Treatment and Education for Chlamydia

Case Study #2 -A 31-year-old African American female is concerned about a white vaginal discharge. She has self-treated in the past with over-the-counter vaginal creams with some success. She has had no relief thus far for this episode.

This case study has a limited amount of information which makes it difficult to form a diagnosis. Asking the patient additional questions is needed to narrow potential diagnosis. Inquiring about vaginal itching, pain with sex or urination, odor, consistency of discharge, sexual behaviors, menstrual cycle, medical history, and medications should be reviewed. Schuiling & Likis (2017) recommends using the Five P’s to obtain sexual information: type of sexual partners, type of sexual practices, pregnancy prevention plan, protection plan from sexually transmitted diseases (STD), and history of STDs. Many STDs are asymptomatic and can be misdiagnosed by non-sexually transmitted gynecological conditions such as vulvovaginal candidiasis (VVC), bacterial vaginosis, and urinary tract infections (Schuiling & Likis, 2017). While it seems that case study #2 is describing VVC or potentially BV, the discussion post is on STDs. With that in mind the primary diagnosis in this case would be Chlamydia.

Primary Diagnosis

1-Chlamydia-the most reported STD caused by bacteria Chlamydia trachomatis (Schuiling & Likis, 2017). Two of the most common risk factors include multiple sex partners and failure to use condoms (MedlinePlus, 2018). Schuiling and Likis (2017) report there is a higher prevalence of chlamydia in African American (AA) women than in Caucasian women. Most often Chlamydia, like other STDs can go undetected, however some early symptoms may be abnormal vaginal discharge, burning with urinations or pain with intercourse (MedlinePlus, 2018). I chose chlamydia as the primary diagnosis since this is the most often reported STD and because there is a higher rate of chlamydia in AA women than white women.

Differential Diagnosis

2-Gonorrhea-second most common STD next to chlamydia, this is a bacterial infection caused by Neisseria gonorrhoeae organism (Tharpe, Farley, & Jordan, 2017). Most often women are unaware of symptoms from gonorrhea, however, frequently report a change in vaginal discharge that is often mistaken for other common vaginal infections such as a yeast infection (Centers for Disease Control [CDC], 2014). Chlamydia and Gonorrhea can occur at the same time and it is recommended to treat both STDs if one is diagnosed (CDC, 2014).

3-Trichomoniasis-STD caused by Trichomoniasis vaginalis parasite in which only thirty percent of patients aware of infection. Signs and symptoms include changes in vaginal discharge, foul odor, itching, burning with urination or intercourse (CDC, 2017). This is another STD that is often asymptomatic and misdiagnosed as VCC or BV.

Treatment and Education for Chlamydia

First line treatment for chlamydia is antibiotics. The CDC (2015) recommends a one-time oral dose of Azithromycin 1000 mg, preferable given at exam site or doxycycline 100 mg twice daily for seven days. Erythromycin or Levofloxacin 500 mg orally for seven days is another alternative (CDC, 2015). Education should be provided on the vigilant use of condoms to prevent STD transmission. Education should be given to take all medications as directed, to abstain from intercourse for seven days and to not have intercourse with anyone else with chlamydia until they have been treated as well (CDC, 2015). Follow up appointment for retesting in four to six weeks at which time reinforcement of educations should be discussed.

I have learned from my clinicals that most cases of chlamydia are discovered due to routine screening. Routine screening for all women age 24 or younger and all high-risk women is recommended. (LeFevre, 2014). A vaginal swab or a urine sample can be used to test for STD. All STD need to be reported to the Health Department.

References

Centers for Disease Control. (2015). Chlamydia infections. Retrieved from

https://www.cdc.gov/std/tg2015/chlamydia.htm

Centers for Disease Control. (2014). Gonorrhea – CDC fact sheet. Retrieved from

https://www.cdc.gov/std/gonorrhea/STDFact-gonorrhea.htm

Centers for Disease Control. (2017). Trichomoniasis-CDC fact sheet. Retrieved from

https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm

LeFevre, M. L. (2014). Screening for Chlamydia and gonorrhea: U.S. Preventive Services Task

Force recommendation statement. Annals of Internal Medicine, 161(12), 902–910. https://doi-org.ezp.waldenulibrary.org/10.7326/M14-1981

MedlinePlus (2018). Chlamydia infections. Retrieved from

https://medlineplus.gov/chlamydiainfections.html

Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Burlington, MA:

Jones and Bartlett Publishers.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery &

women’s health (5th ed.). Burlington, MA: Jones & Bartlett Publishers.