sexual health

Question 1

In a post menopausal women who has come in for a routine papsmear, how would you go about asking if she needs a STI screen?

Answer 1

When I do papsmear, I offered my patients an STI screen as I can do it at the same time?
Thats really good news, how long have you been together?

Question 2

When taken an endocervical swab for clamydia, how do you going about doing it?

Answer 2

locating the entire cervix
if excess cervical mucous, use swab to wipe gently away from exocervix.
insert tip of PCR swab into cervix until tip of swab not seen, rotate 360 degrees or 3-5 seconds.
Avoid touching vaginal surfaces.
Thin prep can be used to test for chlamydia as well.

Question 3

If a patient had a positive urine chlamydia result, how much can you trust in that result?

Answer 3

for PCR testing
Urine Sen 83%, Sp 99.5%
Vaginal/endocervical - Sn 86%, Sp 99.6%

Low false positive rate
High PPV, for people who test positive, they are likely to have the disease.
Higher false negative rate in urine that cervical swabs - for people who test negative to the test, they may still have the disease. Moderate to high NPV. If negative result, cannot rule out the disease.

Question 4

Define first pass urine?

Answer 4

> 1 hour since last urination, first part of urine, needing penile or vaginal fluid.

Question 5

What counselling do you need to do before ordering STI screening?

Answer 5

Window period since exposure
Contact tracing
Consent for testing