Instructions
Please create one response to each peer ( I am providing their posts below). Response posts to peers have no minimum word requirement but must demonstrate topic knowledge and scholarly engagement with peers. Substantive content is imperative for all posts. All discussion prompt elements for the topic must be addressed. Please proofread your response carefully for grammar and spelling. All posts should be supported by a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately. Citations and references must adhere to APA format.
Classroom Participation
Substantive means that you add something new to the discussion supported with citation(s) and reference(s), you are not just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion, however should be correlated to the literature.
Discussion Peer/Participation Prompt (ie; responses)
Instructions:
Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least two of these prompts:
- Do you agree with your peers’ assessment?
- Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
- Share your thoughts on how you support their opinion and explain why.
- Present new references that support your opinions.
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Peer 1
Nathan.
Would you perform a pelvic exam and/or a pap smear?
As her provider, it is important that I address her needs which includes reproductive health. Given her symptoms and history, the key components of the physical exam will include a pelvic exam to visualize the perineum and evaluate the discharge, speculum examination to inspect for abnormalities of the vaginal walls and cervix, and a bimanual exam to evaluate for cervical motion tenderness and palpate for uterine and adnexal tenderness (Cash et al., 2021). I am curious why this patient had a pap smear at a young age. Pap smear for cervical cancer screening is age-specific and it starts at age 21 (Alexander et al., 2017). It was mentioned that this patient is up to date with it and there were no abnormal findings. I do not think it is necessary to do another one at this time.
What is your Diagnosis (Assessment)?
Based on the clinical presentation and the results of the NaCl wet prep and whiff test, I will diagnose her with Trichomoniasis. It is the most common non-viral sexually-transmitted infection caused by Trichomonas vaginalis (Dalby & Stoner, 2022). This condition may be asymptomatic or may cause perineal irritation (Cash et al., 2021). Common symptoms include copious yellow-green or grayish vaginal discharge, vaginal odor, dysuria, pruritis, postcoital bleeding, dyspareunia and abdominal discomfort (Cash et al., 2022).
What is your plan, including treatment and education?
The recommended treatment for trichomoniasis is metronidazole (Dalby & Stoner, 2022). She will need a 7-day course of Metronidazole 500mg po BID. An immediate follow-up is unnecessary unless symptoms are not relieved by treatment (Cash et al., 2022). However, she will need to have a three-month follow-up.
Patient will need coaching on the importance of antibiotic therapy. She must take the medication as ordered. Avoid alcohol for up to 48 hours after the last dose of the metronidazole. The combination of alcohol and metronidazole may result to various side effects such as nausea, vomiting, flushing and abdominal cramps.
I will also educate the patient on the various kinds of STIs and how to prevent them. I will recommend regular testing for STI including HIV. I will also educate her on a healthy lifestyle. Smoking cessation, minimal beer consumption and responsible marijuana use will be discussed.
There was no mention of this patient receiving the HPV vaccine. If applicable, I will educate her on the importance of getting it. HPV vaccine is proven to prevent certain forms of cancer caused by the human papilloma virus which is the most common sexually transmitted infection in the country (Akshaya & Massey, 2022). There are currently 80 million Americans infected with HPV (Akshaya & Massey, 2022).
Would you prescribe treatment for her partner(s)?
I will. The partner will be given a prescription for a one-time dose of metronidazole 2 grams orally.
What contraceptive care/counseling would you offer Geri?
The patient and her boyfriend must understand that they should not have sex during treatment. I will also inform the patient that oral contraceptive pills do not protect an individual from sexually-transmitted diseases. If they are not in a monogamous relationship, using condoms is highly-recommended. They must be screened for STI every 3-6 months if they have multiple partners.
List 2 community resources in your area that you could utilize.
I will offer this patient information on the community’s Planned Parenthood Program where she can obtain affordable reproductive health services such as STI screening, pregnancy counseling and birth control consultation. I will also offer the Los Angeles County helpline 1-800-NO-BUTTS so she can receive counseling on how to quit smoking.
References
Akshaya, S. B., & Massey, P. M. (2022). Google trends on human papillomavirus vaccine searches in the United States
from 2010 to 2021: Infodemiology study. JMIR Public Health and Surveillance, 8(8). https://doi.org/10.2196/37656
Alexander, I., Johnson-Mallard, V., Kostas-Polston, E.A., Fogal, C., & Woods, N. (2017). Women’s Health Care in
Advanced Practice Nursing (2nd ed.). Springer Publishing LLC. https://ambassadored.vitalsource.com/
books/9780826190048
Cash, J., Glass, C. & Mullen, J. (2021). Family practice guidelines (5th ed.). Springer Publishing Company.
Dalby, J., & Stoner, B. P. (2022). Sexually transmitted infections: Updates from the 2021 CDC guidelines. American
Family Physician, 105(5), 514-520. https://prx-herzing.lirn.net/login?url=https://www.proquest.com/scholarly-journals/sexually-transmitted-infections-updates-2021-cdc/docview/2663449694/se-2
PEER 2
Alyia G.
Unit 5 Discussion Post: Sexually Transmitted Diseases
Would you perform a pelvic exam and/or a pap smear?
Given the history of this patient and reinfections of chlamydial cervicitis, I would do both a pelvic and a pap smear. This is because the cervix is involved, and this is recurring, so we need to get all the information about the cells. With cervicitis you can see abnormal cells on a swab (Alexander et al., 2017). That is another reason why I would do a pap and swab the cervix and surrounding involved tissue in the canal.
What is your Diagnosis (Assessment)?
My diagnosis for this patient is Trichomoniasis. It is transmitted during sex and would explain her large amount of yellow discharge (Alexander et al., 2017). The positive wet prep for trichomonads is a giveaway as well. Other pertinent positives would be the odor and positive whiff test, erythema, and itching.
What is your Plan, including treatment and education?
We would swab for other infections as well to confirm that this is the only infections that this patient is dealing with. Pelvic exam with a speculum would be done even though it may be uncomfortable (Alexander et al., 2017). It is important for the provide to note any swelling, ulceration, or erythema. The treatment is Metronidazole 2g orally in once single dose (Alexander et al., 2017). I would give this high dose due to her symptoms. The patient will be advised not to drink during this time.
Would you prescribe treatment for her partner(s)?
The patient should provide information of the last sexual partner or partners. Then the provider needs to determine if they have been treated or not. If they have not, it is likely they will need to be evaluated and then treated as well. Since this is an STI we need to track it to avoid other exposures.
What contraceptive care/counseling would you offer Geri?
The patient needs a lot of education given the recurrent STI she has had in the past. She needs to understand the organism can be alive and transmitted for months even if she is not having symptoms (Alexander et al., 2017). She needs to consider not engaging in sexual practices to protect her partners. She should be advised to continue with her birth control to prevent pregnancy. Condoms should be used to further prevent reinfections. This infection can lead to infertility in the future if not treated timely (Zhang et al., 2022). She is only 18 years old, but she needs to understand the extent of these infections on the body.
List 2 community resources in your are that you could utilize.
DPHS to care staff provides a great confidential service for sex and needle sharing partners of those who have tested positive. They can go to the Department of Health and Human Services for this information (DHHS, 2022). Another resource that is very popular in this area is planned parenthood (Planned Parenthood, 2022). They are well known in providing sex education and assisting with any sexual infections or issues.
References
Alexander, I.M., Johnson-Mallard, V., Kostas-Polston, E.A., Fogal, C.I., & Woods, N.F. (2017). Women’s health care in advanced practice nursing.(2nd. ed.), New York, NY: Springer Publishing Company. ISBN: 978-0-8261-9001-7
Department of Health and Human Services. (2022). STI/HIV resources for healthcare providers. https://www.dhhs.nh.gov/programs-services/disease-prevention/infectious-disease-control/sexually-transmitted-infections-1Links to an external site.
Planned Parenthood (2022). Manchester health center of Manchester, NH. https://www.plannedparenthood.org/health-center/new-hampshire/manchester/03104/manchester-health-center-2740-91770?utm_campaign=manchester-health-center&utm_medium=organic&utm_source=local-listing
Zhang, H., Jing, Z., Li, F., Yue, B., Zhang, P., & Li, H. (2022). The Clinical Effects of Metronidazole Vaginal Effervescent Tablets Combined with Kushen Suppository in the Treatment of Trichomonas Vaginitis. Evidence-Based Complementary & Alternative Medicine (ECAM), 1–7. https://doi.org/10.1155/2022/7730474
For the writer to know background information:
My initial discussion post ( what I posted):
1. Would you perform a pelvic exam and/or a pap smear?
No. A pelvic examination is not indicated in this instance. The history of yellowish and malodorous discharge after sex and the findings of trichomonads from the wet mount demonstrate a low likelihood of Chlamydia and gonorrhea in this instance. At the same time, nurses should aim to reduce invasive and personnel-intensive procedures such as pelvic and PAP smears unless indicated, as they may act as a barrier to universal screening in adolescents and delay seeking medical consultations for STIs (Kling et al., 2017). Additionally, newer tests that do not require pelvic examinations are now available. The Centers for Disease Control and Prevention recommends that cytology and HPV tests should not be considered screening tests for STIs (“STI Treatment Guidelines,” 2022).
2. What is your diagnosis (Assessment)?
Trichomoniasis. Trichomoniasis is an STI caused by Trichomonas vaginalis, a motile protozoan common in the United States. Patients commonly report abnormal vaginal discharge, which may be purulent, frothy, or bloody. Other symptoms are abnormal vaginal odor, pain during sexual intercourse, vulvovaginal itching and burning, lower abdominal pain, postcoital bleeding, and dysuria (Smith, 2022).
3. What is your Plan, including treatment and Education?
A single dose of 5-nitroimidazole is recommended for treating trichomoniasis (Smith, 2022). FDA-approved treatments are 2g of metronidazole, secnidazole, or tinidazole. Patients better tolerate Secnidazole and tinidazole. Health education includes safe sex practices—avoiding multiple sex partners and using condoms. Geri should also reduce her alcohol intake (4 -6 beers is binge drinking) and stop smoking marijuana, which may increase her risk of engaging in unsafe sex.
4. Would you prescribe treatment for her partner?
Yes. The partner should be treated empirically since the infection is often asymptomatic in men.
5. What contraceptive care/counseling would you offer Geri?
Educate her on the proper use of condoms and recommend them as the choice method of contraception since they also protect one from STIs.
6. List two community resources in your area that you could use
Palo Alto Teen and Adolescent Solutions
Stanford Children’s Teen Health Van
References
Kling, J. M., Vegunta, S., Al-Badri, M., Faubion, S. S., Fields, H. E., Shah, A. A., Wallace, M. R., Ruddy, B. E., Bryan, M. J., Temkit, M., & MacLaughlin, K. L. (2017). Routine pelvic examinations: A descriptive cross-sectional survey of women’s attitudes and beliefs after new guidelines. Preventive Medicine, 94, 60–64. https://doi.org/10.1016/j.ypmed.2016.11.007
Smith, D. S. (2022, February 2). Trichomoniasis. Medscape. https://emedicine.medscape.com/article/230617-clinical
STI treatment guidelines 2021: Human papilloma virus (HPV) infection. (2022, January 31). Centers for Disease Control and Prevention. https://www.cdc.gov/std/treatment-guidelines/hpv-cancer.htm
Case Study
Geri is a 18-year-old high school student in your clinic today because of vaginal discharge. You have seen Geri three times this past year for the same complaint and have diagnosed chlamydial cervicitis two of the three times. The other time Geri had bacterial vaginosis.
Chief Complaint: “Lots of yellow vaginal discharge”
HPI: yellow discharge X3 weeks with odor especially after sex; started burning with urination 2 days ago; denies vaginal/vulvar sores or irritation; says has noticed some itching on the outside.
PMH: allergy to PCN and sulfa; OCP’s x 2 years for birth control; no other meds
OB/GYN: no pregnancies, LMP 1 week ago; Paps UTD and WNL; Hx chlamydia cervicitis treated with doxycycline.
FH: Mother with HTN (smoker)
SH: Lives with mother and sister (parents divorced); currently in apartment with mother’s sister and her boyfriend because her mother is out of work; smokes 1/2 ppd x 2 years; 4-6 beers every week-end; marijuana every week-end; denies other recreational drugs; junior in high school and works at Hardees.
Exam:
Abdomen soft non tender
inguinal lymph without adenopathy
perineum normal hair distribution; no lesion or discharge
vagina rugated, slightly erythematous, large amount yellow green discharge; no lesion
cervix; nullip, erythematous; no exudate at os, mobile, slightly tender, with palpation
uterus firm, mobile, non-tender
adnexae without palpable mass or tenderness bilateral
rectovag confirms findings
Lab
urine dip-neg blood, neg leuks, neg nitrates
KOH wet prep neg hyphae, spores
NaCl wet prep pos trichomonads, neg clue, pos whiff, pos WBC,s neg RBC’s rare lactobacilli
Questions
- Would you perform a pelvic exam and/or a pap smear?
- What is your Diagnosis (Assessment)?
- What is your Plan, including treatment and education?
- Would you prescribe treatment for her partner(s)?
- What contraceptive care/counseling would you offer Geri?
- List 2 community resources in your are that you could utilize.
