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Patient 32, married, multiparous than 3 vaginal deliveries, pelvic control goes to because he approached from the office for their Pap test.
, the patient is concerned and when interviewed by the midwife, it invites you to have a NIE cervicopatía 1 associated with HPV.
The patient does not understand what it is and asks for an explanation in simple terms.
Do I have cancer? If I have now, do I have chance of cancer? What chance? Is it false positive Pap? What about false negatives? What to do? How did this happen to me?
1. How do you inform the patient of the above?
intraepithelial neoplasia 1 (NIE I) is not cancer, but it is a disease that alters the normal barrier of the cervix, which is likely to get cancer, thus being a premalignant condition. The NIE 1 in more than half of the cases (70%) and improved return spontaneously, leaving a percentage of the injury remains stable, and a small percentage progressing to NIE 2 and 3 and possibly to cancer .
The PAP has false positives and negatives. Is estimated to have a sensitivity of 50-60% for the diagnosis of histological atypia, but its specificity is 90-99%. False positives are 16%, and false negatives 20%. This means that the test will not detect all patients with abnormal, but if detected, is very sure that you have an injury.
must have a serial control (clinical and PAP) on a regular basis to control the natural progression of this injury. In general has a good prognosis.
How would report it acquired a virus?
will inform you the truth about how he acquired the virus. What is sexual transmission. This is because the benefits we get with education and awareness are higher than hide this information.
Do you have the obligation to do so? What cases do you have?
the doctor is obliged to inform the way they acquired the virus, since in this particular disease, infection with this pathogen is a major risk factors and etiologies that explain their picture. For this reason, allows us to educate the patient, and to take all appropriate action.
2. A person with an STD is more likely to have another STD. Is this an STD?
A person with an STD, have a higher risk of having another STD depending solely on their risk factors (promiscuity, unsafe sex without protection methods, etc.). In this case we must evaluate the background to suspect in other infections. But the caveat is that this type of infection is highly prevalent in the general population, so given the high prevalence does not to think about other sexually transmitted infections if there are no risk factors.
3. The patient wants to explain to her husband. What did you say?
You must first find a comfortable and sheltered. It should be explained naturally, without falling in intonation or severity alarm. We explained that an infection is highly prevalent in the general population, which corresponds to a sexually transmitted disease course is often asymptomatic, and can generate lesions that have a partner. We partner education. We believe it is important to explain the possible form of timely transmission of the infection.
4. The patient tells you that, so this does not happen to their daughters, you want to vaccinate. Is there a vaccine to protect them?
There is a vaccine that can immunize against the human papilloma virus. It is necessary to investigate the ages of the girls, because to be effective, it has been shown to be applied before the start of sexual life. Anyway, once begun is effective sexual life, but it depends entirely on chance of not having a relationship where you purchased the virus. We advise you to vaccinate their daughters, as has been proven effective for 70 to 95% protection against the most prevalent strains that produce cancer cervical. It is also important to educate people about safe and healthy sexual behavior.
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