9. Sexual History, STI and Family Planning

Question 1

17YO M presents with penile discharge and burning when peeing.

What history is important?

Answer 1

1. All history
2. Sexual history (5 Ps)
   
   1. Partners (in last 12 months)
   2. Practices (use condoms, site of exposure)
   3. Prevention of pregnancy
   4. Protection from STIs/HIV
   5. Past history of STI
3. Received HPV vaccine?

Question 2

17YO M presents with penile discharge and burning when peeing.

What PE is important?

Answer 2

1. Heart and lungs
2. Abdominal exam
3. GU exam

Question 3

Screening for HIV and Syphillis

Answer 3

• HIV: Screen for HIV from 15-65YO. If younger or older and at increased risk, screen; all pregnany W and those in labor if HIV status is unknown
• Syphillis: Screen in asymptomatic and non-pregnant ppl at increased risk; all pregnant W

Question 4

Screening for HepB and STI

Answer 4

• HepB: high-risk non-pregnant adolescents and adults; screen pregnant W at first pre-natal visit
• STI

Question 5

Who needs behavorial screening?

Answer 5

1. All sexually active adolescents
2. All adults at increased risk of STIs

Question 6

Gardasil recommendation

Answer 6

9-45 YO

• 2 doses if 9-14 YO
• 3 doses if 15-26 YO, over 6 months.

Question 7

What should be discussed in behavioral counseling?

Answer 7

1. Information of STI and STI transmission
2. Risk of STI transmission
3. Condom use and safe sex

Question 8

20YO F patient that goes to clinic for family planning.

What history should be retrived?

Answer 8

1. All history
2. Sexual history
3. GYN history
4. OB history
5. Gravida and para

Question 9

GYN history

Answer 9

1. LMP
2. Hx of previous surgery
3. Hx of infertility
4. If over 21, last pap smear
5. If over 50, last mammogram

Question 10

OB history

Answer 10

1. Number of total pregnancies
2. Live deliveries (gravida/para)
3. Mode of delivery

Question 11

20YO F patient that goes to clinic for family planning.

What PE should be performed?

Answer 11

1. Heart and lungs
2. Abdomen
3. NOT pap smear bc not over 21
4. NO pelvic exam unless STI

Question 12

Screen for pap smear and gonn/chlam

Answer 12

• Pap smear: 21-65
• Gon/chlam: all sexually active adolesents less than 24 and older women at increased risk of infection; not helpful in sexually active men

Question 13

What is the most effective form of birth control with the lowest failure rate?

Answer 13

IUD

Question 14

_____ are at risk for clots with estrogen-containing birth control

Answer 14

tobacco smokers

Question 15

OCP is CI in who?

Answer 15

migraine with aura + ischemic heart disease + stroke

Question 16

How do you counsel a 20YO F who goes to the clinic for family planning?

Answer 16

1. Build a good rapport with open-ended questions
2. GOOD history so that we can personalize contraception
3. Discuss all options, how to use them and AE
4. Get pregnancy test. If (-) => start contraception

Question 17

How should we do pre-conception counseling with Level A evidence?

Answer 17

1. Counsel W with GM on importance of glycemic control before conception.
2. Help acheive NL A1C levels to reduce risk of congenital anomalies
3. Advise folic acid suppliments (400mcg/day)

Question 18

How should we do pre-conception counseling with Level C evidence?

Answer 18

1. Counsel on weight/BMI
2. Chronic meds and risk of teratogenicity
3. Screen for STI
4. Make sure up-to-date on vaccination