Discussion Peer/Participation Prompt
Instructions:
Please respond to two peers’ posts regarding their plan. What did you find interesting about their response? How did their plan compare to yours? Do you agree with their plan and recommendations?
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.
please use updated references i will provide both peers post for response ,please favorable responses
peer#1
Nicholas Lounsberry
Aug 3, 2022Aug 3 at 1:07pm
Pertinent positives: reporting “almost fish-like smelling discharge from my vagina that started about a week ago;” She usually notices it after intercourse; She describes the discharge as thick, tan, foul-smelling, slimy discharge; she would sometimes have pain and burning on urination; They do not use condoms since she is on birth-control; Does not use condom, uses oral contraception; Admits to smoking cigarette; No hx of Pap Smear; 13 y.o. Last menstrual period two weeks ago, regular periods; Complains of foul-smelling vaginal discharge and pain with urination for 1 week; Vagina: Mucosa moist and slightly reddened, small amount of thick, tan, odorous discharge noted; Bimanual exam: lower pelvic tenderness
Pertinent negatives: She tried to use Monistat gel with no relief with her symptoms; Denies abd pain, fever or chills; No family history of cancer; does not use recreational drugs or alcohol; Patient denies any mood changes, change in appetite, weight loss/ gain, fatigue, or fever; Denies nipple abnormality or discharge; Denies vaginal itching; Denies history of pregnancy or STD; Denies…abdominal pain; Urethral meatus normal without discharge or irritation; vaginal walls pink; Cervix: pink, w/o lesion or mass; Anus: No hemorrhoids or fissure noted
Further questioning: Have you noticed any purulent discharge? Is your boyfriend mutually monogamous with you? Why are you resistant to using condoms? Has your boyfriend told you about or have you seen purulent discharge from his penis?
The discharge should be collected and cultured to figure out which organism could be causing the current problem. Education should be provided to the patient on how to prevent STIs and she should be talking with her partner as well. They both should be treated once the culture comes back, and they should use condoms every time they have intercourse.
Priority diagnosis: pelvic inflammatory disease – thick, tan, odorous discharge, burning upon urination, does not practice safe sex, vaginal mucosa redness, lower pelvic tenderness (Marcin, 2022).
Plan: It is likely that the patient has some sort of sexually transmitted infection. She stated during the interview that she is monogamous with her boyfriend, but we do not know if he is monogamous with the patient. They do not use condoms during intercourse, and he could have brought the infection to her. The discharge should be sent off to be tested for specific organism. Pelvic inflammatory disease (PID) could be caused by gonorrhea, chlamydia, or trichomoniasis, which are the most common STIs (Centers for Disease Control and Prevention, 2022). It is important to clear the infection quickly because there could be reproductive risks if not taken care of. She should be educated on safe sex, and getting her partner tested and treated to prevent reinfection (Marcin, 2022).
References
Centers for Disease Control and Prevention. (2022). Sexually transmitted diseases – information from cdc. Centers for Disease Control and Prevention. https://www.cdc.gov/std/default.htm
Marcin, A. (2022). Brown vaginal discharge: causes, treatment, when to see doctor. Healthline. https://www.healthline.com/health/brown-vaginal-discharge#infection
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peer#2
Sarah Johnson
MondayAug 8 at 12:44pm
In this case study, we see a 17-year-old female
Pertinent Positives
Foul smelling vaginal discharge for 1 week, usually noticed after intercourse
Pain and burning on urination for 1 week
Vaginal mucosa slightly reddened
Positive for thick, tan, odorous discharge on exam
Lower pelvic tenderness on bimanual exam
Tried monistat gel without relief
Sexually active with 1 partner
Taking birth control
Smokes cigarettes
Mild depression
Pertinent Negatives
Reports no abdominal pain, fever, or chills
This has never happened before
No pertinent family history
No recreational drug use or alcohol use
Negative for HEENT, breast, cardiovascular, GI, musculoskeletal, and neurological concerns
Other Information
Other questions I would have for this patient
Do you have dyspareunia?
Are you having any bleeding in between periods?
How would you describe the odor?
How many sexual partners have you had in your lifetime?
Is your partner monogamous
How are you managing your depression?
Are you uncomfortable or being forced to have sex?
Differentials
Bacterial vaginosis (N76.0) Priority diagnosis: Bacterial vaginosis is described as foul vaginal discharge that is often noted after intercourse, this fits with our patient’s descriiption of symptoms. However, discharge from BV is often noted as gray. This warrants further testing to correctly delineate what treatment is needed (Sobel & Mitchell, 2022a).
Trichomonas (A59.01) Trichomonas is typically associated with dyspareunia, which is not mentioned in the information we have. Trichomonas does often cause irritation of the urethra, so I would still consider this a possible diagnosis. I would want to test for both, and it is possible that both infections are present. However trichomonas alone does not fit quite as well as the diagnosis of bacterial vaginosis (Sobel & Mitchell, 2022b).
Chlamydia (A56.02) I don’t think she has chlamydia due to the lack of cervical motion tenderness noted on exam. However, it would be good to test for all STDs including chlamydia to rule out. It is also possible she has concurrent infections and the chlamydia could be causing the cystitis and urethritis symptoms
Plan for Priority Diagnosis
NAAT for chlamydia, gonorrhea, trichomonas (Sobel & Mitchell, 2022b)
Point of care swab for bacterial vaginosis if available (Sobel & Mitchell, 2022a)
Vaginal pH test as this can help determine what organism the symptoms are caused by, bacterial vaginosis has a pH greater than 4.5 (Sobel & Mitchell, 2022b)
Urinalysis with culture for urinary discomfort
Therapeutics
Therapeutics for bacterial vaginosis include either oral flagyl 500 mg PO BID x 7 days or vaginal metronidazole (aka metrogel) 0.75%, 5grams per vagina once daily for 5 days or clindamycin cream 2%, 5 grams per vagina for 7 days (Sobel & Mitchell, 2022a).
Education
I would provide the CDC handout on bacterial vaginosis (Centers for Disease Control and Prevention [CDC], 2022). This handout shows that the exact cause of BV is not known, however it is important to use condoms to prevent STDs, especially since having BV may increase your risk of contracting STDs (CDC, 2022). Oral flagyl may be more convenient, but there are side effects such as GI upset and headache, it is also important not to drink alcohol when taking oral flagyl (Sobel & Mitchell, 2022a). I would also recommend adding a daily oral probiotics as some studies show they may be helpful in restoring and maintaining vaginal flora (Sobel & Mitchell, 2022a).
Collaboration
At this point, I do not think collaboration is warranted. However, if symptoms persist and all other testing is negative, it may be warranted to refer to gynecology.
References
Centers for Disease Control and Prevention. (2022, June 6). Std facts – bacterial vaginosis. https://www.cdc.gov/std/bv/stdfact-bacterial-vaginosis.htm (Links to an external site.)
Sobel, J. D., & Mitchell, C. (2022a). Bacterial vaginosis: Clinical manifestations and diagnosis (R. L. Barbieri & K. Eckler, Eds.). UpToDate. Retrieved August 8, 2022, from https://www.uptodate.com/contents/bacterial-vaginosis-clinical-manifestations-and-diagnosis?search=bacterial%20vaginosis%26source=search_result&selectedTitle=2~111&usage_type=default&display_rank=2 (Links to an external site.)
Sobel, J. D., & Mitchell, C. (2022b). Trichomoniasis (R. L. Barbieri & K. Eckler, Eds.). UpToDate. Retrieved August 8, 2022, from https://www.uptodate.com/contents/trichomoniasis?search=foul%20vaginal%20discharge%26topicRef=5477&source=see_link (Links to an external site.)
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