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 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 At SLH Opening hours on web out of date – till 7pm Tues and Wed Symptoms: seen within 24 hours Just advice: seen within 48 hours GP refer, or self refer No audit, but no reason to believe people not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?