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Clinical week III experience
This week in my clinical rotation, I encountered a 19-year-old African American female college student who came into the office stating she would like to have her well-child visit and needed an STD panel and an HGC blood test to ensure she isn’t pregnant. I was surprised that she came to a pediatric clinic for that request. However, my preceptor told me that she was an established patient, and she’s been coming to the clinic over the past eight years. The patient states she recently had a sexual encounter with a male who was recently released from prison. The patient came in anxious and said she had him wear protection; however, he would not show it to her after intercourse. The patient denied vaginal discomfort, itching, vaginal odor, or bleeding. However, she states she has had a thick, white discharge. Sexual history revealed the patient has had “a few” sexual partners over the past year due to “alcohol and college parties.” The patient also has a history of herpes virus type 2 on valacyclovir. A vaginal swab was performed, and a white curdle-like discharge was noted to the cervical area. The wet prep sample sent off cytology studies inclusive of HPV and trichomoniasis. Urine was sent off for U/A w/reflex to culture, chlamydia, and gonorrhea. Blood was sent to test for HIV, Hep B, C, and syphilis, and pregnancy HCG level was sent per the patient’s request. A diagnosis of yeast infection/Candidiasis infection was given. The patient was prescribed fluconazole be taken once by mouth. Her vital signs were BP 118/56 HR 61 RR 18 TMP 98.1 O2sat 100%
The organism Candida albicans cause most vaginal yeast infections. This fungus lives intolerable quantity in the vagina; however, vaginal yeast infections occur when new yeast is introduced into the vaginal area or when there is an increase in the quantity of yeast already present in the vagina relative to the number of normal bacteria. A vaginal yeast infection is not a sexually transmitted disease. It can occur as a result of injury to the inner vagina, occurring after chemotherapy. In addition, it can occur from steroid use, antibiotic use, oral contraceptives, in pregnancy and diabetes, or even as a result of douching or using rented vaginal products (Sobel 2021). Symptoms include itching, vaginal irritation, pain during sexual intercourse, or voiding. The most common symptom is a thick, whitish-gray, odorless, vaginal discharge sometimes described as cottage cheese-like in nature. Management may include vaginal or oral therapy. Oral therapy used is fluconazole which can be taken once. However, a second dose may be warranted in complicated yeast infections (Sobel 2021).
The patient was also given a prescription for a one-time oral dose of Zithromax 1gram. Keflex 500mg bid for seven days was given to treat prophylactically for any gonorrhea and chlamydia. The CDC recommends combination therapy, using a highly effective gonococcal therapeutic agent with cotreatment for chlamydia (St. Cyr, Barbee, Workowski, Bachmann, Schlanger, Torrone, Weinstock, Kersh & Thorpe 2020). The patient was then given counseling on safe sexual practices and prevention of STIs and unwanted pregnancies
References
Sobel, J., (2021) Patient education: Vaginal yeast infection (Beyond the Basics). UpToDate. Accessed on 11/04/2012 from com/contents/vaginal-yeast-infection-” rel=”noreferrer noopener” target=”_blank”>https://www.uptodate.com/contents/vaginal-yeast- (Links to an external site.)
infection (Links to an external site.) – beyond-the-basics
St. Cyr S, Barbee L, Workowski KA, Bachmann, LH., Schlanger, K., Torrone, E., Weinstock, H., Kersh, E. & Thorpe, P. (2020). Update to CDC’s Treatment Guidelines for Gonococcal
hInfection, 2020. Center for Disease Control and Prevention. Accessed 11/04/ 2021 from http://dx.doi.org/10.15585/mmwr.mm6950a6 external icon
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