1. WOMEN’S HEALTH Sexually Transmitted Infections & Cervical Screening
Zoe Wragg, Bradford VTS

2. 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

3. Plan for station: Picture Quiz – ‘Spot the Spots’
Taking a sexual history
Case studies
What help is out there?
Common things – recognising and treating

4. “Spot the Spots”

5. 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

6. History of presenting complaint:
Symptoms….
Partners…………..
Contraception
Previous STI diagnoses
Menstrual history
PMH
Smear history
Drug 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 People
Chlamydia Screening Project
Bradford 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Opening hours on web out of date – till 7pm Tues and Wed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

12. 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

13. Common Things – Recognising and Treating
Vaginal Discharge
Herpes
Warts
Cervical conditions
Non-infective causes of vulval irritation

14. Vaginal Discharge: Also vulval irritation and odour: Candida / Thrush
Bacterial vaginosis
Trichamoniasis Vaginalis

15. Thrush Discharge: Course: Findings on examination: Treatment:
Sexually transmitted?:
Long term effects?

16. BV Discharge: Course: Findings on examination: Treatment:
Sexually transmitted?:
Long-term effects?;

17. TV Discharge: Course: Findings on examination: Treatment:
Sexually transmitted?:
Long-term effects?:

18. Herpes Discharge: Course: Findings on examination: Treatment:
Sexually transmitted?:
Long-term effects?:

19. Genital Warts Discharge: Course: Findings on examination: Treatment:
Sexually transmitted?:
Long-term effects?:

20. Chlamydia: Discharge: Course: Findings on examination: Treatment:
Sexually transmitted?:
Long-term effects?:

21. Non-infective Causes of Vaginal Irritation
Psoriasis
Seborrhoeic dermatitis
Tinea cruris
Lichen simplex chronicus
Chronic dermatitis (contact or irritant)
Lichen planus
Lichen sclerosus

22. Any questions?