see attachment
Table 1
Infection Description Presentation Causes/ Risk
Factors
Treatment per
CDC
Addtl
info
Candida
Fungal
infection due
to candida
albicans
Pruritic,
soreness,
dyspareunia
,
occasionally
thick
vaginal
discharge
and dysuria.
KOH
demonstrate
s budding
Pregnancy,
immunosupression,
antibiotic use,
diabetes
– Fluconazole 150
mg single dose
Not
usually
considere
d an STI.
BV
Vaginal
discharge or
malodorous in
childbearing
people. N
Mal-
odorous/
fishy odor,
thin gray-
white
discharge,
clue cells on
sexual activity,
particularly with
new or multiple
partners, the use of
douching, and not
using condoms
Metronidazole 500
mg BID x 7 days
OR 0.75% gel x 5
days
Not
sexually
transmittt
ed
Chlamydi
a
STI caused by
Chlamydia
trachomatis
Often
Asymptoma
tic;
cervicitis,
urethritis,
dysuria,
postcoital
bleeding
having multiple or
new sexual
partners, not using
condoms during
sex, and having a
history of other
STIs
Doxycycline 100
mg BID x 7 days
(preferred); or
Azithromycin 1 g
PO x1
Sexually
transmitt
ed;
screen
annually
Gonorrhe
a
STI caused by
Nisseria
gonorrheae
Purulent
discharge,
pelvic pain,
dysuria,
urethritis,
often
asymptomat
ic in women
unprotected sex,
having multiple
sexual partners, a
history of other
sexually
transmitted
infections (STIs),
and being a young
adult (under 25)
Ceftriaxone 500
mg IM x1 (if <150
kg); treat
Chlamydia
empirically unless
ruled out
Sexually
transmitt
ed,
screen
annually
Trichomo
nas
STI caused by
Trichomonas
vaginalis
Frothy
yellow-
green
discharge,
strawberry
cervix, foul
odor,
Multiple partners,
unprotected sex
Metronidazole 500
mg BID x 7 days
or 2g PO x1
Sexually
transmitt
ed,
partner
needs to
be
treated
Cervicitis
Inflammation
of cervix due
to STI
Mucopurule
nt
discharge,
cervical
bleeding
with contact
Chlamydia,
Gonorrhea, HSV
Treat based on
organism;
empirically cover
Chlamydia &
Gonorrhea
Can
cause
PID if
not
treater
PID
Ascending
polymicrobial
infection of
upper genital
tract
Pelvic pain,
cervical
motion
tenderness,
fever,
discharge
Untreated
Chlamydia/
Gonorrhea,
multiple partners
Ceftriaxone 500
mg IM x1 +
Doxycycline 100
mg BID x 14d
Metronidazole
Risk for
infertility
HIV
Human
immunodeficie
ncy virus , a
virus that
attacks cells
that help the
body fight
infection.
Affects the
Acute: flu-
like
symptoms
Chronic:
becomes
opportunisti
c infection
Unprotected sex,
IV drug use, MSM,
mother-to-child
ART
(Antiretroviral
therapy) – lifelong
Screenin
g should
be
offered
annually
Syphilis
STI caused by
treponema
pallidum
Primary:
Painless
chancre
Secondary:
rash on
palms, soles
Tertiary:
neurological
and cardiac
involvement
MSM, HIV+,
multiple partners,
unprotected sex
Benzathine
penicillin G 2.4M
units IM x1
(early); weekly x3
(late/unknown
duration)
Screen
all
pregnant
patients,
treat
partners.
Table 2
Hep B
hepatitis B
virus is a small
DNA virus that
belongs to the
“Hepadnavirid
ae” family.
Fatigue,
jaundice,
RUQ pain
Sexual contact, IV
drug use, perinatal
transmission,
healthcare
exposure
Supportive care
(acute); Antivirals
for chronic (e.g.,
tenofovir,
entecavir)
Screenin
g done to
all
pregnant
patients,
vaccine
available
Hep C
Hepatitis C is a
viral infection
that causes
liver swelling,
called
inflammation.
Hepatitis C can
lead to serious
liver damage.
Faituge,
jaundice
IV drug use, blood
transfusions
(pre-1992), sexual
exposure
Direct-acting
antivirals (e.g.,
sofosbuvir/
velpatasvir) for 8–
12 weeks
Screen
adults, no
vaccine
available
HSV
Herpes
Simplex Virus.
Herpes is a
common virus
that can cause
cold sores or
genital sores. It
spreads
through skin-
to-skin contact
Painless
vesciles or
ulcers,
dysuria,
systemic
symptoms
during
primary
infection
Oral/genital
contact,
unprotected sex,
vertical
transmission
Acyclovir 400 mg
TID x 7–10 days
or Valacyclovir 1g
BID x 7–10 days
Lifelong
therapy
Question Answer
Name 10 Risk Factors for contracting STI’s
and HIV
1. Having unprotected sex
2. Having multiple partners
3. Injection of drugs with dirty needle
sharing.
4. History of previous STI
5. Substance use
6. Sex work or transactional sex
7. Lac of access to healthcare or education
8. Not being vaccinated against preventable
STIs
9. Being incarcerated or having a partner
who is
10.Sexual coercion or violence
Name 5 safer sex practices
1. Limiting sexual partners
2. Regular STI testing, especially with new
partners
3. Use condoms every tine you have sex
4. Avoid sex under the influence of drugs or
alcohol
5. Inspect partners for visible sore or
symptoms
Can HIV be transmitted through sweat, saliva,
and tears? (Include rationale)
No, HIV can be transmitted from one infected
person to another through blood, semen,
vaginal secretions, rectal fluids and breast
milk. For HIV to occur, the HIV in these fluids
must get into the bloodstream of an HIV-
negative person through a mucous membrane
through open cuts or sores, or by direct
injection.
Lisa is a 19-year-old female who presents to the clinic c/o abnormal vaginal discharge for one
week after having unprotected vaginal intercourse with a new male partner she has been dating
for a couple of weeks. Lisa’s pregnancy test is negative and her LMP was 2 weeks ago. As her
health care provider, you will need to perform testing to determine if Lisa has contracted a
sexually transmitted infection or other vaginal infection.
SOAP NOTE
Demographic: 19/ Female G0P0
Subjective
Chief complain: “abnormal vaginal discharge for one week after having unprotected vaginal
intercourse with a new male partner that I have been dating for a couple of weeks.”
Name 2 types of intercourse are at the highest
risk for contracting HIV
1. Unprotected vaginal sex
2. Unprotected anal sex
Why are women more susceptible to HIV in a
male to female relationship (versus a male
contracting it from a female)?
In women, several factors can increase the risk
of HIV transmission. For example, during
vaginal or anal intercourse, women are at
greater risk of acquiring HIV because
receptive sex is generally riskier than insertive
sex. Age-related thinning and dryness of the
vaginal tissue—common in older women—
can lead to microtears during intercourse,
providing a pathway for HIV transmission.
Biologically, women are more vulnerable to
infection due to the larger mucosal surface
area exposed during penile penetration.
Additionally, young women under the age of
17 are at even higher risk because they have
an underdeveloped cervix and produce less
protective vaginal mucus.
HPI:
Lisa is a 19 year ld female G0P0 who presents with a one week history of abnormal discharge
after having unprotected vaginal intercourse with a new male partner.
• Onset: one week
• Locating: vaginal
• Duration: ongoing
• Characteristic: abnormal
• Aggrevating/relieving factors: none stated
• Treatment: none tried
HPI questions:
• Is there any vaginal itching, burning or odor?
• Are you having any symptoms such as cramping, pelvic pain, fever, burning when you pee?
• Have you had this type of discharge in the past?
• When was the last time you were tested for STIs?
Gyn history:
• LMP: 2 weeks ago, stated, regular
• Unknown if on birth control at this time
• Sexually active, new male partner, no protection
• No known gynocological issues at this time.
Medical history
• No known medical conditions
• No known surgical conditions
• No known drug allergies
• Immunizations: up to date
Family history:
• Mother: no known medical history
• Father: no known medical history
• Maternal grandmother: no known medical history
• Paternal grandmother: no known medical history,
Social history
• Goes to school
• Balanced diet
• Regular exercise
• No drug or alcohol use
• Sexual history: one new male partner, no protection
• Relationship: new
Other questions
• Are you in a monogamous relationship?
• Do you practice safe sex?
Review of systems:
• General: healthy, denies fever denies chills
• Neuro: denies headacces or dizziness
• Cardiovascular: denies chest pain or palpitations
• Resp: denies shortness of breaeth or cough
• GI: denies nausea, vomiting or diarrhea or abdominal pain
• GU: positive abnormal discharge
• Skin: denies rash, denies new lesions
• Health maintenance: No Pap in the last 12 months due to age
Objective
Vitals: WNL
• Temp: 98.6
• BP: 120/80
• HR:78
• RR: 17
• Heihgt: 5’4”
• Weight: 135
• BMI: 23.2
Physical exam:
• General: AAOx4, no acute distress
• abdomen soft, non tender
• Pelvic:
o Vulva: normal appearance
o Vagina: abnormal discharge
o Cervix: normal
o Uterus: non tender
o Adnexa: no masses or tenderness
POCT
• Urine pregnancy : negative
o Rule out pregnancy due to age and no condom use
• Wet mount with KOH and send out check for chlamydia, gonorrhea, BV, trichomonas
o KOH to help identify yeast, or bv or trichomonas cells
• NAAT
o For STI screening
Assessment
Final diagnosis:
• Vaginal candidiasis B37.3 – clinical presentation of abnormal discharge
Differential:
• Bacterial vaginosis N76.0 – due to new sexual partner after unprotected sex
• Trichomoniasis A59.9 – due to new sexual partner after unprotected sex
• Chlamydia A56.0 – due to new sexual partner after unprotected sex
Plan
Diagnostics:
• NAAT: Chlamydia, Gonorrhea and trichomonas
• KOH for BV
• Serology for HIV, syphilis, Hep B and C
• Pap smear
Treatments:
• Fluconazole 150 mg Po x 1 dose orally
o This medication is being prescribed at tis time as it is the first line therapy for uncomplicated
candidiasis, some of the side effects are GI upset, and elevated liver enzymes. This
medication should not be prescribed if patient has a history of liver disease.
If STI positive: depending on what STI patient comes back positive for, prescriptions will
change. Both patient and partner will need to be treated and abstain from sex for a week.
Patient education:
• Risk factors for STIs
• Abstain from sex for 7 days until symptoms have resolved, and medication taken
• Practice safe sex
• Refrain from having multiple partners as it can place you at higher risks for HIV andSTIs
• Routine STI screening
Complications: if untrearted can causes recurect yeast infectons, risk of spreading infection to
partner and increased risk for HIV and other STIs.
Referals: refer to GYN follow up
Follow up;
• Office will call when lab results return
• Follow up in one week if symptoms do not improve
• Pap smear
Health maintenance:
• Pap smear starting at age 21
• Hpv vaccine
• STI screening annualy or whena new partner
• Up to date on vaccines
