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Yr 4 - GOSH > OSCE: Sexual Health History > Flashcards

OSCE: Sexual Health History Flashcards

1
Q

As well as identifying symptoms, what else shoud you always consider in a sexual health (SH) history?

A

1) Confidentiality

2) Safeguarding

3) Risk-taking behaviours e.g. STIs, recreational drug use

4) Prevention of onward transmission e.g. potential exposed partners, partner notification

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2
Q

What to state about confidentiality at start of a SH history?

A

State that the consultation will be confidential unless there is risk of harm to them or someone else.

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3
Q

Structure of SH history?

A

1) Introduction

2) Presenting complaint

3) HPC
- vaginal symptoms
- penile symptoms
- rectal symptoms
- oral symptoms

4) ICE

5) Summarise & signpost

6) Systemic enquiry

7) Last sexual contact

8) Sexual violence

9) Blood borne virus risk assessment

10) PMH

11) DH & allergies

12) SH

13) Closing

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4
Q

Vaginal symptoms to ask about in SH?

A
  • Abnormal vaginal discharge: volume, colour, consistency, smell
  • Abnormal vaginal bleeding: PCB, IMB, PMB
  • Dyspareunia
  • Abdominal & pelvic pain: dysuria, abdo pain with shoulder tip pain, constant cramping
  • Vulval skin changes/itching/lesions
  • Menstrual history
  • Gynae history
  • Obstetric history
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5
Q

What to clarify about vaginal bleeding in a SH history?

A
  • Nature & pattern: ask about post-coital & intermenstrual
  • Volume: spotting, soaking through pads
  • Colour
  • Impact on QoL
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6
Q

What to clarify about dyspareunia in a SH history?

A
  • Location: deep or superficial
  • Duration
  • Nature e.g. sharp, aching, burning
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7
Q

What may abdo pain with shoulder tip pain indicate?

A

typical of a ruptured ectopic pregnancy

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8
Q

Causes of abnormal vaginal discharge?

A
  • STIs
  • BV
  • Candidiasis
  • Retained foreign body e.g. tampon, condom
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9
Q

Causes of PCB?

A
  • Cervical ectropion
  • Cervicitis caused by STIs
  • Vaginal atrophy
  • Cervical cancer
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10
Q

Causes of IMB?

A
  • physiological (ovulation)
  • contraception (progesterone depot)
  • STIS
  • polyps & fibroids
  • malignancy (e.g. uterine cancer, cervical cancer, vaginal cancer)
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11
Q

Causes of PMB?

A
  • vaginal atrophy
  • STIs
  • HRT
  • malignancy (e.g. uterine cancer, cervical cancer and vaginal cancer).
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12
Q

Give some causes of abdo/pelvic pain?

A
  • PID
  • UTI
  • Ectopic
  • Ruptured ovarian cyst
  • Endometriosis
  • Ovarian torsion
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13
Q

What to ask about regarding vulval skin changes/itching/lesions?

A

Clarify location & if painful.

Clarify timing, episodic vs constant and skin irritants (e.g. shower gels, washing powder).

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14
Q

Questions to ask about menstrual history in SH history?

A
  • Date of LMP
  • Cycle length & regularity
  • Any chance they may be pregnant?
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15
Q

Previous gynaecological history may influence investigations and management of some STIs.

What questions to ask about previous gynae history in SH history?

A

1) Ask if the patient has previously had any gynaecological problems:

  • Ectopic pregnancy
  • Sexually transmitted infections
  • Abnormal cervical smear
  • Endometriosis
  • Bartholin’s cyst
  • Cervical ectropion
  • Malignancy (e.g. cervical, endometrial, ovarian)

2) Also ask about previous surgeries e.g. abdo/pelvic surgery, c-section, hysterectomy.

3) Clarify cervical screening history:
- date & result
- treatment
- HPV vaccination (IMPORTANT!)

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16
Q

It is important to take a brief obstetric history as part of sexual history taking.

What questions should you ask?

A
  • If pregnant: gestation, planned mode of delivery & any obstetric concerns/problems
  • Number of children
  • Number of pregnancies
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17
Q

What extra questions should you consider for people with a cervix?

A
  • Menstrual cycle
  • Current contraception
  • Pregnancy
  • Last smear
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18
Q

Penile symptoms to ask about in a SH history?

A
  • Urethral discharge: colour, consistency, volume/frequency
  • Dysuria: consider frequency & haematuria
  • Testicular pain or swelling: if yes, SOCRATES
  • Penile skin changes/itching/lesions
  • Penile swelling
  • Abdo and pelvic pain
19
Q

What may testicular pain and swelling indicate?

A

Epididymo-orchitis (inflammation and pain of the epididymis and/or testes).

  • “Have you noticed any pain or swelling in your testicles?”
  • “Have you noticed any lumps or swellings in the scrotum?”
20
Q

What is acute onset unilateral testicular pain a red flag for?

A

Testicular torison - surgery emergency.

21
Q

Questions to ask about any penile skin changes/itching/lesions?

A
  • Location
  • Painful or not
  • Timing
  • Episodic vs constant
  • Skin irritants e.g. washing powder, shower gels
22
Q

What can penile skin changes/itching/lesions indicate?

A
  • STIs e.g. herpes
  • Geital skin infection e.g. candidiasis
  • Dermatological condition e.g. contact dermatitis, lichen sclerosis
23
Q

What is inflammation of the penis called?

A

Balanitis

This inflammation can lead to swelling of the glans, penis and foreskin (if present).

24
Q

What can balanitis indicate?

A
  • Infection e.g. STIs
  • Derm condition e.g. lichen sclerosus, Zoon’s balanitis
25
Q

Risk assessment in SH history

A

Do you feel safe at home in your relationship?

26
Q

Balanitis can lead to paraphimosis, what is this?

A

Where the foreskin cannot be replaced over the glans.

Ask –> “Are you able to retract and replace your foreskin?”

27
Q

Danger of paraphimosis?

A

This could compromise the blood supply to the penis and requires urgent review.

28
Q

What may abdo or pelvic pain in males indiciate?

A

Prostatitis or UTI

29
Q

What rectal symptoms should you ask about in a SH history?

A
  • Rectal discharge: colour, consistency, volume/frequency, mixed in with stool
  • Rectal pain: ask about pain when passing stool!
  • Rectal lump
  • Anal skin changes/itching/lesions
30
Q

What are some causes of rectal discharge?

A
  • STI
  • Foreign body
  • IBD
  • Malignancy
31
Q

What are some causes of rectal pain?

A
  • Anal fissure
  • Proctitis
  • Haemorrhoids
32
Q

What are some causes of a rectal lump?

A
  • Haemorrhoids
  • Genital warts
  • Malignancy
33
Q

What are some causes of anal skin changes/itching/lesions?

A
  • Genital warts
  • Genital herpes
  • Lichen sclerosus
  • Syphilis
  • Threadworm
  • Anal cancer
34
Q

What can anal skin changes/itching/lesions indicate?

A
  • anogenital skin infection (e.g. folliculitis, scabies)
  • STI e.g. genital herpes
  • derm condition e.g. contact dermatitis, lichen sclerosis
  • haemorrhoids
  • fissures
  • threadworm
35
Q

Questions to ask about anal skin changes/itching/lesions?

A

1) Location
2) Painful or not
3) Timing
4) Episodic vs constant
5) Skin irritants

36
Q

STIs can also be transmitted to the oral cavity and infect the pharynx.

What symptoms should you ask about?

A
  • sore throat
  • ulcers (e.g. HSV)

It is important to ask about oral sex during the sexual history, as pharyngeal swabs may be appropriate.

37
Q

What should systemic enquiry involve in a SH history?

A

STIs can cause systemic infections such as:
- fever (2ary to PID)
- malaise
- weight loss (e.g. HIV)
- rash
- swelling and tenderness of large joints, conjunctivitis (reactive arthritis secondary to chlamydia)

38
Q

Questions to ask about ‘last sexual contact’ in SH history.?

A

Signposting here is beneficial to ensure the patient is prepared for the questions surrounding their sexual history.

1) Timing: when was it?

2) Sexual contact:
- with man or woman?
- regular or casual partner?
- what type of sex: oral, anal, vaginal, giving or receiving?
- was it with a condom? (did it split etc)

3) Other sexual partenrs: ask about the past 3 months

4) STI testing history
- when was last screen?
- previous STIs and treatment?
- any partners been diagnosed with an STI?

39
Q

It is important in a sexual history to screen for sexual violence so appropriate screening, post-exposure prophylaxis (if applicable), signposting, and support can be provided.

How can you explore this?

A

“Do you feel safe with your current partner?”

“Any violence towards you in this relationship?”

“Have you ever had sex that you’ve not consented to?”

“Have you ever had any procedures to your genitals for non-medical purposes such as cutting, piercing or burning?” –> FGM

40
Q

What other safeguarding issues should you aim to identify in a SH history?

A
  • Age of the sexual partner (if the patient is under 18)
  • Recreational drug use
  • Power imbalance
  • Contact with social services
41
Q

For patients who are at higher risk of HIV and other blood borne viruses (BBV), what further questions should you ask?

A

1) Last test for HIV & syphilis (and result)

2) Sex industry: ever been paid for sex or paid anyone for sex?

3) MSM: have they or have they been with someone who is MSM

4) Abroad: have any partners been from abroad or were born abroad?

5) Injecting drugs: have they or any of previous partner been IVDU?

6) Explore immunisation history:
- Hep A/B
- HPV

42
Q

If patient is considered at risk of HIV, what else should you ask about?

A

PrEP or PEP

Possible counselling for this

43
Q

What to offer at end of SH consultation

A
  • Future plan (if relevant) e.g. STI screen, exam (bimanual, pelvic, speculum etc)
  • Offer free condoms & safe sex advice
  • Offer leaflet
  • Organise follow up if outside of STI windows e.g. 2 weeks for G&C, 4 weeks for HIV and 6 weeks for syphilis
44
Q
A

Yr 4 - GOSH (45 decks)

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