GYN COURSE

Based on the case study scenario provided, complete a comprehensive well-woman exam and critically analyze to focus attention on the diagnostic tests then,

Post your differential diagnosis. Include the additional questions you would ask the patient. Be sure to include an explanation of the tests you might recommend, ruling out any other issues or concerns and include your rationale. Be specific and provide examples. Use your Learning Resources and/or evidence from the literature to support your explanations.

ANSWER

GYN Course

Introduction

The case study scenario presents Susan Lang, a 24-year-old Caucasian female who visits the clinic for regular care. She has been working as a full-time administrative assistant and states that she loves what she does. She has not recorded any medical or surgical past accounts and has no allergies or medications. She smokes a cigarette and hard liquor daily. Susan states that she has been experiencing postcoital bleeding for the last six weeks and has had a sore throat for the last three weeks. The test results indicate trichomonads, chlamydia and gonorrhea, positive amine, and positive clue cells. This paper will critically analyze Susan’s condition, examine the primary diagnosis and treatment options.

Differential Diagnosis

The primary diagnosis is Trichomoniasis, a well-known sexually transmitted disease. Trichomoniasis is caused by Trichomonas vaginalis which is a protozoan parasite (Lewis, 2014). The infection is more common in women as compared to men. One gets Trichomoniasis through a parasite that passes from one infected individual to un-infected during sex. In women, it affects the lower genital tract, vagina, vulva, urethra, and cervix. The parasite spreads during sex from a penis to the vagina or from a vagina to the penis. Women with Trichomoniasis may notice burning, itching, soreness, or redness of the genitals and changes in the vagina discharge such as increased volume or thin discharge.

Other symptoms include inflammation, erythema, pruritus, and dysuria. The diagnostic tests for Susan indicate that trichomonads were noted. She had a slight frothy yellow discharge on the cervix. The patient also presents with a sore throat, which can occur when the patient had oral sex with a partner who has Trichomoniasis. The likelihood of having Trichomoniasis is high since the patient has been having sex with different partners and has symptoms linked to the infection, such as yellow discharge on the cervix and irritation.

Additional Questions

• Have you engaged in oral sex with any of your partners?
• What kind of sex do you engage in? Penis/vagina, penis/mouth, penis/anal?
• In the past three months, have any of these partners been diagnosed with an STI?
• How many sex partners have you had in the last three months?
• Have you experienced any soreness, burning, or itching on the lower genital tract?
• How do you protect yourself from sexually transmitted infections?

Diagnostic Tests

The effective use of diagnostic testing is dependent on proper specimen collection. Microscopy and culture will be effective diagnostic tests. Microscopy will depend on the microscopic observation of the protozoa from cervical and virginal samples Van (Gerwen and Muzny, 2019). The wet amount examination will indicate the presence of trichomonad. The cell cultures are more sensitive, allowing the observation of the T-vaginalis and real epidemiology of T-vaginalis.

Treatment Options

Trichomoniasis can be treated through antibiotic medication. Tinidazole and Metronidazole are antibiotics that can attack the bacteria that cause Trichomoniasis (Graves et al., 2019). The medications can be given in small doses or one large dose. Ideally, the medication therapy will eliminate the parasite and reduce the risk of spreading other sexually transmitted infections. There are several steps that one can prevent Trichomoniasis, such as using latex condoms to avoid vagina sex and sticking with one partner that has tested negative for sexually transmitted infections.

References

Graves, K. J., Ghosh, A. P., Schmidt, N., Augostini, P., Secor, W. E., Schwebke, J. R., … & Muzny, C. A. (2019). Trichomonas vaginalis virus among women with Trichomoniasis and associations with demographics, clinical outcomes, and metronidazole resistance. Clinical Infectious Diseases, 69(12), 2170-2176.

Lewis, D. (2014). Trichomoniasis. Medicine, 42(7), 369-371.

Van Gerwen, O. T., & Muzny, C. A. (2019). Recent advances in the epidemiology, diagnosis, and management of Trichomonas vaginalis infection. F1000Research, 8.