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OTHER GENITAL SYMPTOMSFirst assess and advise patient and partner/s 23.LumpsItchy rash in pubic areaGenital wartsIf warts are soft, involve the skin, and < 10mm:• Protect surrounding skin with petroleum jelly and apply 20% tinctureof podophyllin solution. Do not apply internally.• Wash solution off after 4 hours.• Repeat weekly for 4 weeks.• Do a Pap smear.• Check RPR 28.Refer if:• No response or• If warts are > 10mm, hard, on mucosal surfaces or• Pregnant or• Podophyllin not availableMolluscumcontagiosum• Papules withcentral dent• Paint withtincture ofiodine.• If HIV, shouldresolve withART.Pubic liceTreat patient and partner/s:• Apply benzyl benzoate25% from the neck downfor 24 hours. Advisepatient to avoid mucousmembranes, urethralopening and raw areas asit may sting. Repeat after7 days if lice or nits areseen.• Wash clothes and linen.ScabiesTreat patient:• Apply benzyl benzoate 25%from the neck down for24 hours. Advise patient toavoid mucous membranes,urethral opening and rawareas as it may sting.• Repeat after 1 week if necessary.• Wash clothes and linen.• Treat partner/s even ifasymptomatic.CERVICAL SCREENING• Papanicolaou (Pap)/cervical smears detect cervical abnormalities which occur before cancer develops. Cervical cancer is caused by certain types of human papillomavirus (HPV). HPV is usually transmitted sexually.• Women who smoke are more likely to have cervical abnormalities. Advise smokers to stop.• An asymptomatic HIV-negative woman should receive 3 smears in her lifetime from age 30, with a 10-year interval between each smear.• An HIV-positive woman should receive a Pap smear on diagnosis, regardless of her age. If the result is normal, she needs a Pap smear every year.• In pregnancy, Pap smears can be performed safely up to 30 weeks’ gestation.• If the patient has an abnormal vaginal discharge, treat the discharge first and then take a Pap smear at a follow-up visit.• Unsatisfactory smear: repeat within 3 months.• ASC-US: repeat within one year.• 2 consecutive ASC-US and HIV positive: refer colposcopy.• 3 consecutive ASC-US and HIV negative: refer colposcopy.• ASC-H ( ASC-US ?HSIL) or AGUS – refer colposcopy.Manage according to the Pap result• Suspicious of cancer: Refer urgent colposcopy.• LSIL: repeat after one year.• 2 consecutive LSIL: refer colposcopy.• HSIL: refer for colposcopy.• Normal: arrange repeat Pap date according to HIV status.Inform patient of symptoms of cervical cancer (abnormal bleeding, vaginal discharge) and instruct her to return should they occur.ASC-US: Atypical squamous cells of undetermined significance; LSIL: Low-grade squamous intraepithelial lesions; HSIL: High-grade squamous intraepithelial lesions; ASC-H: Atypical cells - cannot exclude HSIL;AGUS: Atypical glandular cells of undetermined significance27