Sexually Transmitted Infections

The Centers for Disease Control and Prevention estimates that there are 19 million new cases of sexually transmitted infections every year in the United States (CDC,

2010b). STIs may present serious health implications for infected patients—especially for those who are unaware of their health condition. Studies show that women are

not only at greater risk of contracting these infections, but they also tend to have more severe health problems resulting from infections than men (U.S. Department of

Health and Human Services, 2009b). As an advanced practice nurse, you must educate female patients and emphasize the importance of prevention and STI testing for all

women regardless of marital status, race, ethnicity, or socioeconomic status.

For this Discussion, consider STI education strategies for the three patients in the following case studies:

Case Study 1:
A 19-year-old Asian American female comes into the clinic for a well-woman checkup. She states that about three weeks ago she had a non-tender sore on her labia that

resolved without treatment. Her gynecologic exam is normal but she has maculopapular lesions on her trunk, neck, palms, and soles of her feet. The remainder of her

exam was unremarkable.

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.

Case Study 3:
A 21-year-old nulligravida comes to see you concerned about vague lower abdominal pain for two days associated with a yellowish, nonodorous, vaginal discharge. Past

history reveals regular menstrual periods and no previous surgeries or significant medical problems. Her last menstrual period was normal and ended two days ago. She

had a similar episode about eight months ago for which she did not seek care because of lack of health insurance. She is currently sexually active with one partner and

has had two partners in the past year. She is not using any type of contraception. On physical exam you note a temperature of 38º C, a regular pulse of 100, and a BP

of 110/65. Her abdomen is diffusely tender in both lower quadrants. Pelvic exam reveals a yellowish cervical discharge with cervical motion tenderness and a tender

fullness in both adnexa.

To prepare:
Review Chapter 21 of the Schuiling and Likis text and the Centers for Disease Control and Prevention article in this week’s Learning Resources.

Review and select one of the three provided case studies. Reflect on the patient information.

Consider a differential diagnosis for the patient in the case study you selected.

Think about the most likely diagnosis for the patient.
Think about a treatment and management plan for the patient.

Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

Consider strategies for educating patients on the treatment and management of the sexually transmitted infection you identified as your primary diagnosis.

Discuss the differential diagnosis for the patient in the case study you selected. Provide a minimum of three possible diagnoses, and list them from highest priority

to lowest priority.

Explain which is the most likely diagnosis for the patient and why.

Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating

patients on the sexually transmitted infection.

Readings
Schuiling, K. D., & Likis, F. E. (2013). Women’s gynecologic health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.
Chapter 11, “Sexuality” (pp. 209–225)

This chapter explores components of female sexuality, including sexual desire, sexual response, and women’s views of themselves in society. It also examines strategies

for maintaining satisfactory sexual health in women.
Chapter 20, “Gynecologic Infections” (pp. 467–483)

This chapter identifies strategies for assessing, diagnosing, and managing patients experiencing gynecologic infections. It also provides recommendations for treating

gynecologic infections, including alternative treatments for pregnant women.
Chapter 21, “Sexually Transmitted Infections” (pp. 485–533)

This chapter describes strategies for preventing, identifying, and managing patients with sexually transmitted infections (STIs). It explores common STIs, such as HPV,

HIV, syphilis, and gonorrhea, and identifies risk factors associated with these conditions.
Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health (4th ed.). Burlington, MA: Jones & Bartlett

Publishers.
Chapter 7, “Care of the Woman with Reproductive Health Problems”
“Care of the Woman with an Abnormal Pap Smear” (pp. 333–341)

This section examines management strategies for abnormal pap smears, focusing on the implementation of evidence-based guidelines. It also describes the roles that

physical examinations and diagnostics play in treatment and management decisions.
“Care of the Woman with Bacterial Vaginosis” (pp. 344–347)

This section identifies the presentation and incidence of bacterial vaginosis and provides strategies for diagnosing and treating this infection.
“Care of the Woman with Chlamydia” (pp. 352–354)

This section describes the presentation and impact of chlamydia on women. Chlamydia screenings and strategies for diagnosis and treatment are also examined.
“Care of the Woman with Gonorrhea” (pp. 378–381)

This section explains the presentation of gonorrhea and its association with chlamydial infections. It also presents strategies for diagnosing and treating patients

with this condition.
“Care of the Woman with Hepatitis” (pp. 381–385)

This section identifies the five primary types of hepatitis infections, including appropriate treatment options and recommended follow-up care.
“Care of the Woman with Herpes Simplex Virus” (pp. 385–388)

This section examines the herpes simplex virus, including transmission of the condition, special considerations for pregnant women, and recommended treatment and

management strategies.
“Care of the Woman with Human Immunodeficiency Virus” (pp. 389–393)

This section explores HIV, transmission of the condition, diagnosis, long-term treatment, and implications for women. It also describes the potential impact of the

condition on pregnant women and their newborns.
“Care of the Woman with Human Papillomavirus” (pp. 393–396)

This section describes the prevalence of HPV and its impact on women. It also identifies screening tests for HPV as well as clinical management guidelines for HPV-

infected patients.
“Care of the Woman with Parasitic Infestation” (pp. 399–402)

This section explains difficulties of treating and preventing parasitic infestations, including lice and scabies.
“Care of the Woman with Syphilis” (pp. 418–421)

This section identifies possible presentations of syphilis. It also presents treatment options for managing this condition, as well as special considerations for

pregnant women and their newborns.
“Care of the Woman with Trichomoniasis” (pp. 421–424)

This section explores the presentation, impact, and treatment of trichomoniasis on women. It also identifies follow-up care guidelines for patients with this

infection.
“Care of the Woman with Vulvovaginal Candidiasis” (pp. 424–427)

This section examines the prevalence of vulvovaginal candidiasis, as well as factors that may contribute to a diagnosis of this condition.
Centers for Disease Control and Prevention. (2010a). Sexually transmitted diseases treatment guidelines, 2010. Morbidity and Mortality Weekly Report, 59(RR-12).

Retrieved from http://www.cdc.gov/std/treatment/2010/STD-Treatment-2010-RR5912.pdf

This article provides guidelines for treating patients with sexually transmitted diseases, including HIV, syphilis, chlamydia, and HPV. The care of special populations

of women is also discussed.
Optional Resources