Download sti and cervical screening

WOMEN’S HEALTH
Sexually Transmitted Infections &
Cervical Screening
Zoe Wragg, Bradford VTS
AIMS
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How to take a sexual history
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How to recognise STI’s and potential
complications
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Know of sexual health services available to
us in Bradford area
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Know cervical screening guidelines
Plan for station:
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Picture Quiz – ‘Spot the Spots’
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Taking a sexual history
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Case studies
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What help is out there?
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Common things – recognising and treating
“Spot the Spots”
Taking a Sexual History
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Key points:
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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:
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Symptoms….
Partners…………..
Contraception
Previous STI diagnoses
Menstrual history
PMH
Smear history
Drug and social history
Case Studies:
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A 21 year old woman complains of a vaginal
discharge. She was treated for similar
symptoms 6 weeks ago with a clotrimazole
pessary.
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What is the differential diagnosis and how
should she be investigated?
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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.
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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?
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GUM clinic
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The Information Shop for Young People
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Chlamydia Screening Project
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Bradford District Public Health Network:
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Pantman –
http://www.bbc.co.uk/radio1/onelife/fun/health/pants/pantman.html
No internet based resources / helpline
GUM CLINIC
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Prefer us to refer rather than treat!
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At SLH
Opening hours on web out of date – till 7pm Tues and Wed
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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
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Very topical, as just starting to vaccinate
teenage girls against HPV 16 & 18
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Not boys
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What about smears?
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No NICE guidelines – PACE guidelines
Common Things –
Recognising and Treating
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Vaginal Discharge
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Herpes
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Warts
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Cervical conditions
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Non-infective causes of vulval irritation
Vaginal Discharge:
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Also vulval irritation and odour:
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Candida / Thrush
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Bacterial vaginosis
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Trichamoniasis Vaginalis
Thrush
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Discharge:
Course:
Findings on examination:
Treatment:
Sexually transmitted?:
Long term effects?
BV
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Discharge:
Course:
Findings on examination:
Treatment:
Sexually transmitted?:
Long-term effects?;
TV
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Discharge:
Course:
Findings on examination:
Treatment:
Sexually transmitted?:
Long-term effects?:
Herpes
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Discharge:
Course:
Findings on examination:
Treatment:
Sexually transmitted?:
Long-term effects?:
Genital Warts
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Discharge:
Course:
Findings on examination:
Treatment:
Sexually transmitted?:
Long-term effects?:
Chlamydia:
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Discharge:
Course:
Findings on examination:
Treatment:
Sexually transmitted?:
Long-term effects?:
Non-infective Causes of
Vaginal Irritation
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Psoriasis
Seborrhoeic dermatitis
Tinea cruris
Lichen simplex chronicus
Chronic dermatitis (contact or irritant)
Lichen planus
Lichen sclerosus
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Any questions?