Sexually Transmitted Infections, Essay Example

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.

Differential Diagnosis

Differential diagnoses for this patient include the following: trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis. Symptoms of trichomoniasis include inflammation and irritation, as well as a thin discharge that could be yellow or white (CDC, 2014). Symptoms of vulvovaginal candidiasis include dysuria and an odorless vaginal discharge, while bacterial vaginosis is characterized by vaginal discharge, often with an unpleasant odor, particularly after sexual intercourse (Office on Women’s Health, 2012). The patient’s vaginal discharge is white in nature; however, no information regarding smell is provided. Therefore, the likely cause of her current condition is vulvovaginal candidiasis, which is characterized in the following manner (DermNet NZ, 2013):

• A burning sensation or discomfort in the vagina and vulva
• A white vaginal discharge with a curd-like consistency
• A red rash that affects the vulva and that may spread to other nearby areas

Treatment and Management

For patients with vulvovaginal candidiasis, the most common treatment methods include the use of topical antifungal creams that include clotrimazole or miconazole, and for recurrent infections, the use of oral medications that include fluconazole or itraconazole are likely to provide relief to patients (DermNet NZ, 2013). It is also recommended that patients with recurrent infections should be evaluated for other possible conditions that could contribute to this state, such as diabetes or iron deficiency (DermNet NZ, 2013). In addition, other recommendations include wearing cotton underwear and clothing that is not restrictive, the use of hydrocortisone cream, no soap when taking a bath, antifungal cream prior to the menstrual period, and topical antifungal agents in some cases (DermNet NZ, 2013). Typically, treating sexual partners does not provide any alleviation of the condition, in addition to other factors that lack evidence such as low sugar diets and natural remedies (DermNet NZ, 2013). These factors are not effective in providing any relief to patients, thereby requiring additional evaluation in order to effectively treat the condition (DermNet NZ, 2013).

Education

In addition to treating vulvovaginal candidiasis, it is important to develop an educational strategy that will support client health and wellbeing. Recommended activities include washing of the external genitals with water, avoiding soaps or other perfumes when taking baths to minimize exposure to irritants, no douching is permitted, and patients must take their medications at the recommended levels and finish the dose (HRSA, 2014). In addition, patients should avoid pregnancy when taking fluconazole or ketoconazole, and clean all birth control devices after use (HRSA, 2014). These factors require patients to recognize the risks of flare ups that might occur, thereby increasing the potential for new strategies to alleviate symptoms or to prevent the condition altogether (HRSA, 2014).

It is also important for patients to recognize the risk factors of vulvovaginal candidiasis, including but not limited to pregnancy, the frequent use of antibiotics, diabetes, HIV infection, an immunocompromised immune system, and the use of corticosteroids (BC Centre for Disease Control, 2012). Furthermore, patients experience some type of vaginal discharge that does not appear to be normal, dyspareunia, and burning and irritation in the vulva (BC Centre for Disease Control, 2012). This information is relevant because it supports a more accurate diagnostic and treatment plan in order to alleviate symptoms as best as possible. A physical evaluation and possible diagnostic tests may be required to form a definitive diagnosis and treatment plan (BC Centre for Disease Control, 2012).

References

BC Centre for Disease Control (2012). Vulvovaginal candidiasis. Retrieved from http://www.bccdc.ca/NR/rdonlyres/9C183CF3-50BA-4E3D-84E2-30CB1095D634/0/STI_DST_Noncertified_VVC_20120914.pdf

Centers for Disease Control (2014). Trichomoniasis – CDC Fact Sheet. Retrieved from http://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm

DermNet NZ (2013). Vulvovaginal candidiasis. Retrieved from http://www.dermnetnz.org/fungal/vaginal-candidiasis.html

HRSA (2014). Candidiasis, Vulvovaginal. Retrieved from http://hab.hrsa.gov/deliverhivaidscare/clinicalguide11/cg-609_candidiasis_vulvo.html