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Respond to your colleagues’ posts and explain how you might think differently about the types of tests you might recommend and explain why. Use your Learning Resources and/or evidence from the literature to support your position. Patient Information: CB, 22, F S. CC (chief complaint): burning with urination and fishy discharge for 3 days HPI: 22-year-old female presents with complaint Location: vagina, onset: 3 days ago, Character: burning with urination associated signs and symptoms: fishy discharge, timing: none, exacerbating factors: unprotected sex Current Medications: Multivitamin, Sprintec daily Allergies: no known drug allergies PMHx: anxiety and depression Soc & Substance Hx: social alcohol, denies tobacco and recreational drug use. Fam Hx: Mother is alive with breast cancer in remission and hypothyroidism, paternal grandfather is alive with prostate cancer, sister has type 1 diabetes, father is HTN, type 2 diabetes and hyperlipidemia, brother with no medical history. Surgical Hx: surgical history is unremarkable Mental Hx: Depression Violence Hx: none noted Reproductive Hx: G0P0, currently having unprotected sex, denies multiple sex partners. ROS: GENERAL: 5’5”, weight 148, BP”: 132/68, P 62 HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat. SKIN: No rash or itching. CARDIOVASCULAR: chest clear to auscultation bilaterally RESPIRATORY: normal respiration, rhythm and depth upon r GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood. NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. MUSCULOSKELETAL: none noted HEMATOLOGIC: none noted LYMPHATICS: none noted PSYCHIATRIC: hx of depression and anxiety ENDOCRINOLOGIC: none noted GENITOURINARY/REPRODUCTIVE: Burning upon urination, fishy vaginal discharge ALLERGIES: no history O. Physical exam: 5’5”, wt 148, BP 132/86, p 62. No headache, no visual problems, no hearing problems, no nose problems, no throat complications. Lymph nodes of the neck are grossly normal. Chest is clear to auscultation, bilaterally, normal respirations, rhythm, and depth. Breast are normal on exam, complaint of some abdominal suprapubic tenderness. On pap exam cervix is firm, smooth, copious amounts of green discharge present, uterus is mobile, non-tender. Ovaries, fallopian tubes and ligaments are normal. Diagnostic results: lab: wet mount of vaginal secretions A vaginal pH test can be performed with a pH test stick or paper to determine either bacterial vaginosis or trichomoniasis, however the test alone is not a reliable test for diagnosing (Mayo Clinic, 2022). A. Trichomoniasis – a common sexually transmitted infection the is cause by a parasite that may cause women to experience a foul vaginal discharge and itching and painful urination, while men may experience no symptoms (Mayo, 2022). Bacterial Vaginosis Bacterial Vaginosis, also known as BV occurs when there is an excess of bacteria that changes the normal balance of bacteria in the Vagina (CDC, 2022). Yeast Infection – Very common vaginal infection that can cause itching, discharge and burning caused by an overgrowth of Candida P. Treatment : Trichomoniasis – Tinidazole 2g po once Bacterial Vaginosis – Flagyl 500mg BID x 7 days Yeast Infection – Monistat Cream or Diflucan Extra questions and education Do you feel safe in your home? LMP? Does your boyfriend have any penile discharge or any pain? Reflections Young women may not be fully aware of the importance of protecting themselves from sexually transmitted diseases (STI). It is especially important to educate them on the long-term complications caused by STIs. Infertility and infections that can cause death are consequences of unprotected sex. I am not a fan of scare tactics when working with the younger population, but a sincere educational session on loving one’s self and protecting one’s self is sometimes needed. References Centers for Disease Control and Prevention (CDC), 2022. Bacterial Vaginosis https://www.cdc.gov/std/bv/stdfact-bacterial-vaginosis.htm Department of Health and Human Services, Office of Women’s Health (OASH),2021 https://www.womenshealth.gov/a-z-topics/vaginal-yeast-infections Mayo Clinic, 2022 Trichomoniasis https://www.mayoclinic.org/diseases-conditions/trichomoniasis/symptoms-causes/syc-20378609#: Mayo Clinic, 2022. Vaginitis https://www.mayoclinic.org/diseases-conditions/vaginitis/diagnosis-treatment/drc-20354713

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