Sexual History, STIs, and Family Planning Flashcards
what are the 5 Pās in sexual history
- Partners (men, women, both, new partner, multiple partners)
- Practices (how often do you use condoms, anatomic site of exposure)
- Prevention (of pregnancy)
- Protection (from STIs and HIV, condom use, barrier protection)
- Past history of STI (ever had one, have any partners had one)
what are the 3 section of history to take in pt presenting with STI
- all histories (past medical, family, etc.)
- sexual history (5 Ps)
- has patient received HPV vaccine
physical exam for male pt presenting with STI
- routine heart and lungs, plus abdomen
- GU exam (inspection and palpation of penis, testicle, consider attempting to obtain penile discharge for testing)
what are the USPSTF guidelines for HIV infection screening
adolescents and adults aged 15-65
what are the USPSTF guidelines for HIV PrEP meds
give to persons at high risk of HIV acquisition
what are the USPSTF guidelines for syphilis screening
asymptomatic, non-pregnant adults and adolescents who are at increased risk for syphilis infection
what are the USPSTF guidelines for Hep B screening
high risk non-pregnant adolescents and high risk adults
what is included in the behavioral counseling intervention for a pt presenting with STI
Discuss:
- information on STI and STI transmission
- risk of transmission
- condom use and safe sex
what needs to be asked for GYN history in a pt presenting for contraception management
- LMP
- if over 21, last pap
- hx of previous surgeries
- hx of infertility
- if over 50, last mammogram
what important history needs to be obtained in a pt presenting for contraception management
- all histories (past medical, family, etc)
- sexual hx (5 Ps)
- GYN hx
- OB history
- gravida para
what needs to be asked for OB history in a pt presenting for contraception management
- number of total pregnancies
- live deliveries
- mode of deliveries
list the aspects of the physical exam in a pt presenting for contraception management
- routine heart and lungs plus abdomen
- no pelvic unless suspected STI
- pap smear not indicated in pts under 21
what are the USPSTF guidelines for performing pap smears
women 21-65
what are the USPSTF guidelines for gonorrhea and chlamydia screening
sexually active women especially less than 24 y/o
what are the USPSTF guidelines for STI counseling
sexually active adolescents and adults
what is the most effective form of birth control with the lowest failure rate
IUD :)
which contraceptives have 6-12 pregnancies per 100 women in a year (medium effectiveness)
- depo
- pill
- patch
- ring
- diaphragm
which contraceptives have 18 or more pregnancies per 100 women in a year (low effectiveness)
- male condom
- female condom
- pulling out (make sure you check out the drawing in the lab handout)
- sponge (?)
what are the least effect contraceptives with 24-28 pregnancies per 100 women per year
fertility awareness-based methods (calendar)
spermicide
tobacco smokers are at risk for ____ when using _____ contraceptives
risk for clots when using estrogen-containing contraceptives
what patients is the oral contraceptive pill contraindicated in
pts with migraine with aura, ischemic heart disease, stroke, etc
how do you counsel a patient who presents for contraception management
- build good rapport w/ open ended questions
- contraception recommendations should be personalized (need good history)
- discuss all contraception methods to give options and discuss side effects
- obtain pregnancy test, consider pelvic exam for IUD placement
- if negative pregnancy status, may initiate contraception
how can a clinician be reasonably certain a woman is not pregnant (negative prediction value of 99%-100%) and thus routine pregnancy testing is not needed before initiating contraception
1) patient has no signs of sx of pregnancy
AND
2) pts meets at least one of the following:
- is 7 days or less after start of menses
- has not had intercourse since start of last menses
- has been correctly and consistently using reliable method of contraception
- is 7 days or less after spontaneous or induced abortion
- is within 4 weeks postpartum
- is fully or nearly fully breastfeeding, amenorrheic, and less than 6 months postpartum
describe the preconception counseling for a patient with level A evidence
(Level A evidence: consistent, good quality patient-oriented evidence)
- counsel women w/ DM about the importance of glycemic control before conception ā> assist pt in achieving an A1C level as close to normal as possible to reduce risk of congenital anomalies
- advise folic acid supplementation (400 mcg daily) to reduce risk of neural tube defects
