Understanding the Rising STI Infection Rates Among Young People- Causes and Implications

Understanding the Rising STI Infection Rates Among Young People- Causes and Implications

Women’s Health

The most common STIs in the United States are gonorrhea and chlamydia (CDC, 2020). Chlamydia is most common in women aged 15-24 who have had new or multiple sex partners, according to Brickley (2021). Gonorrhea, on the other hand, affects women and men aged 15 to 44. (CDC, 2020). This paper discusses diagnosis studies, differential diagnoses, and treatment plans for STIs.

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Which diagnostic or imaging studies should be performed to aid or confirm the diagnosis?

According to the clinical guidelines, Grace is most likely infected with Chlamydia. Chlamydia affects sexually active women over the age of 25. Grace is 32 years old and has a sexual life (Cash & Glass, 2017). Grace also had a new partner last week, putting her at a higher risk of chlamydia infection. Grace denies having some of the symptoms associated with Chlamydia because an infected person is less likely to be in pain (CDC, 2020).

Conversely, Grace reports chlamydia-related symptoms such as vaginal discharge, burning when peeing, and an increased need to urinate. In women, Chlamydia can take 1-3 weeks to clear. Given that Grace had only been intimate with her new partner for a week, the proper diagnosis and appropriate treatment can be administered (CDC, 2020). Differential tests can confirm Grace’s infection with Chlamydia (Cash & Glass, 2017).

What is the most likely differential diagnosis, and why is it that way?

Grace is most likely infected with Chlamydia, which should be distinguished from other sexually transmitted diseases, such as gonorrhea, which has similar symptoms (Cash & Glass, 2017). Chlamydia patients exhibit several symptoms, including a burning sensation while urinating, an urgent need to pee, and an unusual yellow vaginal discharge. Grace has reported experiencing all of the symptoms associated with Chlamydia. Although many symptoms of gonorrhea are similar to those of Chlamydia, a patient may experience a persistent sore throat, vaginal itching, and redness and swelling in the genital area. The vaginal discharge caused by gonorrhoea is predominantly green, white, or yellow. Grace has not complained of a persistent sore throat, vaginal itching, or redness and swelling in her genital area, ruling out gonorrhea as a possible infection (CDC, 2020). Grace may undergo a urine or blood test to identify the bacteria causing the infection through culture or genetic material identification. Chlamydia trachomatis cause chlamydia, whereas Neisseria gonorrhoeae causes gonorrhea. Based on the previous examination of Grace’s symptoms, Chlamydia trachomatis is the most likely bacterium causing the disease (CDC, 2020; Cash & Glass, 2017).

Treatment and Strategy

Samples should be collected as soon as possible to provide patients with practical and timely care (Cash & Glass, 2017). Grace should receive empirical treatment because she showed signs of Chlamydia and gonorrhoea when she visited the clinic (Cash & Glass, 2017). Swabs for NAAT should be collected and tested. Urine should be collected and tested as well. Sexually active men and women should get a chlamydia and gonorrhoea test as soon as possible (Cash & Glass, 2017).

If Grace has no antibiotic allergies, she should be given a 250 mg ceftriaxone intramuscular (IM) injection and a single dose of 1 g azithromycin by mouth. Grace should be educated about Chlamydia and gonorrhea and the importance of informing and treating her new partner. Grace should also notify any sexual partners she has had in the last 30 days so that they can be tested and treated. The partner is asymptomatic and should be informed within 60 days of the intercourse. Grace will also be advised to refrain from sexual activity during the seven days of treatment (Cash & Glass, 2017). Grace’s physician will emphasize the importance of adhering to treatment.

If a NAAT reveals Chlamydia but not gonorrhoea, Grace will be given azithromycin 1 g orally in a single dose or doxycycline 100 mg by mouth twice daily for seven days (Cash & Glass, 2017). A prescription for erythromycin base 500 mg by mouth four times daily for seven days, erythromycin ethyl succinate 800 mg by mouth four times daily for seven days, Levofloxacin 500 mg orally once daily for seven days, or Ofloxacin 300 mg by mouth twice daily for seven days is an alternative regimen for Grace (Cash & Glass, 2017). After three months, the patient should return to have the culture retested to ensure that the chlamydia infection is being appropriately managed (Cash & Glass, 2017). A patient with gonorrhea should be closely monitored for treatment failure. The local or state public health department should be notified within 24 hours if a patient is not treated. Within 60 days, all sexual partners should be treated. Patients who continue to exhibit gonorrhoea symptoms should have culture tests performed (Cash & Glass, 2017).

Are any referrals required?

Grace has been diagnosed and treated, but she returns two weeks later with vaginal itching, a cottage cheese-like vaginal discharge, and claims to have been sexually inactive since her last visit. Grace could have another underlying problem related to the birth control pills she is taking, or she could have a yeast infection, as the wet prep from the pelvic exam indicates pseudohyphae (Cash & Glass, 2017). Grace may be tested for the possibility of having a yeast infection by having a urinalysis performed on her. If the test is negative, Grace will be referred to a gynaecologist, who will determine if the birth control pills cause the white vaginal discharge that is still present. Interprofessional collaboration is essential in evidence-based practice to ensure that the treatment administered to the patient is qualified for the best outcomes (Melnyk & Fineout-Overholt, 2018). When treatment with the recommended dosage fails or patient noncompliance and exposure have been ruled out, consult or refer the patient to a physician (Cash & Glass, 2017).

Would the most likely diagnosis be different if the patient was male?

No. The diagnosis would remain the same because men experience similar chlamydia symptoms, such as a burning sensation while peeing and an urgent need to pee and discharge from the tip of the penis. Men, like women, take 1-3 weeks to develop symptoms of Chlamydia (CDC, 2020). Chlamydia can affect both men and women over 25 who are sexually active or have multiple sex partners (CDC, 2020). Which diagnostic or imaging studies should be performed to aid or confirm the diagnosis?

Clinical guidelines indicate that Grace is most likely suffering from a yeast infection. Grace has complained of itching and a cottage cheese-like vaginal discharge. Grace has not been sexually active since her last clinic visit (CDC, 2020). Yeast infections are not always transmitted through sexual contact but can also be caused by underlying factors such as diabetes. Grace has a family history of diabetes, which could put her at risk for a yeast infection. When a person has a yeast infection, their vaginal PH is around 4.2. Grace’s vaginal PH ranges between 3.8 and 4.2. Grace’s wet prep shows pseudohyphae, which are common in yeast infections. It is, however, critical to perform differential tests to determine whether Grace has a yeast infection (CDC, 2020).

What is the most likely differential diagnosis, and why is it that way?

Grace is most likely to have a yeast infection in the second scenario. Differential diagnoses for Chlamydia and gonorrhea, which may resemble a yeast infection, can be made. Grace has white cottage-cheese-like vaginal discharge, which is common in yeast infections (Brickley, 2021). Chlamydia and gonorrhoea can cause a white, green, or yellow discharge (Brickley, 2021). Grace had been treated for the first infection and reported having none of the symptoms listed. On the other hand, she complains of severe vulva itching, which is familiar with yeast infections.

Chlamydia and gonorrhea are frequently transmitted when people have new or multiple sex partners (CDC, 2020). Grace claims she has not been sexually active since being treated for the previous infection. Yeast infections, on the other hand, are not always transmitted through sexual contact. Pregnancy, uncontrolled diabetes, a weakened immune system, and Candida albicans (naturally occurring in the body) overgrowth or imbalance can all lead to yeast infection (Cash & Glass, 2017; CDC, 2020).

What is the strategy and course of action?

Grace must maintain hygiene and use the appropriate medication to treat the infection effectively (Cash and Glass, 2020). Grace may be prescribed clotrimazole 1% cream or 5 g intravaginally for 7 to 14 days. She could also be given Fluconazole (Diflucan) 150 mg or an oral tablet once (Cash & Glass, 2017). Long-term treatment plans may be necessary to reduce the likelihood of recurrent infections. The doctor may prescribe log-course vaginal therapy for recurrent yeast infections, in which an antifungal medication is prescribed for two weeks, followed by once a week for six months (CDC, 2020). Grace may also be given multiple doses of oral medication or azole-resistant therapy. Patients should be advised to see a doctor if the symptoms persist or worsen. If Grace’s yeast infection recurs, she should be tested for HIV, diabetes, leukaemia, or other immunological dysfunctions. If the yeast infection is severe, patients should be referred to a doctor to examine any underlying causes thoroughly. Individuals with compromised immune systems find it challenging to treat yeast infections. Patients should be taught to prevent yeast infections (CDC, 2020).

Is a referral required?

When yeast infections are adequately treated, they are not considered severe conditions but relatively mild (Brickley, 2021; Cash & Glass, 2017). If the infection does not clear in two weeks, Grace should see a doctor to find an alternative drug or medication to treat the condition effectively. If the infection does not resolve, it is also recommended that the patient seek medical advice from a physician, as there may be underlying factors causing it (Cash & Glass, 2017).

Is there a family history of diabetes in this case, and why? (Five points)

It is, indeed. Patients with type 2 diabetes are more likely to develop yeast infections because their blood sugar levels are higher than in nondiabetic individuals. Type 2 diabetes suppresses the patient’s immune system (Rodrigues et al., 2019). Increased blood sugar levels in diabetic patients feed the fungus that causes yeast infections. Yeast infections reoccur if blood sugar levels are not controlled. Grace should be tested for diabetes because it runs in her family. Diabetes can be a genetically transmitted disease ( (Rodrigues et al., 2019)

Conclusion

Chlamydia and gonorrhoea are the most common STIs in the United States, affecting women aged 25 and up who are sexually active. Diagnostic studies aid in determining the specific infection that a patient has to provide adequate and timely treatment. Women can get vaginal infections from various sources, including candidiasis, bacterial infection, vaginosis, Chlamydia, gonorrhea, and trichomoniasis. These symptoms may overlap, making it difficult to make the correct diagnosis and thus prescribe the appropriate treatment. Effective diagnosis and effective treatment improve the quality of evidence-based practice and patient outcomes.

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References

Bickley, L. S. (2021). Bate’s guide to physical examination and history taking (13th Ed.). Lippincott, Williams, & Wilkins. https://books.google.com/books? hl=en&lr=&id=g0Ao61hGAloC&oi=fnd&pg=PP2&dq

Cash, J. C., & Glass, C. A. (4th Ed.). (2020). Family practice guidelines. Springer Publishing Company. https://b-ok.africa/book/3560057/546017

CDC (2020). Sexually transmitted disease surveillance 2017. https://www.cdc.gov/std/default.htm

CDC (2020). Fact Sheet: 10 Ways STDs impact women differently from Men. https://www.cdc.gov/std/health-disparities/stds-women-042011.pdf

Melnyk, B. M., & Fineout-Overholt, E. (4th Ed.). (2018). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins. https://books.google.com/books? hl=en&lr=&id=hHn7ESF1DJoC&oi=fnd&pg=PT15&dq

Rodrigues, C. F., Rodrigues, M. E., & Henriques, M. (2019). Candida sp. infections in patients with diabetes mellitus. Journal of Clinical Medicine, 8(1), 76. https://doi.org/10.3390/jcm8010076

Wiesenfeld, H. C. (2017). Screening for Chlamydia trachomatis infections in women. New England Journal of Medicine, 376(8), 765-773. https://doi. org/10.1056/NEJMcp1412935

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 Women’s Health

Women’s Health & STIs

Discussion Topic

Infection rates for many STIs continue to be highest among young people (typically around 15–24 years old). What are some reasons for this?

What would you recommend to increase prevention or encourage testing or treatment among this group?

Discussion Requirements:

At least 250 words

External Resource: STDs during Pregnancy

Explore the CDC website to learn more about how STDs can impact pregnant women

 Course Materials• Required Text or E-Book: Alexander, L., LaRosa, J., Bader, H., & Garfield, S., Alexander, W. (2007). New Dimensions in Women’s Health, 7th ed. Sudbury, MA: Jones and Bartlett.ISBN# 978-1284088434

APA Format