STD Case Study

STD Case Study

Subjective:

Martha is a 26-year-old female who reports vaginal burning for 3 days. She says that she can barely focus on other things because of the burning. She also reports a copious foul-smelling vaginal discharge. Her last pap smear was at age 21 and was negative. She has not received the HPV vaccine series. Martha denies previous episodes and states that she is otherwise healthy.

She denies fever, chills, nausea, vomiting, or diarrhea. She is sexually active and has been sexually active with males since age 15. She states that she has had 2 relationships in the past year. Last intercourse was last week. She admits to dyspareunia and burning with urination. She denies using vaginal sprays, douches, or powders or using new soaps, detergents, or clothing. She wears a thong regularly.

Past Medical History:

Tonsillectomy at the age of 7.

Currently on no medications or herbal/vitamin supplements

Family History:

Mom with diabetes; Dad COPD; Brother healthy

Social History:

Martha is a college graduate and lives alone in an apartment. She feels safe and has a good relationship with her boyfriend. Martha works as a teacher and feels financially secure. She does not smoke and denies drug abuse. She drinks socially on the weekends with 1-2 glasses of wine.

NKDA

Allergies:

Objective

Vital signs: Martha is afebrile. Her B/P is 110/70. Pulse is 64 and regular. Respirations are 18. She is 5 feet 3 inches tall and weighs 120 lbs.

General: Martha is pleasant and cooperative but anxious about the visit

Cardiac: Regular rate and rhythm without murmurs

Respiratory: Lungs are clear

Abdomen: Soft, non-tender, non-distended, and without organomegaly

Pelvic Exam:  Inguinal lymph nodes are without swelling or tenderness; vaginal mucosa is moist, pink, and mildly swollen. There is a fishy odor; copious discharge in the introitus. The cervix is pink and friable. There is a negative chandelier sign. PH is mildly alkaline, and wet prep indicates trichomonads.

List top 3 differentials using chart

 Neisseria gonorrhoeae

Neisseria gonorrhoeae is a bacterial pathogen responsible for gonorrhea and various sequellae that occur when an asymptomatic infection ascends within the genital tract or disseminates to distal tissues. The main symptoms of Neisseria gonorrhoeae include greater frequency and urgency of urination, painful urination, increased foul-smelling vaginal discharge, pelvic or abdominal pain, and bleeding after intercourse (Kirkcaldy et al., 2019).

The patient’s symptoms collaborate with this diagnosis since she has dyspareunia, a burning sensation in her vagina that makes it difficult for her to focus on other things, a burning sensation when urinating, and a foul-smelling vagina discharge.

Chlamydia trachomatis

Chlamydia trachomatis is the most common cause of curable bacterial sexually transmitted infection worldwide. It manifests primarily in urethritis in men and endocervicitis in women. The condition is asymptomatic in women, or there are minimal symptoms. If left untreated, however, it can lead to tubal factor infertility, ectopic pregnancy, salpingitis, endometritis, and pelvic inflammatory disease (Huai et al., 2020).

Chlamydia trachomatis include foul-smelling vaginal symptoms, painful urination, painful intercourse for women, and bleeding between periods. The patient’s illness is positive for all these symptoms making Chlamydia trachomatis a possible diagnosis.

List all diagnoses.

1. Primary Trichomonas vaginalis
2. Secondary diagnoses, if applicable: No Secondary Diagnosis

PLAN

Diagnostics:

• Nucleic acid amplification test (NAAT)- susceptible for trichomoniasis, often detecting 3-5 times more infections than the wet mount microscopy (Craig-Kuhn et al., 2019).
• Vaginal pH- the normal vaginal pH for women of childbearing age is 4.5. Elevation of the pH indicates bacterial infections such as trichomoniasis and atrophic vaginitis (Craig-Kuhn et al., 2019).

Medications:

• Metronidazole 500mg PO daily. The one-time dose of metronidazole works for trichomoniasis but has significant side effects, including severe upset GI issues. However, this gradual dose will reduce the side effects and help relieve the current trichomoniasis symptoms (Howe & Kissinger, 2018).
• Cost: $4 for seven pills at Walmart Good RX (Craig-Kuhn et al., 2019).
• Patient education: Alcohol consumption should be avoided during treatment and for 24 hours (Craig-Kuhn et al., 2019).
• Common side effects:
• Nausea
• Diarrhea
• Abdominal cramps
• Vomiting
• Epigastric discomfort

Non-pharm

• Patient education: male condoms will help prevent the spread of infections. Lactobacillus acidophilus supplements in the diet will help prevent the recurrence of infectious vaginitis. Abstinence from douching and sexual activity is recommended until the completion of treatment (Craig-Kuhn et al., 2019).

Follow up:

• Follow up in 10 days to find out if the symptoms have subsided
• No referrals necessary for this patient

References

Craig-Kuhn, M. C., Granade, C., Muzny, C. A., Van Der Pol, B., Lillis, R., Taylor, S. N., & Kissinger, P. (2019). Optimal timing for Trichomonas vaginalis test of cure using nucleic acid amplification testing. Sexually Transmitted Diseases, 46(5), 312. doi: 10.1097/OLQ.0000000000000968

Huai, P., Li, F., Chu, T., Liu, D., Liu, J., & Zhang, F. (2020). Prevalence of genital Chlamydia trachomatis infection in the general population: a meta-analysis. BMC Infectious Diseases, 20(1), 1-8. https://doi.org/10.1186/s12879-020-05307-w

Howe, K., & Kissinger, P. (2018). Single-dose compared to multi-dose metronidazole for the treatment of trichomoniasis in women: A meta-analysis. Sexually Transmitted Diseases, 44(1), 29. doi: 10.1097/OLQ.0000000000000537

Kirkcaldy, R. D., Weston, E., Segurado, A. C., & Hughes, G. (2019). Epidemiology of gonorrhea: a global perspective. Sexual Health, 16(5), 401-411. doi: 10.1071/SH19061

Poole, D. N., & McClelland, R. S. (2018). Global epidemiology of Trichomonas vaginalis. Sexually Transmitted Infections, 89(6), 418-422. http://dx.doi.org/10.1136/sextrans-2013-051075