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Zorluk: OrtaPreventive Care and Screening

An asymptomatic 24-year-old female presents to her primary care provider to establish care and undergo a health maintenance visit. She reports feeling well overall. Her only regular medication is a combined oral contraceptive pill. She reports becoming sexually active with a new male partner three months ago, noting inconsistent use of barrier protection. She has a lifetime history of three sexual partners. She has never smoked cigarettes or used illicit drugs. She denies abnormal vaginal discharge, dyspareunia, or genital lesions. A review of her electronic medical record indicates that she underwent a normal cervical cytology (Pap smear) at age 21, but has not had any other preventive screenings since that time. Physical examination reveals a normal cervix with no cervical motion tenderness or adnexal masses. Based on current guidelines, which of the following is the most appropriate screening strategy for this patient today?

  1. Cervical cytology and nucleic acid amplification testing for Chlamydia trachomatis and Neisseria gonorrhoeaeCevap
  2. B
    Cervical cytology, human papillomavirus testing, and nucleic acid amplification testing for Chlamydia trachomatis and Neisseria gonorrhoeae
  3. C
    Cervical cytology and human papillomavirus co-testing only
  4. D
    Cervical cytology, nucleic acid amplification testing for Chlamydia trachomatis and Neisseria gonorrhoeae, and herpes simplex virus type 2 serology
  5. E
    Nucleic acid amplification testing for Chlamydia trachomatis and Neisseria gonorrhoeae only, with cervical cytology deferred until age 25

Cevap

The most appropriate strategy is to perform cervical cytology alongside nucleic acid amplification testing for Chlamydia trachomatis and Neisseria gonorrhoeae.
The correct strategy combines two strongly indicated preventive measures for a 24-year-old sexually active woman: cervical cancer screening and STI screening. According to USPSTF guidelines, cervical cancer screening should commence at age 21 with cervical cytology alone every 3 years. Because this patient had her last cytology at age 21, she is exactly due for her next screening at age 24. Furthermore, the USPSTF and the CDC recommend annual screening for Chlamydia trachomatis and Neisseria gonorrhoeae in all sexually active women aged 24 years or younger, regardless of relationship status or contraceptive use.

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1
Determine the patient's requirement for cervical cancer screening based on her age and previous testing history.
The patient is 24 years old and her last normal cervical cytology was at age 21.
Guidelines state that cervical cancer screening should begin at age 21 and be repeated every 3 years with cytology alone until age 30. Therefore, a 3-year interval has elapsed, and she is due for cytology today.
2
Assess the need for human papillomavirus (HPV) testing.
HPV testing is not indicated for this patient.
HPV testing (either alone or as co-testing) is not recommended for average-risk women under the age of 30 because transient HPV infections are extremely common in this age group and most clear spontaneously without causing dysplasia.
3
Evaluate the patient's requirement for sexually transmitted infection (STI) screening based on her demographic and social history.
The patient is sexually active and under the age of 25, making her eligible for routine chlamydia and gonorrhea screening.
The USPSTF recommends annual screening for Chlamydia trachomatis and Neisseria gonorrhoeae in all sexually active women aged 24 years and younger.
4
Determine if any other routine STI serology is indicated.
Routine HSV serology is not indicated.
The USPSTF recommends against routine serologic screening for HSV in asymptomatic individuals due to a high rate of false positives and a lack of clinical utility in reducing transmission.

Anahtar Kavram

In average-risk women, cervical cytology is performed every 3 years from ages 21 to 29 without routine HPV testing; simultaneously, all sexually active women aged 24 and younger require annual screening for chlamydia and gonorrhea.
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Preventive Care and Screening

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