2. What are the most 3 common presenting symptoms of
STIs? (3 marks)

● Urethral discharge
● Vaginal Discharge
● Genital ulceration
Q3. A 27 year old female presents with vaginal itching and
soreness. On speculum examination, there is a ‘cottage
cheese’ appearance. Diagnosis?
A. Bacterial vaginosis
B. Vaginal Candidiasis
C. Gonorrhoea
D. Trichomonas vaginalis
Q4. What species of Candida is most associated with vaginal
candidiasis?
A. Candida rugosa
B. Candida tropicalis
C. Candida glabrata
D. Candida albicans
Q5. A 30 year old woman presents with an offensive, fishy
discharge. She describes it being watery and grey. What is
most likely?

A. Trichomonas vaginalis
B. Candida
C. Chlamydia
D. Bacterial vaginosis
E. Physiological discharge
Q6. You suspect your patient has bacterial vaginosis.
Overgrowth of which of the following is most likely to cause
BV?

A. Lactobacilli
B. Trichomonas
C. Candida
D. Mycoplasma hominis
E. Gardnerella
Q7. An 18 year old female presents with clear/white
discharge which she gets for a few days every month. She
has not other symptoms. Likely diagnosis?
A. Vaginal Candidiasis
B. Chlamydia
C. Physiological discharge
D. Bacterial vaginosis
Q8. 20 year old male presents with painful lesions on penis,
with low grade malaise. Diagnosis?

A. Genital Warts
B. Syphilis
C. Genital Herpes
D. Chlamydia
Q9. Which HSV is the usual cause of orolabial herpes?

A. HSV 1
B. HSV 2
C. HSV 6
Q10. 90% of cases of anogenital warts are caused by which
strains of HPV?
A. 6 and 11
B. 16 and 18
C. 1 and 2
Q11. A 35 year old male presents with a painless penile
ulcer. He is otherwise well. What is the most likely
diagnosis?
A. Anogenital warts
B. Primary syphilis
C. Secondary syphilis
D. Genital herpes
Q12. Which organism causes syphilis?

A. Herpes simplex virus type 2

B. Mycoplasma genitalium
C. Treponema pertenue
D. Treponema pallidum
Q13. Secondary syphilis is most associated with?

A. Painless ulcer
B. Granulomatous lesions of skin and bones
C. Rash on palms and soles
D. Cataracts
Q14. Tertiary syphilis is most associated with?

A. Chancre
B. Cataracts
C. Aortic aneurysm
D. Mulberry molars
Q15. An 18 year old male presents with abnormal penile
discharge and pain during urination. On inspection there is a
large amount of mucopurulent discharge around the
urethral meatus. Most likely diagnosis?

A. Chlamydia
B. Gonorrhoea
C. Non specific urethritis
Q16. What percentage of males with gonorrhoea are
symptomatic?

A. 90%
B. 70%
C. 50%
Q17. What is the usual incubation period for gonorrhoea?

A. 2-5 days
B. 7-14 days
C. 10-90 days
Q18. What percentage of females with chlamydia are
asymptomatic?

A. 90%
B. 70%
C. 50%
Q19. A 25 year old lady presents with deep dyspareunia,
fever and a white vaginal discharge. Diagnosis?

A. Chlamydia
B. Vaginal candidiasis
C. Urinary tract infection
D. Pelvic inflammatory disease
Q20. What is the most common cause of Pelvic
inflammatory disease in the UK?
A. Chlamydia trachomatis
B. Mycoplasma genitalium
C. E coli
D. Neisseria gonorrhoeae
Q21. List 3 complications of pelvic inflammatory disease

● Tubo-ovarian abscess
● Peritonitis
● Tubal infertility
● Increased risk of ectopic pregnancy
● Recurrent infections
● Chronic pelvic/abdo pain
● Fitz-hugh-curtis syndrome - perihepatitis
RUQ pain
Picture Round
Q22
Q23
Q24
Q25
Q26
Q27

(30 year old

female has
been on the
COCP for 10
years)
Screening and testing
Q28. A 20 year old female has a positive Gonorrhoea NAAT.
What other test must you do? (1 mark)
Culture and sensitivity

If GC diagnosed on NAAT - always do a culture to look for

antibiotic sensitivities to ensure bacteria is sensitive to
treatment.

All GC isolates are tested for azithromycin resistance.

 Q29. You diagnose your patient (20 year old Female) with
gonorrhoea. All sexual contacts in the last (?) should be
notified

A. 2 weeks
B. 3 months
C. 6 months
D. 1 year
 Q30. You diagnose an asymptomatic female with chlamydia.
All sexual contacts in the last (?) should be notified?

A. 2 weeks
B. 3 months
C. 6 months
Q31. You diagnose a 25 year old male with genital herpes
simplex. His asymptomatic girlfriend should be screened for
HSV and treated before they can have sex again

True

False
Q32. ‘Clue cells’ on microscopy are indicative of?

A. Gonorrhoea
B. Trichomonas
C. Syphilis
D. Bacterial vaginosis
Q33. Spirochetes and T. pallidum on dark ground
microscopy is indicative of?
A. Syphilis
B. Gonorrhoea
C. Chlamydia
D. Bacterial vaginosis
Q34. Which of the following is not part of Amsel’s criteria
for diagnosing bacterial vaginosis

A. Thin white, homogeneous discharge

B. Vaginal pH >4.5
C. Strawberry cervix
D. Clue cells on microscopy
E. Positive whiff test
Q35. What is the most accurate test for picking up
trichomonas vaginalis?

A. Light field microscopy

B. High vaginal swab for microscopy and
culture
C. High vaginal swab for NAAT testing
Q36. A 23 year old woman is diagnosed with genital warts,
which she has never had before. She has been in a
monogamous relationship for 6 months, therefore it
suggests her partner must have been unfaithful
True

False
Q37. A 22 year old male has a positive chlamydia NAAT test.
He tells you that he has recieved oral sex from a casual
female partner in the last week. Do you need to test her?

Yes. She should be tested and treated

No. She does not require testing and treating

Q38. An asymptomatic 20 year old female presents to the
GUM clinic requesting an STI screen. What tests would you
offer her as a bare minimum? (4 marks)
● Self taken Vulvovaginal swab for CT and GC
(throat swab if appropriate)
● Blood test for HIV and Syphilis

● Hep B and Hep C if at risk

● Offer pregnancy test if needed
Q39. Which vaginal swab is used to perform a gonorrhoea
culture and sensitivity in a symptomatic female?

A. Endocervical charcoal swab

B. High vaginal swab
C. Vulvovaginal swab
Q40. Where do you take a high vaginal swab from? (1 mark)

Posterior Fornix
Q41. Which blood borne virus is important to vaccinate men
who have sex with men?

Hepatitis B
Q42. The HPV vaccine protects against which strains of
HPV?

● 16 and 18 - high-risk HPV (16 responsible for 60% of all

cervical cancers, 18 responsible for 15%)
● 6 and 11 - cause the majority of cases of genital warts

2008 vaccine only contained 16, 18. 2012 vaccine included

all 4 strains (Gardasil)
Q43. Who is the HPV vaccine routinely offered to?

Females aged 12-13 years (year 8-9).

Usually 2 dose schedule. If over 15, 3 dose schedule.

Females under 18 who have not received the vaccine can still
receive it free of charge.
Q44. Patient is aged 45. How often should she be invited for
cervical screening?

A. Every 3 years
B. Every 5 years
C. Every 10 years
Q45-48. A 31 year old woman with a history of a normal smear has a
routine smear. What is the most appropriate action?
1. Normal smear A. Refer for colposcopy
B. Refer for urgent colposcopy
in 2 weeks
2. Moderate dyskaryosis
C. Repeat smear in 1 year
D. Repeat smear in 3 years
3. Borderline dyskaryosis E. Repeat smear in 5 years
(HPV negative) F. Send repeat smear
G. Request confirmation of HPV
status
4. First inadequate smear
Q49. What is the cell border called where you take a
cervical smear from?
Squamo-columnar junction -

Endocervix = columnar
Ectocervix = non keratinized stratified
squamous
Q50. What is the method used to process samples from
cervical screening?

Liquid based cytology

Q51. What ages are included in the National Chlamydia
Screening programme? (1 mark)

Under 25s
Management
Q52. A 31 year old man presents with copious penile
discharge. Microscopy of urethral swab shows ++ white cells
and gram negative diplococci. What do you prescribe?

A. Doxycycline 100mg PO BD 7 days

B. Metronidazole 2g PO stat
C. Azithromycin 1g PO stat
D. Ceftriaxone 500mg IM stat + Azithromycin 1g
PO stat
Q53. How long should a patient with gonorrhoea (and their
partners) abstain from sex?
A. Abstain until they have finished treatment
B. Abstain for the first 3 days of treatment
C. Abstain for 7 days after they have
completed treatment
Q54. Patient has a positive chlamydia NAAT. What drug do
you prescribe?

Doxycycline 100mg PO BD for 7 days, or

Azithromycin 1g PO stat
 Q55. A 45 year old female is diagnosed with Trichomonas
Vaginalis. What is the most appropriate management?
A. Oral Doxycycline
B. Advice re hygiene and cotton underwear
C. Oral Azithromycin
D. Oral Metronidazole
Q56. 36 year old man presents with a painless penile ulcer.
Dark ground microscopy +ve for spirochaetes. What is the
most appropriate?

A. Doxycycline
B. Metronidazole
C. Benzathine penicillin
D. Amoxicillin
Q57.What general advice could you give to someone who has
been diagnosed with bacterial vaginosis? (2 marks)

Avoid vaginal douching

Advise against use of shower gel, bubble

bath, antiseptic agents or shampoo in the
bath
Q58. A 35 year old complains of a ‘fishy smell’ down below.
Microscopy reveals ‘clue’ cells. What treatment do you
advise?

A. Metronidazole 400mg for 5 days

B. Doxycycline 100mg for 7 days
C. Fluconazole 150mg stat
D. Azithromycin 1g PO stat
Q59. A 27 year old male is diagnosed with genital herpes. He
first noticed the lesions appearing a week ago. He now feels
well in himself, and no new lesions have appeared. What is
the most appropriate management?

A. 5 day course of aciclovir

B. 2 day course of aciclovir
C. Self-care measures
D. Continuous Aciclovir as prophylaxis
Q60. What conservative management approaches could you
advise of in genital herpes? (2 marks)

Saline bathing
Petroleum jelly (vaseline)
Analgesia
5% lidocaine ointment
Q61. When would you consider prescribing suppressive
antiviral treatment?

A. More than 2 episodes a year

B. More than 3 episodes a year
C. More than 6 episodes a year
Q62. 30 year old female presents with 3 fleshy soft
pigmented lesions on her vulva. What is the most
appropriate initial management?

A. Oral aciclovir
B. Topical podophyllum
C. Topical salicylic acid
D. Topic aciclovir
E. Electrocautery
 Q63. A 36 year old woman presents with vaginal itching,
soreness and a white ‘cheesy’ discharge. What is the most
appropriate prescription?

A. Doxycycline
B. Clotrimazole
C. Azithromycin
D. Metronidazole
Q64. You diagnose a 19 year old female with chlamydia and
you prescribe her a stat dose of azithromycin. You also test
and treat her partner. When can they have sex again?
A. Immediately
B. Wait 48 hours
C. Wait 72 hours
D. Wait a week
Q65. A 32 year old woman attends your clinic 8 weeks
pregnant and wants a termination of pregnancy. She wishes
to have a medical termination. What medications would you
use to facilitate this?
A. Metronidazole only
B. Metronidazole and prostaglandins
C. Mifepristone only
D. Mifepristone and prostaglandins
E. Prostaglandins only
Q66. A 19 year old girl who is 9 weeks pregnant has a
surgical termination of pregnancy. Which of the following is
the most common following a TOP?

A. Infection
B. Haemorrhage
C. Uterine perforation
D. Failure
E. Cervical trauma
 Q67. You are a GP and your patient wishes to have a medical
abortion. You find the consultation difficult as you do not
personally agree with abortion. What should you do?
A. Discuss her options and explain that due to your beliefs
you will arrange for here to see another doctor who will
make arrangements
B. Explain your views regarding abortion and the reasons you
feel this way, and advise her to make an appointment with
a different GP
C. Explain that while her choice is not something you approve
of, you will organise the next steps and arrange referral
Contraception
 Q68. If condoms are used perfectly, how effective are they?

A. 80%
B. 85%
C. 90%
D. 98%
E. 99%
Q69. If condoms are used with typical use, how effective are
they?

A. 80%
B. 85%
C. 90%
D. 98%
E. 99%
Q70. What are the disadvantages of taking the COCP
(5 marks)
Increased risk of:
Venous thromboembolic disease
Breast cancer
Cervical cancer
Stroke and ischaemic heart disease (esp in smokers)

Does not protect against STIs

Less effective than LARCs
SEs - headache, breast tenderness, menstrual irregularities (20%
have irregular bleeding)
 Q71. What UKMEC category defines a condition where the
risks usually outweigh the advantages of using the method?

A. UKMEC 1
B. UKMEC 2
C. UKMEC 3
D. UKMEC 4
E. UKMEC 5
Q72. Which one of the following is an absolute
contraindication (UKMEC 4) to prescribing the combined
oral contraceptive

A. Migraine without aura

B. Aged 36 and smoking 15 cigarettes
a day
C. BMI 38
D. Breastfeeding at 6 weeks
Q73. 20 year old lady is taking the COCP. She has missed
one pill yesterday in the second week of her pack. What’s
the most appropriate action?

A. Take the missed pill and todays pill . No

additional contraception is needed
B. Take the missed pill and todays pill.
Consider emergency contraception
Q74. 18 year old taking the COCP presents having missed 2
pills in the second week of her pack. She has not missed
any other pills. What is the most appropriate advise?

A. Take the last pill now and consider

emergency contraception
B. Take the last pill now. There is no need
for emergency contraception
Q75. A 33 year old presents after missing her POP (noriday)
this morning and is unsure what to do. She normally takes
the pill around 0900 and it is now 1230. What do you
advise?
A. Take the missed pill ASAP and advise condom use for
48 hours
B. Take the missed pill ASAP and omit pill break at
end of the pack
C. Take missed pill ASAP and no further action is
needed
D. Emergency contraception should be offered
Q76. What is a ‘mini-pill’?

POP
Only contains progesterone.
Contains a lower dose of progesterone than
LARCs
E.g. noriday contains 350micrograms, Depot -
150mg
Q77. How often do you get the contraceptive injection?

A. Every 8-10 weeks

B. Every 12-14 weeks
C. Every 16 weeks
Q78. List 2 potential side effects of the Depo-provera
injection (2 marks)

Reduction in bone density

Weight gain
Hormonal side effects
Delay in return in fertility (up to 12
months)
Q79. How long does the implant last for?

A. 1 year
B. 2 years
C. 3 years
D. 5 years
Q80. How long does the contraceptive patch last for?

A. 1 week
B. 3 weeks
C. 4 weeks
Q81. What does the contraceptive patch contain?

A. Oestrogen
B. Progesterone
C. Oestrogen and progesterone
Q82. A 25 year old woman is due to have elective ankle
surgery in 4 weeks time. She will be immobilised for a
minimum of 10 days following surgery. What is the correct
advice regarding her COCP?
A. Stop in 2 week and use barrier protection
B. Stop in 2 weeks and use POP
C. Stop immediately and switch to POP
D. Continue throughout surgery
E. Stop 2 days before surgery and use POP
Q83. A 25 year old female wishes to have an IUS inserted.
What is the most common side effect occurring within the
first 6 months of insertion should you advise about?
A. Menorrhagia
B. Irregular bleeding
C. Uterine perforation
D. Pelvic inflammatory disease
E. Weight gain
Q84. A 30 year old presents wishing to have a copper IUD.
Besides pregnancy, which of the following is important to
exclude before inserting?
A. Migraines with aura
B. Pelvic inflammatory disease
C. History of ectopic pregnancy
D. History of venous thromboembolism
Q85. What is the ‘sayana press’?

A. Implant
B. IUS which lasts for 3 years
C. IUD
D. Depot injection for patient use
Q86. A 49 year old lady presents to you thinking she is
menopausal. Her LMP was 6 months ago. She no longer
requires contraception
True
False
Q87. What conditions need to be met for the lactational
amenorrhoea to be effective?

1. Complete amenorrhoea
2. Fully or very nearly fully breastfeeding
3. Six months or less since the birth of the
baby

(woman is no longer fully breastfeeding if

the baby is getting less than 85% of its
feeds as breast milk)
Q88. Alice is a 29 year old lady who have birth 3 days ago
and wishes to talk about contraception. She is not
breastfeeding. How long after birth will she need
contraception?
A. After 28 days
B. Immediately after giving birth
C. After 2 months
D. After 21 days
E. After 14 days
Q89. A 25 year old female delivered her first baby 4 weeks
ago. She is exclusively breastfeeding and wishes to start
using contraception. Which is absolutely contraindicated?

A. Implant
B. COCP
C. POP
D. Mirena coil
E. Depo-provera
 Q90. Which one of the following contraceptives are most
likely to cause a delay in returning to normal fertility?

A. Progesterone implant
B. Intrauterine system (IUS)
C. Progesterone only pill (POP)
D. Combined oral contraceptive (COCP)
E. Depo Provera
Q91. What should be offered first line to a patient wanting
emergency contraception?

Copper coil
Q92. How long after UPSI can you use a copper coil?

A. Up to 72 hours
B. Up to 120 hours (5 days)
C. Up to 48 hours
Q93. What drug does Ella-One contain?

A. Ulipristal Acetate
B. Levonorgestrel
C. Progestogen
Q94. How long after an UPSI can you use Ella One?

A. Up to 72 hours
B. Up to 120 hours (5 days)
C. Up to 48 hours
Q95. How long after an UPSI can you use levonorgestrel?

A. Up to 72 hours
B. Up to 120 hours
C. Up to 48 hours
Q96. Mechanism of action of ‘ulipristal acetate’?

Selective progesterone receptor modulator

Q97. How many times can you use Ellaone in a cycle

A. Once
B. Twice
C. Three times
Q98. Difference between Gillick competence and Fraser
guidelines?

Gillick competence - under 16s able to consent to medical

treatment or intervention if they have sufficient
understanding, and intelligence to fully understand what it
involved in proposed treatment - purpose and nature, likely
effects and risks, chances of success and availability of
other options

Fraser guidelines - specifically relate only to

contraception and sexual health
Q99. Outline the components of Fraser Guidelines (5 marks)
1. He/she has sufficient maturity and intelligence to
understand the nature and implications of the proposed
treatment
2. He/she cannot be persuaded to tell her parents or to
allow the doctor to tell them
3. He/she is very likely to begin or continue having
sexual intercourse with or without contraceptive
treatment
4. His/her physical or mental health is likely to suffer
unless he/she received the advice or treatment
5. The advice or treatment is in the young person’s best
interests.
Q100. A 12 year old girl presents to your GP clinic
requesting contraception. She has had a boyfriend for 8
months who is 13. What is the most appropriate action?
A. Explore the reasons why contraception is needed, respect
her autonomy, confidentiality and give her a prescription
B. Explain that she is too young to be having sex and
suggest she stops
C. Contact the relevant safeguarding lead as this is a child
protection issue
D. Give her some contraception and ask her to discuss the
consultation with her parents
Resources
Bash guidelines – STIs
NICE CKS
Patient info – especially good for ‘missed pills’ and emergency
contraception
Passmedicine
Sexual and reproductive health at a glance