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Weekly Clinical Experience 6

This week’s clinical experience was another great one. The clinic was a lot busier than it has been in the past couple weeks. We saw a lot of different patients with many different conditions. It seems that this week we saw a lot of eye infections. That seemed to be the trend of the week. I am super comfortable with charting and managing multiple charts at the same time.

One particular patient that was seen this week was a woman in her late 30’s, presenting with symptoms of a vaginal yeast infection. She states she has never had symptoms like this before and was very embarrassed during her assessment. She reported symptoms of extreme itching, thick, white discharge, and small red bumps on her vaginal area. Upon assessment, it was noted that she did have small red bumps on her vaginal area. The patient reported that she has only had one pap smear in her life and it was many, many years ago. The nurse practitioner asked her about the possibility of any exposure to an STD, she became very defensive and immediately stated that she has been only sexually active with her husband and she believes the same of her husband. The NP explained that we have to ask because the red bumps are usually not seen with a yeast infection. The patient refused to have any STD testing while she was here.

Candidiasis is an infection caused by a yeast, or fungus called Candida. Candida normally lives inside the body and on skin without causing any problems. Sometimes Candida can multiply and cause an infection if the environment inside the vagina changes in a way that encourages its growth. Candidiasis in the vagina is commonly called a “vaginal yeast infection.” The usual symptoms include vaginal itching and soreness, pain during sexual intercourse, pain when urinating, and abnormal vaginal discharge (Centers for Disease Control and Prevention, 2020).

This particular patient was prescribed oral Fluconazole to treat the yeast infection and was also referred to establish with a Gynecologist to evaluate the red bumps and also to obtain a pap smear. The patient was also educated to wear cotton underwear, to avoid any tight fitting clothing, and to keep the vaginal area cool and dry.

Some potential differential diagnoses for a vaginal yeast infection would be bacterial vaginosis, trichomonas vaginitis, or cervicitis. Bacterial vaginosis is a common condition that is caused by changes in the amount of certain types of bacteria in the vagina. Women with bacterial vaginosis usually present with symptoms of unusual, milky or gray vaginal discharge, burning with urination, itching around the outside of vagina, and vaginal irritation. Bacterial vaginosis is easily treated (U.S. Department of Health & Human Services, 2020). Trichomonas vaginitis is the most common non-viral STI. The majority of men and women with trichomonas vaginitis are usually asymptomatic. Among those who do have symptoms, they include urethral discharge and dysuria. Symptoms among women include vaginal discharge, which is often diffuse, malodorous, yellow-green,dysuria, itching, vulvar irritation and abdominal pain (Kissinger, 2017). Cervicitis is a clinical syndrome characterized by the presence of a purulent or mucopurulent discharge that is visible in the endocervical canal or that can be detected with an endocervical smear. Other clinical signs of inflammation, such as persistent endocervical bleeding (Young & Argaez, 2017).

This week I learned more about the approach to a women’s health examination and how this can be uncomfortable for many women to experience. Some women become very defensive and embarrassed with the uncomfortable conversation of STDs, or even women’s health in general. I believe that I learned a lot about how to approach this conversation with my preceptor, to have the best outcome and results and to have the patient feel comfortable and trust you.

References

Centers for Disease Control and Prevention. (2020). Vaginal candidiasis. Centers for Disease Control and Prevention. https://www.cdc.gov/fungal/diseases/candidiasis/genital/index.html.

Kissinger, P. (2017). Trichomonas vaginalis: a review of epidemiologic, clinical and treatment issues. BMC Infectious Disease, 15(37). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC45257…

U.S. Department of Health & Human Services. (2020). Bacterial vaginosis. U.S. Department of Health & Human Services. https://www.womenshealth.gov/a-z-topics/bacterial-vaginosis.

Young, C., & Argaez, C. (2017). Management and treatment of cervicitis: A review of clinical effectiveness and guidelines. CADTH Rapid Response Report: Summary with Critical Appraisal. https://www.ncbi.nlm.nih.gov/books/NBK525875/.