Nursing assignment 4

STI & Vaginitis Case Analysis

Purpose: The purpose of this assignment is to apply advanced assessment and clinical reasoning skills to a patient presenting with symptoms of sexually transmitted infections and vaginitis. Students will analyze subjective and objective findings, interpret diagnostic data, and formulate evidence-based management approaches that reflect current clinical guidelines and patient-centered care principles.

Instructions: Read the patient case study provided and respond to the questions using clinical reasoning and evidence-based guidelines.

Patient Profile

A.B. is a 28-year-old G0P0 AA female presenting with 7 days of vaginal itching, burning with urination, dyspareunia, and abnormal vaginal discharge. She describes the discharge as thin, yellow-green, and foul-smelling. She reports two male sexual partners in the past 3 months with inconsistent condom use. The last STI screening was over one year ago. She used OTC miconazole without relief.

Pertinent History

· LMP: 2 weeks ago, regular cycles

· Contraception: Combined oral contraceptive pill

· Past STI: Chlamydia (treated, age 22)

· No chronic medical conditions

· No known drug allergies

Physical Exam

· Vitals: Stable, afebrile

· External genitalia: Mild erythema

· Vaginal exam: Thin, frothy yellow-green discharge

· Cervix: Mild erythema, friable

· Bimanual exam: Mild cervical motion tenderness

Diagnostic Findings

· Vaginal pH: 6.0

· Wet mount: Motile trichomonads, increased WBCs

· Nucleic Acid Amplification Test (NAAT): Trichomonas vaginalis positive

· Urinalysis: Negative

· Pregnancy test: Negative

Assignment Questions

1. Identify the most likely diagnosis and two differential diagnoses.

2. Explain which clinical findings support the primary diagnosis.

3. Outline evidence-based treatment according to current CDC guidelines.

4. Describe appropriate patient education and partner management.

5. Identify recommended follow-up and rescreening.

· Submission Instructions: Submissions (at least 2-3 pages excluding the title and reference pages) supported by at least two current scholarly sources

· No AI detectable, no plagiarism, turnitin similarity report must be less than 5%

· All paragraphs must have 5 sentences.

· All references must be cited

· All references must include “doi” if applicable

· Use current apa format

Grading Rubric 

Your assignment will be graded according to the grading rubric.

Essay/Paper Rubric

1

Trichomoniasis Case Analysis

Yairys Pereda

St. Thomas University

ADVANCED FNP WOMEN'S HEALTH: NUR-514

Donna Howard, DNP, APRN, FNP-BC, PMNHP-BC

November 9, 2026

Trichomoniasis Case Analysis

Diagnosis and Clinical Findings

The primary diagnosis is trichomoniasis in this 28-year-old patient with symptomatic vaginitis. Her positive nucleic acid amplification test identifies Trichomonas vaginalis, and motile organisms on microscopy provide additional confirmation. The yellow-green, frothy discharge, malodor, irritation, and dyspareunia fit the clinical presentation described by Hufstetler et al. (2024). Her vaginal pH of 6.0 and increased leukocytes further support an inflammatory vaginal infection. Recent sexual exposures and inconsistent condom use strengthen the indication for comprehensive sexually transmitted infection assessment.

The two principal alternative diagnoses are bacterial vaginosis and vulvovaginal candidiasis. Bacterial vaginosis can explain thin, malodorous discharge and elevated vaginal pH, but the case does not report clue cells or a positive whiff test (Centers for Disease Control and Prevention [CDC], 2021a). Candidiasis can produce itching, erythema, external dysuria, and dyspareunia, but usually occurs with vaginal pH below 4.5 (CDC, 2021d). The frothy discharge and failed miconazole trial make candidiasis less persuasive, although treatment failure alone cannot exclude yeast infection. Neither alternative explains the detected trichomonads, but concurrent infection remains possible if symptoms persist.

Assessment and Evidence Based Treatment

Cervical friability and mild cervical motion tenderness require assessment beyond uncomplicated vaginitis. The clinician should clarify whether dyspareunia is deep and ask specifically about pelvic pain, lower abdominal pain, bleeding, and systemic symptoms. Examination should assess uterine and adnexal tenderness because the supplied findings do not establish or exclude pelvic inflammatory disease (PID). CDC (2021b) recommends presumptive PID treatment when an at-risk patient has otherwise unexplained pelvic or lower abdominal pain plus cervical motion, uterine, or adnexal tenderness. Her afebrile status should not prevent treatment if the overall assessment supports PID.

For confirmed trichomoniasis without PID, prescribe metronidazole 500 mg orally twice daily for seven days, dispensing 14 tablets without refills (CDC, 2021c). This multidose regimen provides better outcomes in women than single-dose metronidazole, as summarized by Kissinger et al. (2022). Tinidazole 2 g orally once is an alternative when clinically appropriate, but intravaginal metronidazole gel is unsuitable for trichomoniasis. Obtain gonorrhea and chlamydia NAATs, HIV testing, and syphilis serology because confirmation of one infection does not exclude others (Hufstetler et al., 2024). Review medications, allergies, treatment access, and the negative pregnancy result before finalizing prescriptions.

If further assessment supports mild-to-moderate PID suitable for outpatient care, seven days of metronidazole alone is insufficient. The standard CDC regimen is ceftriaxone 500 mg intramuscularly once plus doxycycline 100 mg orally twice daily and metronidazole 500 mg orally twice daily, both for 14 days (CDC, 2021b). For documented gonorrhea in a patient weighing at least 150 kg, the ceftriaxone dose increases to 1 g. This broader regimen treats upper genital tract infection while also providing therapy active against trichomoniasis. Arrange reassessment within 72 hours if treating PID, with escalation for deterioration or lack of improvement.

Patient Education and Partner Management

Discuss the diagnosis privately and use neutral language that encourages questions about symptoms, treatment, and relationships. Explain that miconazole treats yeast and does not treat this protozoal infection. Review the full medication schedule, encourage completion, and use teach-back to identify practical barriers. Counsel her to avoid douching and use condoms consistently once sexual activity resumes (CDC, 2021c). Her contraceptive pill prevents pregnancy when used correctly but does not protect against sexually transmitted infections.

Partner treatment is essential because untreated infection can lead to reinfection despite successful initial therapy (Kissinger et al., 2022). Clarify which of the two recent partners remain current partners and facilitate notification, evaluation, and presumptive treatment of current partners. The CDC-recommended regimen for men is metronidazole 2 g orally as a single dose (CDC, 2021c). Advise abstinence until she and her partners have completed treatment and symptoms have resolved. Consider expedited partner therapy only when permitted by applicable law and supported by local practice procedures.

Follow Up and Rescreening

Schedule repeat trichomonas testing approximately three months after treatment, even if partners report receiving therapy (Hufstetler et al., 2024). If that visit cannot occur, arrange retesting at the next encounter within 12 months (CDC, 2021c). Advise prompt reassessment for persistent discharge or irritation and urgent evaluation for fever, worsening pelvic pain, or vomiting. Persistent symptoms require review of adherence, reexposure, coinfections, and possible resistance before selecting additional treatment (Kissinger et al., 2022). If NAAT is used for suspected persistence, wait at least three weeks after treatment completion to avoid detecting residual nucleic acid.

References

Centers for Disease Control and Prevention. (2021a). Bacterial vaginosis. https://www.cdc.gov/std/treatment-guidelines/bv.htm

Centers for Disease Control and Prevention. (2021b). Pelvic inflammatory disease (PID). https://www.cdc.gov/std/treatment-guidelines/pid.htm

Centers for Disease Control and Prevention. (2021c). Trichomoniasis. https://www.cdc.gov/std/treatment-guidelines/trichomoniasis.htm

Centers for Disease Control and Prevention. (2021d). Vulvovaginal candidiasis (VVC). https://www.cdc.gov/std/treatment-guidelines/candidiasis.htm

Hufstetler, K., Llata, E., Miele, K., & Quilter, L. A. S. (2024). Clinical updates in sexually transmitted infections, 2024. Journal of Women’s Health, 33(6), 827–837. https://doi.org/10.1089/jwh.2024.0367

Kissinger, P. J., Gaydos, C. A., Seña, A. C., McClelland, R. S., Soper, D., Secor, W. E., Legendre, D., Workowski, K. A., & Muzny, C. A. (2022). Diagnosis and management of Trichomonas vaginalis: Summary of evidence reviewed for the 2021 Centers for Disease Control and Prevention sexually transmitted infections treatment guidelines. Clinical Infectious Diseases, 74(Supplement_2), S152–S161. https://doi.org/10.1093/cid/ciac030

STI & Vaginitis Case Analysis

Purpose: The purpose of this assignment is to apply advanced assessment and clinical reasoning skills to a patient presenting with symptoms of sexually transmitted infections and vaginitis. Students will analyze subjective and objective findings, interpret diagnostic data, and formulate evidence-based management approaches that reflect current clinical guidelines and patient-centered care principles.

Instructions: Read the patient case study provided and respond to the questions using clinical reasoning and evidence-based guidelines.

Patient Profile

A.B. is a 28-year-old G0P0 AA female presenting with 7 days of vaginal itching, burning with urination, dyspareunia, and abnormal vaginal discharge. She describes the discharge as thin, yellow-green, and foul-smelling. She reports two male sexual partners in the past 3 months with inconsistent condom use. The last STI screening was over one year ago. She used OTC miconazole without relief.

Pertinent History

· LMP: 2 weeks ago, regular cycles

· Contraception: Combined oral contraceptive pill

· Past STI: Chlamydia (treated, age 22)

· No chronic medical conditions

· No known drug allergies

Physical Exam

· Vitals: Stable, afebrile

· External genitalia: Mild erythema

· Vaginal exam: Thin, frothy yellow-green discharge

· Cervix: Mild erythema, friable

· Bimanual exam: Mild cervical motion tenderness

Diagnostic Findings

· Vaginal pH: 6.0

· Wet mount: Motile trichomonads, increased WBCs

· Nucleic Acid Amplification Test (NAAT): Trichomonas vaginalis positive

· Urinalysis: Negative

· Pregnancy test: Negative

Assignment Questions

1. Identify the most likely diagnosis and two differential diagnoses.

2. Explain which clinical findings support the primary diagnosis.

3. Outline evidence-based treatment according to current CDC guidelines.

4. Describe appropriate patient education and partner management.

5. Identify recommended follow-up and rescreening.

· Submission Instructions: Submissions (at least 2-3 pages excluding the title and reference pages) supported by at least two current scholarly sources

· No AI detectable, no plagiarism, turnitin similarity report must be less than 5%

· All paragraphs must have 5 sentences.

· All references must be cited

· All references must include “doi” if applicable

· Use current apa format

Grading Rubric 

Your assignment will be graded according to the grading rubric.

Essay/Paper Rubric