Vaccination- HPV


A 21 year old girl comes in to your office for a well visit/annual exam and vaccination.  She is otherwise healthy and a junior in college studying nursing.  Also she takes no medications, drinks socially, doesn’t smoke anything or use illicit drugs. The girl currently has no symptoms: no pain with urination/sexual activity/vaginal discharge.   In regard to your sexual history… she is sexually active. Occasionally she uses condoms and is taking an estrogen only OCP.  She has had four male partners in the last year and has been pregnant once and had one abortion at age 19.  She has never had an abnormal pap smear but was not vaccinated against HPV because “her parents didn’t believe in it”.  Her last pap smear was at age 16.

   What now?  Is she due for a pap smear or any other screening tests? If so what tests would you order and why and would you do a pap smear today?   What is a pap smear? What is it short for and who were they?   How would you talk to her about best sexual practices? I.e. condoms, STDs screening, pregnancy prevention, etc..   What would your discussion be regarding HPV vaccination at this point?   When would you see her back? In a year or sooner? Would you call her with her test results or make her come back in?

A 48-year-old woman presents to your clinic for a new patient visit.  She has a personal history of HTN and anxiety which are both managed well with medications.  Her family history is notable for her mother dying of breast cancer at age 55 and two aunts who both were treated with mastectomies and chemotherapy.

 Her exam is unremarkable including a breast and gynecologic exam.

 How would your discussion go regarding screening?

 Would you recommend a mammogram or an MRI in this patient?  Is she “high risk” or standard risk?

 Would you recommend screening for BRCA1/2 or would you refer her to a geneticist for such screening?

 What is a BI-RADS score and what are the six scores?

What are you personal thoughts on self-examination?  Does it help? Does it do more harm than good?

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