Review the presentations below, Discuss how health disparities in women could affect their care (for example, geographic location, race, finances, literacy, etc.). Use the UpToDate database as one of your required references and a second scholarly reference of your choice; remember you should have at least two references for each peer post.
An 18-year-old is accompanied by her mother for her first visit to the gynecologist. She has never been sexually active. She has no concerns with her menses. Her mom reports that she brought her in “because she is 18 and when I turned 18, I had to get my first Pap smear.” Her mother requests the patient have a Pap smear and be tested for HPV “just in case.” The patient is up to date on all vaccines “mandatory for school” but has never had the HPV vaccine.
- What are the recommendations on the HPV vaccine?
The CDC (2020) recommends that the vaccination series starts at age 11 or 12 years old and also recommends for everyone through the age of 26 years old if they have not been vaccinated before. It is a series of two or three doses depending on age when starting the series. It is not recommended for those over 26 because of effectiveness, but some providers and patients may decide to vaccinate anyway (CDC, 2020).
- How would you counsel this patient about the HPV vaccine?
I would discuss the importance of the HPV vaccination to the patient as well as the mother as she is in the age range where many patients become sexually active after high school. I would inform her of what HPV is and how it could affect her life. I would also explain the benefits and risks of the vaccination. I would highly recommend that this patient start this vaccine series before she becomes sexually active. I would tell mom that since she is not sexually active and has no symptoms, testing for HPV would not be necessary but also listen to her concerns if she still feels its necessary.
- What are the current ASCCP guidelines for Pap smears and HPV testing?
The ASCCP (2012) recommends that pap smears start at the age of 21. This can be younger if they are sexually active. This screening is to be done every 3 years unless there is a abnormal pap smear result. HPV testing is recommended during pap smear exam for those 30-65 years old every 5 years but not recommended for those under 30 years old. After 65 years old and no abnormal pap smears of concern, women can stop pap smear screening if recommended by their provider. These continue to be the current guidelines according to the ASCCP (ASCCP, 2012).
- How will you explain the rationale to the patient and the mother?
I would explain to the patient and mother that according to the CDC and ASCCP guidelines, she is not criteria to start her pap smear exams or have HPV testing since she is under the age of 21 and is not sexually active. I would also explain the research found that “Each year, more than 13,000 women are diagnosed with cervical cancer in the United States. Yet cervical cancer is one of the most preventable cancers today.” (NCCC, 2020). I would state that at this time she doesn’t need the pap smear or HPV testing but would highly recommend the HPV vaccinations series to be started since cervical cancer is so preventable with the vaccination.
STI Prevention and Screening
The case study that presents itself is a 52 year old female who is recently divorced and has been engaging in unprotected sex. The patient within the case study expressed that she has been with multiple partners and has not practiced “safe sex”. This particular patient also expresses an increase in the amount of alcohol consumption during the duration of this time period. With all the information provided, the advanced practiced registered nurse (APRN), is responsible for properly educating and screening this patient for sexually transmitted infections (STI). In doing so, will ensure this patient receives high-quality care.
Questions and Risk Factors
The types of questions the APRN would want to ask this patient pertain to a health history. The APRN would ask the patient if she has noticed any vaginal discharge, pain during urination, unusual vaginal bleeding, and if the patient is experience any lumps, blisters, or sores around the genital region. These types of questions will allow the APRN to identify if the patient has potentially contracted an STI and exactly what symptoms they might be experiencing. The patients present risk factors are centered around unprotected sex, increased consumption of alcohol, and a recent life-changing experience through a divorce. These risk factors will influence the APRN screening of this patient as it will allow them to ask appropriate questions related to the patients current situation and how to treat the patient accordingly.
Current Guidelines for STI
The current guild elites for STI screening are different for both men and women. According to the CDC, women, should be screened for chlamydia and gonorrhea if they are sexually active under the age of 25 or older than 25 as well (STD Screening Recommendations – 2015 STD Treatment Guidelines, 2015). For herpes, trichomonas, and HIV, women who engage in sexual activity with multiple partners without protected sex should be screened immediately upon visit (STD Screening Recommendations – 2015 STD Treatment Guidelines, 2015). With this information, the patient should be screened for chlamydia, gonorrhea, herpes, trichomonas, and HIV given her current presentation and according to CDC guidelines. In addition, a recent article highlighted that Congress has increased federal funding for STD prevention with $3.51 million in additional base funding to the CDC’s STD prevention programs (AHC MEDIA, 2020). With this increase in funding, STD prevention programs will help raise more awareness to STD’s within the community and prevent them from spreading.
Recommendations for “Safe Sex”
In order to implement “safe sex” practices, it is important to understand what this term means. Safe sex practices refer to sexual activity and especially sexual intercourse in which various measure such as latex condoms or practice of monogamy are taken to avoid STI’s (Addoh, Sng, & Loprinzi, 2017). Along with this information, it is important for the APRN to be aware of the patients current drinking situation and her behavior as well. It is reported that having sex under the influence of drugs or alcohol enhances sexual risk behaviors and is strongly associated with the increase risk of STI’s (Newville, Sorensen, Hatch-Maillette, & Calsyn, 2018). In understanding this information, this allow the APRN to incorporate safe sex practices for this particular patient. In relation to alcohol and sexual behavior, it is important for the APRN to educate the patient about this increased risk of contracting an STI. In addition to alcohol and sexual intercourse education, the APRN should educate the patient about the importance of latex condoms, hand hygiene, receiving immunizations, and becoming familiar with a partners sexual history.
Other Preventative Guidelines
For this particular patient, there are no other additional guidelines that should be discussed with this patient. Education surrounding alcohol and sexual intercourse is a primary discussion point with this patient. Also, engaging in sexual intercourse with multiple partners without using proper protection further increases this patients risk for STI’s. These guidelines surrounding education in relation to the topics discussed above will allow the patient to receive the necessary knowledge needed to reduce her chances of contracting an STI.