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Obstetrics & Gynecology


Answer 2
  1. Empiric treatment for gonorrhea and chlamydia. This patient is at increased risk for STDs (age, < 26 yr; sporadic use of condoms; smoking) and she should be screened. However, empiric treatment for gonorrhea and chlamydia in an asymptomatic patient is not warranted. The Advisory Committee on Immunization Practices (ACIP) and ACOG recommend the quadrivalent HPV vaccine for all women aged 9 to 26 years regardless of when sexual contact was initiated.4 The vaccine protects against HPV types 6, 11, 16, and 18. Even when patients test positive for HPV 16, the vaccine may still protect them from acquiring HPV 6, 11, and 18 and therefore decreases their chance of developing cervical dysplasia or genital warts.4 HPV vaccines for types 16 and 18 have demonstrated an efficacy of 90% in preventing HPV infection and subsequently cervical dysplasia.5 There are also emerging data that the type-specific vaccines may protect against future reinocculation to specific HPV types and provide cross protection against other strains of HPV. Cigarette smoking is a cofactor for progression of cervical dysplasia to cervical cancer.6 Therefore, every clinician should recommend smoking cessation to women at risk of cervical dysplasia. Concurrent tobacco smoking with hormonal contraception increases the risk of thromboembolic disorders in women, especially those over age 35 years. These risks should be taken into consideration when discussing contraception with this patient.

    REFERENCES
    4. Committee on Adolescent Health Care, ACOG Working Group on Immunization. ACOG Committee Opinion No.344: Human papillomavirus vaccination. Obstet Gynecol 2006;108(3 Pt 1):699–705.

    5. Villa LL, Costa RL, Petta CA, et al. Prophylactic quadrivalent human papillomavirus (types 6, 11, 16 and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol 2005;6:271–8.

    6. Cannistra SA, Niloff JM. Cancer of the uterine cervix. N Engl J Med 1996;334:1030–8.

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