STD Case Study
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
Mom with diabetes; Dad COPD; Brother healthy
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.
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
|Epidemiology (short synopsis) for each
Who, Where, When
|Trichomonas vaginalis is the most prevalent curable sexually transmitted infection globally, with 80% of the infections being asymptomatic. There are over 248 million new infections each year, with more than half of these infections occurring in men.||This is the most common sexually transmitted infection commonly reported as the second most common infectious disease in the US. Symptomatic gonorrhea results in urethritis in men and cervicitis in women. The CDC indicates that there were 1.6 million new infections in 2018, and more than half of these infections occurred in people between 15-24 years.||Youth aged 15 to 24 years account for two-thirds of new chlamydia infections. According to estimates, 1 in every 20 sexually active young women aged 14 to 24 has chlamydia. Disparities between racial and ethnic minorities still exist. In 2020, African Americans/Blacks had six times the rate of Whites regarding chlamydia.|
|Pertinent positives for each|| – Foul-smelling discharge from the vagina
– Vaginal burning
– Burning feeling during urination
|– foul-smelling vaginal discharge||– dysuria- smelly vaginal discharge
– friable cervix
|Pertinent negatives for eachwhich require more analytical and creative thinking, are gleaned from the differential diagnosis and function to “rule out” other diagnostic possibilities||
Negative for chills, fever, diarrhea, vomiting, and nausea
|Negative for fever, vomiting, chills, diarrhea, and nausea||Negative for chills, fever, diarrhea, vomiting, and nausea
|Patho short summary for each
|Trichomoniasis is produced by damage to the host epithelia caused by a multitude of events during infection, and new research has highlighted the dynamic interplay between the parasite and the host, as well as the commensal microbiota and symbionts. Altering the vaginal PH leads to overgrowth of normal microorganisms present in the vagina. The hydrogen peroxide that produces lactobacilli is critical in preventing the overgrowth of the anaerobes in the vaginal flora (Poole & McClelland, 2018).||The obligatory human pathogen Neisseria gonorrhoeae produces mucosal surface infections of the male and female reproductive systems, the pharynx, the rectum, and the conjunctiva. Gonorrhea is a simple mucosal infection that causes a pustular discharge. Salpingitis and pelvic inflammatory disease are more serious side effects that can lead to infertility and ectopic pregnancy. The pathogen might spread through the circulation on rare occasions (Kirkcaldy et al., 2019).||Cervicitis, pelvic inflammatory illness, urethritis, epididymitis, prostatitis, and lymphogranuloma venereum are all urogenital infections caused by C. trachomatis. Conjunctivitis, perihepatitis, pharyngitis, reactive arthritis, and proctitis are all extragenital infections produced by C. trachomatis (Huai et al., 2020).|
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 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.
- Primary Trichomonas vaginalis
- Secondary diagnoses, if applicable: No Secondary Diagnosis
- 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).
- 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:
- Abdominal cramps
- Epigastric discomfort
- 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 in 10 days to find out if the symptoms have subsided
- No referrals necessary for this patient
Advanced Pharmacy Clinic
123 Pill Ave., Anywhere, TX 70001
Name: Martha Jennings Date: 18/06/2022
Address: 123 Pill Ave, Anywhere, TX 70001 United States DOB: 20/07/1996
℟ Metronidazole 500mg tablet
Dispense #7 (seven)
SIG: Take one tablet a day for seven days
Refill zero Times
Lynda Jarrell APRN, FNP
|A.B. Smart MD phone (123)456-7890 Lynda Jarrell, DNP, RN, FNP-BC123 Pill Ave, Anywhere, TX 70001 NPI ID# 1223345687
DEA# AB12345 DPS# 112321 DEA# LJ 30999
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