What are the recommended health screenings and preventive measures for a sexually active female patient of reproductive age regarding STIs, birth control, and pregnancy planning?

Comprehensive Women's Health Screening for Sexually Active Females of Reproductive Age

For sexually active women of reproductive age, assess STI risk and reproductive goals at every visit, screen all women under 25 annually for chlamydia and gonorrhea regardless of risk factors, provide contraceptive counseling with emphasis on highly effective methods, and ensure folic acid supplementation for all women capable of pregnancy. 1

STI Screening Protocol

Universal Screening (All Sexually Active Women)

• Screen annually for chlamydia and gonorrhea in all sexually active women younger than 25 years, regardless of other risk factors 1
• Screen women 25 years and older only if high-risk sexual behaviors are present (multiple partners, new partner, inconsistent condom use, sex while using drugs/alcohol, sex in exchange for money/drugs) 1

Risk-Based STI Screening

For women with high-risk behaviors at any age, screen for: 1

• Chlamydia and gonorrhea
• HIV infection
• Syphilis
• Hepatitis B (if unvaccinated or unknown status)

Pregnancy-Specific STI Screening

All pregnant women require universal screening for: 1

• Syphilis (early pregnancy, repeat in third trimester and at delivery for high-risk women)
• Hepatitis B surface antigen
• HIV infection

Pregnant women under 25 or with high-risk behaviors require screening for: 1

• Chlamydia (third trimester to prevent neonatal infection)
• Gonorrhea (third trimester)

Structured Risk Assessment Approach

Use the "Five P's" framework at initial and annual visits: 2

• Partners: "In the past 2 months, how many partners have you had sex with?"
• Practices: "To understand your STI risks, I need to understand the kind of sex you have had recently" (ask specifically about vaginal, anal, oral sex)
• Protection from STIs: Document condom use frequency and barriers to use
• Past history of STIs: Previous infections increase future risk
• Prevention of pregnancy: Assess current contraceptive method and satisfaction

Additional high-risk behavior questions: 2

• "Have you or any of your partners ever injected drugs?"
• "Have you or any of your partners exchanged money or drugs for sex?"

Contraception Counseling

Initial Contraceptive Discussion

Discuss contraception and pregnancy planning at the initial or early visit with all women of reproductive age, offering the full range of methods tailored to patient preference. 1

Reproductive Life Plan Assessment

At every visit, ask three key questions: 1

• "Do you have any children now?"
• "Do you want to have (more) children?"
• "How many (more) children would you like to have and when?"

Method Selection Based on Efficacy

When pregnancy is not desired, prioritize highly effective methods: 1

• Intrauterine devices (IUDs): 0.1-0.8% failure rate with typical use 3
• Progestin implants: 0.05% failure rate 3
• Combined oral contraceptives: 5% failure rate with typical use (0.1% with perfect use) 3
• Progestin-only pills: 5% failure rate with typical use (0.5% with perfect use) 3

Recommend barrier methods (male condoms: 14% typical use failure rate) if more effective methods are contraindicated, and counsel that condoms provide the best protection against STIs including HIV, gonorrhea, HSV, hepatitis B, and chlamydia. 1, 3, 4

Critical Contraceptive Counseling Points

Counsel all patients that hormonal contraceptives do not protect against HIV or other STIs. 3

For women at high risk for both pregnancy and STIs, recommend dual protection: a highly effective hormonal method plus condoms. 4

Provide emergency contraception counseling when necessary. 1

Pregnancy Planning and Preconception Care

Universal Preconception Interventions

For all women of reproductive age, regardless of pregnancy intention: 1

• Folic acid supplementation: Advise all women to take folic acid daily and consume folate-rich foods (higher doses for women at high risk of neural tube defects)
• Immunization review: Update annually as needed, particularly rubella, varicella, hepatitis B, HPV, influenza, and tetanus
• Blood pressure monitoring: Check during routine care; counsel on pregnancy-safe medications if hypertensive
• Weight assessment: Counsel women with BMI ≥30 or <18.5 kg/m² about infertility risks and pregnancy complications

Chronic Disease Optimization

Screen and optimize management for: 1

• Depression and anxiety: Screen at reproductive age; adjust medications before conception if appropriate
• Diabetes: Counsel about importance of glycemic control before pregnancy
• Teratogenic medications: Assess and optimize medication risk profile

Social and Behavioral Screening

Screen all women of reproductive age for: 1

• Alcohol consumption, tobacco use, and drug use
• Current, recent past, or childhood physical, sexual, or emotional interpersonal violence (refer to appropriate resources when identified)

When Pregnancy is Desired

Provide counseling on: 1

• Medications, health conditions, and activities that may affect fertility
• Importance of birth spacing (discuss optimal interpregnancy intervals)
• Family and genetic history assessment based on maternal age, paternal health, obstetric history

Additional Preventive Services

Related Screening Recommendations

Consider need for: 1, 5

• Cervical cancer screening (per age-appropriate guidelines)
• Breast cancer screening (individualized for women 40-49 years, routine for women ≥50 years)
• Cardiovascular risk factor screening (obesity, lipids, diabetes)

Screening Frequency Adjustments

Increase STI screening frequency to every 3-6 months for women with: 2

• Multiple or anonymous partners
• Methamphetamine use
• Sex in conjunction with drug use
• Partners with these behaviors

Common Pitfalls to Avoid

• Do not defer contraceptive counseling until a woman requests it; discuss at every visit as part of reproductive life planning 1
• Do not screen women 25 and older for chlamydia/gonorrhea without documented risk factors, as routine screening is not recommended in this population 1
• Do not assume oral contraceptives provide STI protection; explicitly counsel about need for condoms 3, 4
• Do not overlook community-level risk factors (local STI prevalence, geographic location, socioeconomic factors) when determining screening intensity 1, 2
• Do not forget to assess for intimate partner violence, which affects contraceptive autonomy and STI risk 1