Would you perform a pelvic exam and/or a pap smear?

It would be beneficial for this patient to receive a pelvic exam as well as a pap smear. Sexually transmitted infections are more common in women compared to men due to the greater mucosal surface area in the genitals and the creation of microlesions that occur during intercourse (Rigo et al., 2022). In order to confirm a diagnosis, a pelvic exam as well as a pap smear is required especially because the patient has already been seen at the office for having the same problem occur over three different times (Kissinger et al., 2022). With these reoccurring symptoms, it is important to do a pelvic examination looking inside as well as a pap smear to further look into any underlying concerns (Rigo et al., 2022). A pelvic exam will also help to ensure that there is no permanent damage occurring to the patient’s anatomy or genitals plus will help the provider with collecting more information to confirm the diagnosis of trichomoniasis (Kissinger et al., 2022). The pelvic exam will help to provide more specific and objective data to the advanced practice provider in order to confirm the diagnosis of which will be small, red ulcerations on the vaginal wall or cervix upon inspection (Rigo et al., 2022). However, the most definite diagnosis would be the wet mount test to confirm trichomoniasis (Kissinger et al., 2022). It is essential to treat trichomoniasis because it can strongly elevate the risk for cervical cancer in patients. 


What is your Diagnosis (Assessment)?

This patient for the past three weeks has been experiencing yellow discharge with a strong odor after having intercourse and for the past two days has experienced burning while urinating. The patient also expressed that the outside of the vagina has been itchy (Kissinger et al., 2022). The physical examination showed that the vagina is erythematous, has a large amount of yellow, green discharge, and an erythematous cervix that is slightly tender with palpitation (Rigo et al., 2022). This patient is diagnosed with trichomoniasis based upon the examination (Kissinger et al., 2022). Trichomoniasis is considered a parasite infection that spreads through sexual contact and the symptoms are foul-smelling vaginal discharge, genital area itching, and painful urination. 


What is your Plan, including treatment and education?

The plan for this patient would begin with treatment which would be a single 2-gram dose of Metronidazole, a single 2-gram dose of Tinidazole, or a 7-day course of Metronidazole 500 mg twice daily are the three best therapies for trichomoniasis (Rigo et al., 2022). As the provider this patient would most likely be prescribed a single 2-gram PO dose of Metronidazole. With the patient being 18 years old, the author is worried that the patient will not take the antibiotic for the entire seven days therefore it is easier to take a single dose (Kissinger et al., 2022). This patient should be seen within two to three months to return for more testing and if the Metronidazole does not work then Tinidazole can be used (Rigo et al., 2022). It is also important to educate the patient to abstain from alcohol for about four days before and after the medication (Kissinger et al., 2022). The patient should also be educated that while taking this antibiotic, she could experience heart palpitations, tachycardia, nausea and vomiting, as well as skin flushing (Rigo et al., 2022). The patient should also be educated to abstain from sex while being treated to avoid reinfection and that the patient should wait seven days after receiving antibiotics to have intercourse again. 


Would you prescribe treatment for her partner(s)?

The patient’s partner should be treated as well; however, the boyfriend needs to be confirmed of having trichomoniasis by a physical examination (Rigo et al., 2022). The patient’s sexual partner and any other recent partners should be tested as well and treated (Kissinger et al., 2022). It is important to treat this condition because there can be complications that can be extremely detrimental to the reproductive system.


What contraceptive care/counseling would you offer Geri?

In order to avoid contracting trichomoniasis or a sexually transmitted infection, it is vital to wear protection which is condoms. Condoms are an effective approach if a person is to have sex to help avoid the incidence of sexually transmitted infections as well as contraceptive use (Rigo et al., 2022). Other contraceptive techniques would include birth control implants, injections, and pills however it is important to educate that these do not protect the patient from sexually transmitted infections (Kissinger et al., 2022). The patient should be educated that condoms are the only form of birth control that help to prevent sexually transmitted infections and that both the partner and the patient need to be checked for diseases (Rigo et al., 2022). The incidence of sexually transmitted infections is reduced if a patient is only having intercourse with one partner and the patient should be educated to not douche since it destroys the healthy bacteria in the vagina that help to fight off infections (Rigo et al., 2022). Douching also increases the risk of contracting sexually transmitted infections therefore it should be avoided. 


List 2 community resources in your area that you could utilize.

There are various community resources that can be utilized in this patient’s situation such as safe sex counseling. This will help to educate the patient on safe sex practices and how to avoid pregnancy as well as sexually transmitted infections (Rigo et al., 2022). There is also a sexually transmitted infection clinic in the author’s nearby area that helps to provide free condoms, contraception that is free, as well as counseling on safe sex (Kissinger et al., 2022). Another clinic is nearby which is a pregnancy clinic which provides education to patients on how to avoid pregnancy and if the patient is pregnant what they will need and what to expect as well as safe sex practice counseling (Rigo et al., 2022). This clinic also provides free contraceptives and support if the patient is pregnant. 

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