Both Human Papillomavirus (HPV), a disease that can cause malignancies, and gonorrhea are sexually transmitted infections (STIs), which pinpoint to the fact that this patient’s partner may have these health issues as well. In order to properly communicate with the patient, it is essential to explain that these diseases are treatable in case all prescriptions are followed. This information should be provided in a confident and open manner, allowing the patient to understand that all possible assistance will be provided. She needs teaching about the causes and symptoms of HPV and gonorrhea, as well as possible ways to treat and prevent them in the future (Crum et al., 2018). She should also notify her partner so that he or she can screen and start the treatment if necessary. The psychosocial response of the patient should be noted during the communication and counseling. The follow-up should include the cytological test in terms of cervical-cancer screening program along with the repeated pap smear tests after three and six months post-treatment.
The analysis of complaints and anamnesis of the disease should be collected: the onset of the disease, pain, discomfort level, odor, et cetera. This patient is required to provide information about her recent sexual activity, including contraception and partners – this information will help in identifying possible infection causes. Some information regarding hygiene practices and immunity will also be beneficial in diagnosing the patient as poor sanitation and hypothermia may lead to bartholinitis or other infections (Crum et al., 2018). In addition, it is important to ask about any previous vagina infections and related diseases that were noted in the family members.
Considering that the symptoms occurred within two weeks after the treatment with metronidazole that is rather effective, the most likely cause of trichomoniasis recidivism is that the patient’s partner was not treated and infected her. In this case, the management of both the patient and her partner should be repeated, and they should refrain from the sexual intercourse until full recovery. Tinidazole in the form of oral medication may be selected as the alternative to metronidazole. The use of contraception measures (condoms) should be recommended as the prevention option. More to the point, it should be clearly explained to the patient that her partner may still transmit trichomoniasis.
Since both the fluorescent treponemal antibody absorption and rapid plasma reagin tests are positive, it is possible to suggest that the patient has syphilis. Such historical data as previous syphilis cases, the infection of the family members, and any symptoms should be revealed. The physical assessment should be conducted to identify any possible sores on the skin as the first signs. As for the additional laboratory testing, direct fluorescent antibody testing for T pallidum, serologic tests, and the T pallidum hemagglutination assay may be recommended to either prove or reject the mentioned diagnosis (Janier et al., 2014). They may be indicated prior to the treatment and after it to ensure that the patient is healthy. All these tests should be performed to detect syphilis produced antibodies.
Human Papillomavirus (HPV) is the most likely diagnosis for genital warts that look like cauliflower. The follow-up should include the screening for cervical cancer, namely, precancerous conditions and cancer among women who do not have symptoms and feel healthy since HPV, in many cases, lead to the mentioned conditions. If screening reveals precancerous states, they can be effectively treated, thus preventing the development of cancer.
The first treatment option is for warts on the skin – over-the-counter (OTC) salicylic acid may be used to eliminate this symptom based on Podophyllin or Podofilox. The patient should understand that the treatment of the disease is impossible, and only symptoms may be addressed. In case of the need to perform a surgical intervention, electrocautery in order to burn the abnormal areas and cryotherapy to freeze abnormal cells may be recommended. Some possible side effects are possible, including overall weakness and repeated symptoms. The patient should understand that she may transmit the disease to others via the close contact.
Bacterial vaginosis, a gynecological disease in which the vaginal microflora changes, yet inflammation is not observed, is the most likely diagnosis. It is characterized by abundant and prolonged discharge, in which gonococci, trichomonads, fungi, and other pathogenic microorganisms are not detected (Crum et al., 2018). During the survey, the doctor should ask if a woman suffers from diseases of the reproductive system along with endocrine and somatic conditions, if she takes hormonal preparations and antibacterial agents, uses contraceptives. Information regarding any births, abortions, and surgical interventions on the genitals, as well as the intensity of sexual activity should be clarified.
In terms of the physical examination, the patient’s vagina should be inspected. An increase in the light reflection of the vaginal walls would indicate a raise in the humidity of the walls, while no inflammation is expressed. Labia, cervix, and discharge from the cervix are moderate, and there is no pain when urinating and during intercourse. A physician should take a smear from the patient for a microbiological (bacterioscopic) examination. In addition, bacterial flora can be studied under a microscope, and the patient may be offered FemExam rapid test strips.
The patient should know that the combined therapy of bacterial vaginosis is based on the use of immunomodulators containing interferon-alpha, general and local antibacterial agents, intravaginal antiseptics, and medication that restore the intestinal and vaginal microflora. The treatment of both bacterial vaginitis and vaginosis is aimed primarily at the elimination of the existing pathogenic flora, followed by correction of the damaged ecosystem of the vagina. The most effective medication is metronidazole, the effect of which extends to the simplest and anaerobic flora induced the production of interferon. The sexual intercourse should be suspended up to full recovery of the patient.
In case of laboratory confirmation of trichomoniasis, treatment is prescribed in a complex manner according to an individual scheme for every patient. It contains the use of anti-trichomonas medication – metronidazole, ternidazole, or others derivatives (Crum et al., 2018). In combination, topical treatment may be prescribed in the form of vaginal tablets and suppositories as well as a number of procedures: physiotherapy, immunotherapy, urethral instillation, and general immunotherapy. Upon completion of the disease treatment, a doctor prescribes a set of control laboratory tests that are to be provided after the end of the patient’s menstrual cycle within three months.
Considering the mentioned symptoms, one may assume that the patient has vaginitis. Usually, a doctor prescribes antibacterial and anti-inflammatory drugs in the form of tablets. If necessary, local or general hormone therapy should be offered to patients with recurrent vaginitis. A special role in the treatment and prevention of the disease, especially if it is caused by such pathogenic flora as Candida, is played by a diet. It is extremely important to exclude fats, carbohydrates, as well as spicy and salty foods.
After the intake of antibiotics against genital diseases, damage to microflora of the vagina may be caused, which leads to inflammation of various origins. In order to avoid unpleasant consequences, local therapy should be carried out in parallel with the main one. For example, suppositories with lactic acid bacteria may be used for ten days. After treatment for gonorrhea, repeat tests are necessary to ensure that the disease has receded. It is also advisable to pass the bio-material on adjacent sexually-transmitted diseases since chlamydia, trichomoniasis, and primary syphilis are often detected with gonorrhea. In order to avoid the consequences of sexually transmitted diseases, condoms should be used, while it is prohibited to have sex until complete recovery. The patient’s partner should also receive antibiotics and the local therapy.
It is important to clarify that her symptoms are characteristics of vaginal infection that can only be transmitted through the sexual intercourse. Since she is infected, it is most likely that her fiancé has the same disease that was acquired from another sexual partner. The patient should be explained that she needs to speak about it with him to prevent further complications as it is also critical for him to check for the infection. The follow-up for her partner should consist of monitoring within three months.
Since the patient is a young 14-year-old lady, she just started having vaginal discharge, which is the main reason for her concern. Therefore, she needs teaching and counseling about the nature of normal discharge and potential alarming symptoms. The main focus should be directed to the facts that discharge is a way to cleanse the cervix, and it may be colorless, milky white, or pale yellow, depending on the phase of the menstrual cycle. Moisturizing the mucous membrane, these secretions prevent the growth of pathogenic bacteria, protect against infections, and promote self-cleaning of the vagina. Since her discharge and laboratory tests are normal, no intervention I required.
The allergic vaginitis caused by the use of diaphragm is the most likely diagnosis for the given patient. The vaginal diaphragm has the form of a dome-shaped cap, made mostly of latex, and supplemented with a flexible rim and spring, which hold it into the vagina. The diaphragm should be inserted into the vagina just before sexual contact. The patient should be offered an alternative contraception measure to support the diagnosis. Also, the partner should be asked about any symptoms that occurred after the start of the sexual intercourse with this patient.
The transmission of genital herpes occurs during sexual intercourse through vagina, mouth, and rectum. It is most possible to infect a partner during an exacerbation of the disease, yet the risk of transmitting herpes remains even when rash is absent. In addition, approximately 80 percent of patients with genital herpes occur without visible manifestations (Garland & Steben, 2014). It is critical to be sure to use the methods of barrier contraception and better in combination with the means of emergency prophylaxis. It should be kept in mind that with oral contacts herpes from the lips easily falls on the genitals. Therefore, the patient needs to engage in oral sex using special latex wipes. The care provider should explain that it is unethical to keep this information and that the partner should be aware of her health problems as there is the risk of infection. Even though this discussion may lead to the end of relationships, it is better to be open and honest with the partner. In collaboration with the medical specialist, it is possible to create a plan and prepare for the discussion.
Since the patient has late syphilis and does not speak English, her husband acts as a translator. This situation may be used to prepare for proper communication with the patient based on the collaboration of the husband and the care provider. The advantage is associated with the fact that the husband will act as the key person who will decide on how the communication will be built. At the same time, it is the disadvantage as the patient might prefer to keep her disease confident or select another treatment option.
The first way to respond is to clarify that symptoms of herpes are treatable, which will support the patient psychologically. The disadvantage of this method is possible misunderstanding that herpes may be eliminated completely, which is incorrect. The second response refers to presenting the most effective treatment and clarifying that early use of antiherpetic drugs (Zovirax) allows avoiding relapses, reducing itching and soreness, and speed up the healing of sores. Currently, medicine has modern medication that can significantly increase the interrecurrence intervals, suppress the reproduction of the herpes virus, without harming the body of the patient. Once the patient understands this, it will be easier for her to accept her condition, which is the main goal. The key disadvantage is the risk of further disease non-acceptance.
Crum, C. P., Nucci, M. R., Granter, S. R., Howitt, B. E., Parast, M. M., Boyd, T.,… Peters III, W. A. (2018). Diagnostic gynecologic and obstetric pathology (3rd ed.). Philadelphia, PA: Elsevier Health Sciences.
Garland, S. M., & Steben, M. (2014). Genital herpes. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(7), 1098-1110.
Janier, Á., Hegyi, V., Dupin, N., Unemo, M., Tiplica, G. S., Potočnik, M.,… Patel, R. (2014). 2014 European guideline on the management of syphilis. Journal of the European Academy of Dermatology and Venereology, 28(12), 1581-1593.