WOMENS HEALTH

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WOMENS HEALTH

• Sexually Transmitted Infections Cervical
  Screening
• Zoe Wragg, Bradford VTS

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AIMS

• How to take a sexual history
• How to recognise STIs and potential
  complications
• Know of sexual health services available to us in
  Bradford area
• Know cervical screening guidelines

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Plan for station

• Picture Quiz Spot the Spots
• Taking a sexual history
• Case studies
• What help is out there?
• Common things recognising and treating

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Spot the Spots
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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

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History of presenting complaint

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

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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?

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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.

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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

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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• Opening hours on web out of date till 7pm Tues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

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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

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Common Things Recognising and Treating

• Vaginal Discharge
• Herpes
• Warts
• Cervical conditions
• Non-infective causes of vulval irritation

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Vaginal Discharge

• Also vulval irritation and odour
• Candida / Thrush
• Bacterial vaginosis
• Trichamoniasis Vaginalis

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Thrush

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

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BV

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

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TV

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

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Herpes

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

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Genital Warts

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

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Chlamydia

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

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Non-infective Causes of Vaginal Irritation

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

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• Any questions?