Vaginal Discharge
Your patient is a 26 year-old young woman. She has been having a whitish vaginal discharge for the last few days, associated with itching and redness of the vulva. It isn’t painful but the itching seems to be getting worse. She’s tried some over-the-counter cream ‘that said it was for feminine itching,’ without much benefit. She has no other symptoms.
She has a boyfriend of 8 months. She has been sexually active with 2 other men in her life. She does not use condoms, but is currently on birth control pills. Her menstrual periods have been somewhat irregular since she began menstruating at age 13. LMP was 2 weeks ago, lasted 4 days, normal flow/duration. She is not allergic to any medicine. She smokes 1ppd x 7 years. Denies drug use. Last pap was normal 2 years ago.
What are the possible differentials that would be possible for her complaint?
How would you rule them out? List all of the testing and what they would rule out.
What guidelines did you use to select your testing?
Is she behind on getting a pap according to the most recent guidelines? What guidelines are you using?
She has been diagnosed with Chlamydia. What will you use to treat her? What patient education with regards to her other meds? Follow up needed? What guidelines did you use?
Does she have any behaviors that could be contraindicated with her current prescription?
Should she receive HPV testing on her pap specimen according to the guidelines?
Can she receive the HPV vaccine?
Vaginal Discharge
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Vaginal Discharge
What are the possible differentials that would be possible for her complaint?
There are a few potential differential reasons behind irritation around the vagina and vulva. The patient might be using products that are sensitive to her skin. These items may include menstrual pads, soaps, scented creams, lotion, certain substances in underwear, fragrances in douches, and undergarments washed with fragranced detergents (Alani et al., 2019). Moreover, the young woman might be experiencing vaginal yeast infection. Yeast infection results due to overgrowth of Candida in the vagina. Vaginal candidiasis normally happens when something disturbs microorganisms' equilibrium in the vagina. Ordinarily, a balance between valuable microbes and yeast live in the vagina. The microorganisms hold the yeast under control, forestalling excess. However, overgrowth can happen when the bacteria in the vagina do not control the yeast properly. Using douche, hormonal birth control, or pregnancy are common yeast infection causes (Alani et al., 2019). The patient might be suffering from bacterial vaginosis (BV). This condition occurs when the harmful and beneficial bacteria are imbalanced in the vagina. Lastly, the lady might have Chlamydia, genital Herpes, or trichomoniasis. These sexually transmitted infections cause vulva discomfort and itching. Generally, vulva itching has many possible causes.
How would you rule them out? List all of the testing and what they would rule out.
The standard test for a yeast disease is the microscopic assessment of a vaginal smear. This test assists with recognizing the particular sort of yeast that is causing infection. We rule out yeast infection if no cells are in the sample to indicate infection (Rodríguez-Granger et al., 2020). In the case of BV, a sample of vaginal release is checked for "clue cells" if they are found; it implies you might have bacterial vaginosis. Moreover, a vaginal PH of 4.5 and above is also a sign of BV. The procalcitonin (PCR) test aids in identifying genital Herpes. If the fragments of the virus's DNA are absent, the patient has no genital herpes. The Nucleic Acid Amplification Test (NAAT) detects the DNA of bacteria that causes Chlamydia (Rodríguez-Granger et al., 2020). Therefore, the test is negative if no DNA is perceived from a vaginal slob or urine.
What guidelines did you use to select your testing?
I used the Centers for Disease Control and Prevention guidelines to select the tests. According to these guidelines, NAAT is a standard test for Chlamydia. Moreover, the procedure recommends screening STIs in...