A 20-year-old woman comes to the office for a refill of oral contraceptives. She is in a monogamous relationship that began 6 months ago and uses condoms as back-up contraception. The patient became sexually active at age 14 and has had 5 lifetime partners. Her last menstrual period was 2 weeks ago. She has regular menses lasting 4-5 days every 28 days. The patient has not received the human papillomavirus (HPV) vaccination series and has never had a Pap test. Three months ago, she had negative screening for sexually transmitted infection. The patient has no chronic medical conditions and has had no prior surgery. She smokes cigarettes socially but does not use alcohol or illicit drugs. Vital signs are normal. Physical examination shows normal external genitalia without any lesions. Which of the following is recommended for this patient?

Question

A 20-year-old woman comes to the office for a refill of oral contraceptives.  She is in a monogamous relationship that began 6 months ago and uses condoms as back-up contraception.  The patient became sexually active at age 14 and has had 5 lifetime partners.  Her last menstrual period was 2 weeks ago.  She has regular menses lasting 4-5 days every 28 days.  The patient has not received the human papillomavirus (HPV) vaccination series and has never had a Pap test.  Three months ago, she had negative screening for sexually transmitted infection.  The patient has no chronic medical conditions and has had no prior surgery.  She smokes cigarettes socially but does not use alcohol or illicit drugs.  Vital signs are normal.  Physical examination shows normal external genitalia without any lesions.  Which of the following is recommended for this patient?

Quizplus · Accepted Answer

11ec25c8_d988_5514_bc81_c134a6fda1d4_MD0003_00 Human papillomavirus (HPV) is the most common sexually transmitted infection and has been linked to multiple diseases, including condylomata acuminata (ie, anogenital warts) as well as vulvar, vaginal, anal, oropharyngeal, and cervical cancer. Persistent HPV infection (particularly with types 16 and 18) results in cellular dysplasia because the incorporation of viral DNA increases prooncogenic protein expression and inhibits normal cellular regulation. cellular dysplasia The HPV vaccination induces an antibody response that decreases the risk of both HPV infection and subsequent related diseases. Routine administration of the vaccine series is indicated for female and male patients age 11 to 26, but vaccination may be given from age 9 to 45. Catch-up vaccination should be offered for patients who are either unvaccinated or did not complete the series (Choice E). (Choice A) Previous or current HPV infection is not a contraindication to HPV vaccination because vaccination provides protection against other HPV types that the patient may encounter with future sexual activity. (Choices C and D) Pap testing begins at age 21 in immunocompetent patients regardless of age of onset of sexual activity or number of sexual partners. Although most young (age <30) women become infected with HPV shortly after the onset of sexual activity, the infection typically clears and does not progress to cervical dysplasia or cancer. Therefore, routine HPV testing is not indicated in this population because it would increase the rate of unnecessary cervical procedures (eg, conization) and thereby increase the risk of pregnancy complications (eg, cervical insufficiency). Educational objective: Human papillomavirus (HPV) vaccination is recommended to prevent HPV-related disease; it is typically administered to those age 11-26 but can be given from age 9 to 45. Cervical cancer screening with Pap testing begins at age 21 in immunocompetent patients regardless of age of onset of sexual activity. References: Human papillomavirus vaccination for adults: updated recommendations of the Advisory Committee on Immunization Practices. (http://www.ncbi.nlm.nih.gov/pubmed/31415491) Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/31255301)

A 20-Year-Old Woman Comes to the Office for a Refill