Taking a Sexual History Key points: Lack of experience Embarrassment for the patient and doctor Practice….. Privacy Ask permission and explain Dont 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.
Whats 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 At SLH Opening hours on web out of date – till 7pm Tues and Wed Symptoms: seen within 24 hours Just advice: seen within 48 hours GP refer, or self refer No audit, but no reason to believe people not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?