5 Taking a Sexual History Key points:Lack of experienceEmbarrassment for the patient and doctorPractice…..PrivacyAsk permission and explainDon’t make assumptionsUse the right terminologyOnly ask what you need to know
6 History of presenting complaint: Symptoms….Partners…………..ContraceptionPrevious STI diagnosesMenstrual historyPMHSmear historyDrug and social history
7 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?
8 A 25 year old woman attends the surgery for her first cervical smear 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.
9 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.
10 What’s out there for us? GUM clinic The Information Shop for Young PeopleChlamydia Screening ProjectBradford District Public Health Network:Pantman –No internet based resources / helpline
11 GUM CLINIC Prefer us to refer rather than treat! At SLH Opening hours on web out of date – till 7pm Tues and WedSymptoms: seen within 24 hoursJust advice: seen within 48 hoursGP refer, or self referNo audit, but no reason to believe people not happy with going through it all again
12 Cervical ScreeningVery topical, as just starting to vaccinate teenage girls against HPV 16 & 18Not boysWhat about smears?No NICE guidelines – PACE guidelines
13 Common Things – Recognising and Treating Vaginal DischargeHerpesWartsCervical conditionsNon-infective causes of vulval irritation
14 Vaginal Discharge: Also vulval irritation and odour: Candida / Thrush Bacterial vaginosisTrichamoniasis Vaginalis
15 Thrush Discharge: Course: Findings on examination: Treatment: Sexually transmitted?:Long term effects?