week 2 DB response 2

Table 1

Infection Description Presentation Causes/ Risk Factors

Treatment per CDC

Addtl info

Candida

Fungal infection due to candida albicans

Pruritic, soreness, dyspareunia , occasionally thick vaginal discharge and dysuria. KOH demonstrate s budding

Pregnancy, immunosupression, antibiotic use, diabetes

- Fluconazole 150 mg single dose

Not usually considere d an STI.

BV

Vaginal discharge or malodorous in childbearing people. N

Mal- odorous/ fishy odor, thin gray- white discharge, clue cells on

sexual activity, particularly with new or multiple partners, the use of douching, and not using condoms

Metronidazole 500 mg BID x 7 days OR 0.75% gel x 5 days

Not sexually transmittt ed

Chlamydi a

STI caused by Chlamydia trachomatis

Often Asymptoma tic; cervicitis, urethritis, dysuria, postcoital bleeding

having multiple or new sexual partners, not using condoms during sex, and having a history of other STIs

Doxycycline 100 mg BID x 7 days (preferred); or Azithromycin 1 g PO x1

Sexually transmitt ed; screen annually

Gonorrhe a

STI caused by Nisseria gonorrheae

Purulent discharge, pelvic pain, dysuria, urethritis, often asymptomat ic in women

unprotected sex, having multiple sexual partners, a history of other sexually transmitted infections (STIs), and being a young adult (under 25)

Ceftriaxone 500 mg IM x1 (if <150 kg); treat Chlamydia empirically unless ruled out

Sexually transmitt ed, screen annually

Trichomo nas

STI caused by Trichomonas vaginalis

Frothy yellow- green discharge, strawberry cervix, foul odor,

Multiple partners, unprotected sex

Metronidazole 500 mg BID x 7 days or 2g PO x1

Sexually transmitt ed, partner needs to be treated

Cervicitis Inflammation of cervix due to STI

Mucopurule nt discharge, cervical bleeding with contact

Chlamydia, Gonorrhea, HSV

Treat based on organism; empirically cover Chlamydia & Gonorrhea

Can cause PID if not treater

PID

Ascending polymicrobial infection of upper genital tract

Pelvic pain, cervical motion tenderness, fever, discharge

Untreated Chlamydia/ Gonorrhea, multiple partners

Ceftriaxone 500 mg IM x1 + Doxycycline 100 mg BID x 14d

Metronidazole

Risk for infertility

HIV

Human immunodeficie ncy virus , a virus that attacks cells that help the body fight infection. Affects the

Acute: flu- like symptoms

Chronic: becomes opportunisti c infection

Unprotected sex, IV drug use, MSM, mother-to-child

ART (Antiretroviral therapy) – lifelong

Screenin g should be offered annually

Syphilis STI caused by treponema pallidum

Primary: Painless chancre

Secondary: rash on palms, soles

Tertiary: neurological and cardiac involvement

MSM, HIV+, multiple partners, unprotected sex

Benzathine penicillin G 2.4M units IM x1 (early); weekly x3 (late/unknown duration)

Screen all pregnant patients, treat partners.

Table 2

Hep B

hepatitis B virus is a small DNA virus that belongs to the “Hepadnavirid ae” family.

Fatigue, jaundice, RUQ pain

Sexual contact, IV drug use, perinatal transmission, healthcare exposure

Supportive care (acute); Antivirals for chronic (e.g., tenofovir, entecavir)

Screenin g done to all pregnant patients, vaccine available

Hep C

Hepatitis C is a viral infection that causes liver swelling, called inflammation. Hepatitis C can lead to serious liver damage.

Faituge, jaundice

IV drug use, blood transfusions (pre-1992), sexual exposure

Direct-acting antivirals (e.g., sofosbuvir/ velpatasvir) for 8– 12 weeks

Screen adults, no vaccine available

HSV

Herpes Simplex Virus. Herpes is a common virus that can cause cold sores or genital sores. It spreads through skin- to-skin contact

Painless vesciles or ulcers, dysuria, systemic symptoms during primary infection

Oral/genital contact, unprotected sex, vertical transmission

Acyclovir 400 mg TID x 7–10 days or Valacyclovir 1g BID x 7–10 days

Lifelong therapy

Question Answer

Name 10 Risk Factors for contracting STI’s and HIV

1. Having unprotected sex

2. Having multiple partners

3. Injection of drugs with dirty needle sharing.

4. History of previous STI

5. Substance use

6. Sex work or transactional sex

7. Lac of access to healthcare or education

8. Not being vaccinated against preventable STIs

9. Being incarcerated or having a partner who is

10.Sexual coercion or violence

Name 5 safer sex practices

1. Limiting sexual partners

2. Regular STI testing, especially with new partners

3. Use condoms every tine you have sex

4. Avoid sex under the influence of drugs or alcohol

5. Inspect partners for visible sore or symptoms

Can HIV be transmitted through sweat, saliva, and tears? (Include rationale)

No, HIV can be transmitted from one infected person to another through blood, semen, vaginal secretions, rectal fluids and breast milk. For HIV to occur, the HIV in these fluids must get into the bloodstream of an HIV- negative person through a mucous membrane through open cuts or sores, or by direct injection.

Lisa is a 19-year-old female who presents to the clinic c/o abnormal vaginal discharge for one week after having unprotected vaginal intercourse with a new male partner she has been dating for a couple of weeks. Lisa’s pregnancy test is negative and her LMP was 2 weeks ago. As her health care provider, you will need to perform testing to determine if Lisa has contracted a sexually transmitted infection or other vaginal infection.

SOAP NOTE

Demographic: 19/ Female G0P0

Subjective

Chief complain: “abnormal vaginal discharge for one week after having unprotected vaginal intercourse with a new male partner that I have been dating for a couple of weeks.”

Name 2 types of intercourse are at the highest risk for contracting HIV

1. Unprotected vaginal sex

2. Unprotected anal sex

Why are women more susceptible to HIV in a male to female relationship (versus a male contracting it from a female)?

In women, several factors can increase the risk of HIV transmission. For example, during vaginal or anal intercourse, women are at greater risk of acquiring HIV because receptive sex is generally riskier than insertive sex. Age-related thinning and dryness of the vaginal tissue—common in older women— can lead to microtears during intercourse, providing a pathway for HIV transmission. Biologically, women are more vulnerable to infection due to the larger mucosal surface area exposed during penile penetration. Additionally, young women under the age of 17 are at even higher risk because they have an underdeveloped cervix and produce less protective vaginal mucus.

HPI:

Lisa is a 19 year ld female G0P0 who presents with a one week history of abnormal discharge after having unprotected vaginal intercourse with a new male partner.

• Onset: one week • Locating: vaginal • Duration: ongoing • Characteristic: abnormal • Aggrevating/relieving factors: none stated • Treatment: none tried

HPI questions:

• Is there any vaginal itching, burning or odor? • Are you having any symptoms such as cramping, pelvic pain, fever, burning when you pee? • Have you had this type of discharge in the past? • When was the last time you were tested for STIs?

Gyn history:

• LMP: 2 weeks ago, stated, regular • Unknown if on birth control at this time • Sexually active, new male partner, no protection • No known gynocological issues at this time.

Medical history

• No known medical conditions • No known surgical conditions • No known drug allergies • Immunizations: up to date

Family history:

• Mother: no known medical history • Father: no known medical history • Maternal grandmother: no known medical history • Paternal grandmother: no known medical history,

Social history

• Goes to school

• Balanced diet • Regular exercise • No drug or alcohol use • Sexual history: one new male partner, no protection • Relationship: new

Other questions

• Are you in a monogamous relationship? • Do you practice safe sex?

Review of systems:

• General: healthy, denies fever denies chills • Neuro: denies headacces or dizziness • Cardiovascular: denies chest pain or palpitations • Resp: denies shortness of breaeth or cough • GI: denies nausea, vomiting or diarrhea or abdominal pain • GU: positive abnormal discharge • Skin: denies rash, denies new lesions • Health maintenance: No Pap in the last 12 months due to age

Objective

Vitals: WNL

• Temp: 98.6 • BP: 120/80 • HR:78 • RR: 17 • Heihgt: 5’4” • Weight: 135 • BMI: 23.2

Physical exam:

• General: AAOx4, no acute distress • abdomen soft, non tender • Pelvic:

o Vulva: normal appearance o Vagina: abnormal discharge o Cervix: normal o Uterus: non tender o Adnexa: no masses or tenderness

POCT

• Urine pregnancy : negative o Rule out pregnancy due to age and no condom use • Wet mount with KOH and send out check for chlamydia, gonorrhea, BV, trichomonas o KOH to help identify yeast, or bv or trichomonas cells • NAAT o For STI screening

Assessment

Final diagnosis:

• Vaginal candidiasis B37.3 – clinical presentation of abnormal discharge

Differential:

• Bacterial vaginosis N76.0 – due to new sexual partner after unprotected sex • Trichomoniasis A59.9 – due to new sexual partner after unprotected sex • Chlamydia A56.0 – due to new sexual partner after unprotected sex

Plan

Diagnostics:

• NAAT: Chlamydia, Gonorrhea and trichomonas • KOH for BV • Serology for HIV, syphilis, Hep B and C • Pap smear

Treatments:

• Fluconazole 150 mg Po x 1 dose orally

o This medication is being prescribed at tis time as it is the first line therapy for uncomplicated candidiasis, some of the side effects are GI upset, and elevated liver enzymes. This medication should not be prescribed if patient has a history of liver disease.

If STI positive: depending on what STI patient comes back positive for, prescriptions will change. Both patient and partner will need to be treated and abstain from sex for a week.

Patient education:

• Risk factors for STIs • Abstain from sex for 7 days until symptoms have resolved, and medication taken • Practice safe sex • Refrain from having multiple partners as it can place you at higher risks for HIV andSTIs • Routine STI screening

Complications: if untrearted can causes recurect yeast infectons, risk of spreading infection to partner and increased risk for HIV and other STIs.

Referals: refer to GYN follow up

Follow up;

• Office will call when lab results return • Follow up in one week if symptoms do not improve • Pap smear

Health maintenance:

• Pap smear starting at age 21 • Hpv vaccine • STI screening annualy or whena new partner • Up to date on vaccines