During your first 5 weeks of clinical, you have probably had patients with vaginal complaints and possible infections. For this assignment, you will choose three STIs. Then fill in the chart for all columns including presenting symptoms, physical findings, laboratory/ diagnostic findings, and management or treatment. Do not leave any section blank.
Title: Assessment of Common Sexually Transmitted Infections: An Overview
Introduction:
Sexually transmitted infections (STIs) represent a significant public health concern worldwide, necessitating timely diagnosis and appropriate management. Upon entering the clinical setting, it is highly likely that encounters with patients presenting with vaginal complaints and possible infections will occur. This assignment aims to enhance the knowledge and understanding of three selected STIs by analyzing their presenting symptoms, physical findings, laboratory/diagnostic findings, and management/treatment options. By filling in the provided chart, a comprehensive assessment of these STIs can be achieved, aiding in improved clinical decision-making for effective patient care.
Selected STIs:
1. Chlamydia trachomatis (Chlamydia)
2. Neisseria gonorrhoeae (Gonorrhea)
3. Trichomonas vaginalis (Trichomoniasis)
Chart Analysis:
1. Chlamydia trachomatis (Chlamydia):
a) Presenting Symptoms:
Chlamydia infection often manifests with mild or no symptoms. However, when present, individuals may experience:
– Vaginal discharge (yellowish or greenish)
– Lower abdominal pain
– Dysuria (painful or burning sensation during urination)
– Rectal discomfort or discharge (in case of anal intercourse)
– Abnormal vaginal bleeding (post-coital or intermenstrual)
b) Physical Findings:
Physical examination findings in Chlamydia infection may include:
– Vaginal or cervical discharge
– Cervical inflammation (cervicitis)
– Mucopurulent cervicitis (characterized by purulent discharge from the cervical os)
c) Laboratory/Diagnostic Findings:
Laboratory investigations are crucial for the diagnosis of Chlamydia and may involve:
– Nucleic acid amplification tests (NAATs) for Chlamydia trachomatis DNA detection in cervical swabs or urine samples
– Urine-based screening tests (e.g., ligase chain reaction) can be utilized in asymptomatic individuals
d) Management/Treatment:
Treatment guidelines for Chlamydia include:
– First-line agents: Azithromycin 1 g orally as a single dose or doxycycline 100 mg orally twice daily for 7 days
– Sexual partners from the last 60 days should also be treated
– Retesting for cure is recommended after 3 months, especially in pregnant women
2. Neisseria gonorrhoeae (Gonorrhea):
a) Presenting Symptoms:
Gonorrhea infection may present with various symptoms, including:
– Increased vaginal discharge (purulent or greenish)
– Dysuria (painful or burning urination)
– Lower abdominal pain
– Abnormal vaginal bleeding (post-coital or intermenstrual)
– Rectal discomfort, itching, or discharge (in case of anal intercourse)
b) Physical Findings:
Physical examination findings in Gonorrhea can include:
– Purulent vaginal discharge
– Cervical erythema or friability
– Cervical motion tenderness
– Bartholin’s gland inflammation (bartholinitis) if involved
c) Laboratory/Diagnostic Findings:
Diagnostic tests commonly used for Gonorrhea include:
– Nucleic acid amplification tests (NAATs) for Neisseria gonorrhoeae DNA/RNA detection from cervical, urine, or oral samples
– Culture sensitivity tests for confirmation
d) Management/Treatment:
Treatment options for Gonorrhea include:
– Dual therapy: Ceftriaxone 250 mg intramuscularly (IM) in a single dose PLUS Azithromycin 1 g orally in a single dose
– Patients should be counseled about the importance of completing the full course of treatment
– Current guidelines recommend simultaneous treatment of Chlamydia as co-infection is common
3. Trichomonas vaginalis (Trichomoniasis):
a) Presenting Symptoms:
Trichomoniasis may exhibit various symptoms, such as:
– Profuse, frothy, yellowish-green vaginal discharge
– Vaginal odor (foul or ‘fishy’ smell)
– Vulvar itching and irritation
– Dyspareunia (pain during sexual intercourse)
– Dysuria (pain or burning during urination)
b) Physical Findings:
Physical examination findings in Trichomoniasis can include:
– Vaginal erythema (inflammation)
– Frothy discharge observed from the vaginal introitus
c) Laboratory/Diagnostic Findings:
Laboratory tests for the diagnosis of Trichomonas vaginalis include:
– Wet mount microscopy, revealing motile trichomonads in saline solution
– Nucleic acid amplification tests (NAATs) have high sensitivity and specificity
d) Management/Treatment:
Treatment of Trichomoniasis typically involves:
– First-line agents: Metronidazole 2 g orally in a single dose or Tinidazole 2 g orally in a single dose
– Both partners should be treated simultaneously, regardless of symptoms
– Abstinence from alcohol should be advised during and for 48 hours after treatment due to a disulfiram-like reaction potential
Conclusion:
This assignment aimed to provide a thorough assessment of three common STIs, including Chlamydia, Gonorrhea, and Trichomoniasis. By analyzing their presenting symptoms, physical findings, laboratory/diagnostic findings, and management/treatment options, healthcare professionals can enhance their ability to diagnose and manage these infections effectively. Timely diagnosis and appropriate treatment are crucial in reducing the transmission and long-term sequelae associated with STIs, emphasizing the importance of continued education and awareness among healthcare providers.