Discussion On Sexually Transmitted Infections

Discussion Sexually Transmitted Infectionsthe Centers For Disease Con

Discussion: Sexually Transmitted Infections The Centers for Disease Control and Prevention estimates that there are 19 million new cases of sexually transmitted infections every year in the United States (CDC, 2010b). STIs may present serious health implications for infected patients—especially for those who are unaware of their health condition. Studies show that women are not only at greater risk of contracting these infections, but they also tend to have more severe health problems resulting from infections than men (U.S. Department of Health and Human Services, 2009b). As an advanced practice nurse, you must educate female patients and emphasize the importance of prevention and STI testing for all women regardless of marital status, race, ethnicity, or socioeconomic status.

For this Discussion, consider STI education strategies for the three patients in the following case studies: Case Study 1: A 19-year-old Asian American female comes into the clinic for a well-woman checkup. She states that about three weeks ago she had a non-tender sore on her labia that resolved without treatment. Her gynecologic exam is normal but she has maculopapular lesions on her trunk, neck, palms, and soles of her feet. The remainder of her exam was unremarkable. Case Study 2: A 31-year-old African American female is concerned about a white vaginal discharge. She has self-treated in the past with over-the-counter vaginal creams with some success. She has had no relief thus far for this episode. Case Study 3: A 21-year-old nulligravida comes to see you concerned about vague lower abdominal pain for two days associated with a yellowish, nonodorous, vaginal discharge. Past history reveals regular menstrual periods and no previous surgeries or significant medical problems. Her last menstrual period was normal and ended two days ago.

She had a similar episode about eight months ago for which she did not seek care because of lack of health insurance. She is currently sexually active with one partner and has had two partners in the past year. She is not using any type of contraception. On physical exam you note a temperature of 38º C, a regular pulse of 100, and a BP of 110/65. Her abdomen is diffusely tender in both lower quadrants.

Pelvic exam reveals a yellowish cervical discharge with cervical motion tenderness and a tender fullness in both adnexa. To prepare: Review Chapter 20 of the Schuiling and Likis text and the Centers for Disease Control and Prevention article in this week’s Learning Resources. Review and select one of the three provided case studies. Reflect on the patient information. Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient. Think about a treatment and management plan for the patient, considering appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments. Consider strategies for educating patients on the treatment and management of the sexually transmitted infection you identified as your primary diagnosis.

Paper For Above instruction

For this assignment, I have chosen Case Study 3, concerning a 21-year-old female presenting with lower abdominal pain and abnormal vaginal discharge. The clinical presentation, including fever, tender adnexa, cervical motion tenderness, and abnormal discharge, strongly suggests pelvic inflammatory disease (PID). The differential diagnosis includes several other conditions that can produce similar symptoms such as ectopic pregnancy, ovarian cyst rupture, and urinary tract infection (UTI), but PID remains the most probable diagnosis given her history, physical exam findings, and symptoms.

Differential Diagnosis

The first potential diagnosis is ectopic pregnancy, which can present with lower abdominal pain and vaginal bleeding, especially in women who are sexually active. However, her last menstrual period was reported as normal, and there was no mention of pregnancy testing, which would be essential for ruling out this condition. The second possibility is ovarian cyst rupture. While they can cause acute lower abdominal pain, ovarian cysts typically present with unilateral pain and are less likely to cause cervical motion tenderness or diffuse tenderness involving both adnexa, as seen in this case. The third consideration is urinary tract infection, which can cause suprapubic pain and sometimes flank pain, but usually does not produce cervical motion tenderness or adnexal fullness.

Given her symptoms, physical examination findings, and history, PID is the most likely diagnosis. PID is an infection of the upper genital tract involving the uterus, fallopian tubes, and surrounding tissue, often resulting from sexually transmitted pathogens such as Neisseria gonorrhoeae and Chlamydia trachomatis.

Treatment and Management Plan

The cornerstone of PID management involves prompt antibiotic therapy to eradicate the infection, reduce the risk of complications such as infertility, ectopic pregnancy, and chronic pelvic pain, and prevent further transmission. Empiric antibiotic treatment should target the common causative organisms, with coverage for both gonorrhea and chlamydia. A recommended outpatient regimen is the combination of ceftriaxone 250 mg intramuscularly in a single dose and doxycycline 100 mg orally twice daily for 14 days. Metronidazole 500 mg orally twice daily may be added if anaerobic bacteria are suspected or if the patient has been exposed to bacterial vaginosis. For inpatient treatment, especially if the patient is pregnant, pregnant or unable to tolerate oral medications, IV antibiotics such as cefotetan or cefoxitin combined with doxycycline are appropriate.

Supportive care includes analgesics for pain relief, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen 400-600 mg orally every 6-8 hours as needed. Rest and hydration are also essential components for recovery.

Follow-up is vital to monitor treatment response, usually within 72 hours. Patients should be advised to abstain from sexual activity until they complete therapy and resolve symptoms. Testing for sexually transmitted infections, including chlamydia and gonorrhea, should be performed, with partner notification and treatment to prevent reinfection.

Patient Education Strategies

Educating the patient on the importance of adherence to the prescribed antibiotic regimen is critical to ensure complete eradication of the infection. Patients should understand the necessity of completing the full course of antibiotics, even if symptoms improve earlier. Education should also encompass safe sexual practices, including consistent condom use to reduce future STI risk.

It is crucial to emphasize regular screening for STIs, particularly for sexually active women under 25 and those with multiple partners. Patients should be informed about the signs and symptoms of pelvic infections and other STIs to seek early care. Providing written materials, counseling services, and resources for partner notification and treatment can help reduce STI transmission.

Additionally, discussing the importance of routine gynecologic exams and encouraging vaccination for preventable diseases such as HPV should be part of comprehensive sexual health education. Empowering patients with knowledge enables them to make informed decisions about their sexual and reproductive health, ultimately reducing the incidence and burden of STIs.

References

• Centers for Disease Control and Prevention. (2015). Pelvic inflammatory disease (PID) (NNDSS Data). MMWR Morb Mortal Wkly Rep, 64(7), 1-10.
• Schuiling, K. D., & Likis, F. E. (2017). Women's Gynecologic Health. F. A. Davis Company.
• Hosenball, R. (2014). Pelvic Inflammatory Disease. In: UpToDate. Waltham, MA: UpToDate Inc.
• Workowski, K. A., & Bolan, G. A. (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recommendations and Reports, 64(RR-3), 1-137.
• World Health Organization. (2016). Global health sector strategy on sexually transmitted infections 2016-2021. Geneva: WHO.
• Teo, S., & Friedman, A. (2019). Management of pelvic inflammatory disease. Journal of Family Practice, 68(9), 532-538.
• American College of Obstetricians and Gynecologists. (2020). Practice Bulletin No. 215: Pelvic inflammatory disease. Obstetrics & Gynecology, 135(4), e86-e102.
• Morris, M., et al. (2017). Gonorrhea and Chlamydia screening among young women: Opportunities for prevention. Journal of Women's Health, 26(7), 667-674.
• Klein, R. S., & Nelson, C. (2018). Prevention and management of sexually transmitted infections. Primary Care: Clinics in Office Practice, 45(4), 593-606.
• Peipert, J. F. (2017). STI prevention strategies. Sexual Health, 14(4), 317-323.