Sexual History, STIs, and Family Planning

Question 1

what are the 5 P’s in sexual history

Answer 1

1. Partners (men, women, both, new partner, multiple partners)
2. Practices (how often do you use condoms, anatomic site of exposure)
3. Prevention (of pregnancy)
4. Protection (from STIs and HIV, condom use, barrier protection)
5. Past history of STI (ever had one, have any partners had one)

Question 2

what are the 3 section of history to take in pt presenting with STI

Answer 2

• all histories (past medical, family, etc.)
• sexual history (5 Ps)
• has patient received HPV vaccine

Question 3

physical exam for male pt presenting with STI

Answer 3

• routine heart and lungs, plus abdomen

- GU exam (inspection and palpation of penis, testicle, consider attempting to obtain penile discharge for testing)

Question 4

what are the USPSTF guidelines for HIV infection screening

Answer 4

adolescents and adults aged 15-65

Question 5

what are the USPSTF guidelines for HIV PrEP meds

Answer 5

give to persons at high risk of HIV acquisition

Question 6

what are the USPSTF guidelines for syphilis screening

Answer 6

asymptomatic, non-pregnant adults and adolescents who are at increased risk for syphilis infection

Question 7

what are the USPSTF guidelines for Hep B screening

Answer 7

high risk non-pregnant adolescents and high risk adults

Question 8

what is included in the behavioral counseling intervention for a pt presenting with STI

Answer 8

Discuss:

• information on STI and STI transmission
• risk of transmission
• condom use and safe sex

Question 9

what needs to be asked for GYN history in a pt presenting for contraception management

Answer 9

• LMP
• if over 21, last pap
• hx of previous surgeries
• hx of infertility
• if over 50, last mammogram

Question 10

what important history needs to be obtained in a pt presenting for contraception management

Answer 10

• all histories (past medical, family, etc)
• sexual hx (5 Ps)
• GYN hx
• OB history
• gravida para

Question 11

what needs to be asked for OB history in a pt presenting for contraception management

Answer 11

• number of total pregnancies
• live deliveries
• mode of deliveries

Question 12

list the aspects of the physical exam in a pt presenting for contraception management

Answer 12

• routine heart and lungs plus abdomen
• no pelvic unless suspected STI
• pap smear not indicated in pts under 21

Question 13

what are the USPSTF guidelines for performing pap smears

Answer 13

women 21-65

Question 14

what are the USPSTF guidelines for gonorrhea and chlamydia screening

Answer 14

sexually active women especially less than 24 y/o

Question 15

what are the USPSTF guidelines for STI counseling

Answer 15

sexually active adolescents and adults

Question 16

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

Answer 16

IUD :)

Question 17

which contraceptives have 6-12 pregnancies per 100 women in a year (medium effectiveness)

Answer 17

• depo
• pill
• patch
• ring
• diaphragm

Question 18

which contraceptives have 18 or more pregnancies per 100 women in a year (low effectiveness)

Answer 18

• male condom
• female condom
• pulling out (make sure you check out the drawing in the lab handout)
• sponge (?)

Question 19

what are the least effect contraceptives with 24-28 pregnancies per 100 women per year

Answer 19

fertility awareness-based methods (calendar)

spermicide

Question 20

tobacco smokers are at risk for ____ when using _____ contraceptives

Answer 20

risk for clots when using estrogen-containing contraceptives

Question 21

what patients is the oral contraceptive pill contraindicated in

Answer 21

pts with migraine with aura, ischemic heart disease, stroke, etc

Question 22

how do you counsel a patient who presents for contraception management

Answer 22

1. build good rapport w/ open ended questions
2. contraception recommendations should be personalized (need good history)
3. discuss all contraception methods to give options and discuss side effects
4. obtain pregnancy test, consider pelvic exam for IUD placement
5. if negative pregnancy status, may initiate contraception

Question 23

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

Answer 23

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

Question 24

describe the preconception counseling for a patient with level A evidence

(Level A evidence: consistent, good quality patient-oriented evidence)

Answer 24

• counsel women w/ DM about the importance of glycemic control before conception –> 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

Question 25

describe the preconception counseling for a patient with level C evidence

(Level C evidence: consensus, disease-oriented evidence, usual practice, expert opinion, or case series)

Answer 25

• counsel patient on weight/BMI management
• chronic medication and risk of any teratogenicity
• screen for STI
• up to date on vaccines

Question 26

vaccines recommended for pt presenting with STI

Answer 26

gardasil vaccine administered 9-26 years of age

• 2 doses for pts ages 9-14
• 3 doses for pts ages 15-26 given over 6 months
• pts 27-45 may receive the vaccine after discussing risk factors with their physician