womens health sexually transmitted infections & cervical screening zoe wragg, bradford vts

WOMEN’S HEALTH

Sexually Transmitted Infections & Cervical Screening

Zoe Wragg, Bradford VTS

AIMS

How to take a sexual history

How to recognise STI’s and potential complications

Know of sexual health services available to us in Bradford area

Know cervical screening guidelines

Plan for station:

Picture Quiz – ‘Spot the Spots’

Taking a sexual history

Case studies

What help is out there?

Common things – recognising and treating

“Spot the Spots”

Taking a Sexual History

Key points: Lack of experience Embarrassment for the patient and doctor Practice…..

Privacy Ask permission and explain Don’t make assumptions Use the right terminology Only ask what you need to know

History of presenting complaint:

Symptoms…. Partners………….. Contraception Previous STI diagnoses Menstrual history PMH Smear history Drug and social history

Case Studies:

A 21 year old woman complains of a vaginal discharge. She was treated for similar symptoms 6 weeks ago with a clotrimazole pessary.

What is the differential diagnosis and how should she be investigated?

A 25 year old woman attends the surgery for her first cervical smear. When she sees the practice nurse, the woman tells her that she has noticed some lumps developing on her vulva.

A 20 year old woman has been on your list for 3 years and started the COCP 18 months ago. She is complaining of 3 months of break-through bleeding.

What’s out there for us?

GUM clinic

The Information Shop for Young People

Chlamydia Screening Project

Bradford District Public Health Network: Pantman –

http://www.bbc.co.uk/radio1/onelife/fun/health/pants/pantman.html

No internet based resources / helpline

GUM CLINIC

Prefer us to refer rather than treat!

At SLH Opening hours on web out of date – till 7pm Tues and Wed

Symptoms: seen within 24 hours Just advice: seen within 48 hours

GP refer, or self refer No audit, but no reason to believe people not happy with

going through it all again

Cervical Screening

Very topical, as just starting to vaccinate teenage girls against HPV 16 & 18

Not boys

What about smears?

No NICE guidelines – PACE guidelines

Common Things – Recognising and Treating

Vaginal Discharge

Herpes

Warts

Cervical conditions

Non-infective causes of vulval irritation

Vaginal Discharge:

Also vulval irritation and odour:

Candida / Thrush

Bacterial vaginosis

Trichamoniasis Vaginalis

Thrush

Discharge: Course: Findings on examination: Treatment: Sexually transmitted?: Long term effects?

BV

Discharge: Course: Findings on examination: Treatment: Sexually transmitted?: Long-term effects?;

TV

Discharge: Course: Findings on examination: Treatment: Sexually transmitted?: Long-term effects?:

Herpes

Discharge: Course: Findings on examination: Treatment: Sexually transmitted?: Long-term effects?:

Genital Warts

Discharge: Course: Findings on examination: Treatment: Sexually transmitted?: Long-term effects?:

Chlamydia:

Discharge: Course: Findings on examination: Treatment: Sexually transmitted?: Long-term effects?:

Non-infective Causes of Vaginal Irritation

Psoriasis Seborrhoeic dermatitis Tinea cruris Lichen simplex chronicus Chronic dermatitis (contact or irritant) Lichen planus Lichen sclerosus

Any questions?