Please respond to your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:

• Do you agree with your peers’ assessment?
• Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
• Share your thoughts on how you support their opinion and explain why.
• Present new references that support your opinions.

Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles. Also, be sure you are italicizing titles of online sources.

You have just finished seeing a 16-year-old girl for test of cure follow up after gonorrhea and chlamydia treatment. The cultures you obtained indicate recurrent infection with chlamydia. How will you approach this situation? What are your plans for treatment and education?

Amanda’ D’s Response:

I would approach this encounter by examining the patient’s home situation. The thought of sexual abuse or trafficking would cross my mind. I would attempt to gather information regarding her parents/guardians and living situation. I would inquire regarding the patient’s sexual partners and contacts. I would attempt to interview/assess this patient alone without the presence of her parents or partner. I would assess the patient’s understanding of sex, contraception, and sexually transmitted diseases. Due to the patient’s age, recurrent infection, likely lack of use of condoms, and high-risk sexual behavior – I would follow-up with this patient on a frequent basis. I would place this patient on a long acting reversible contraceptive such as the Depo Provera injection to prevent pregnancy. I would educate her regarding the need for use of condoms to prevent/reduce the risk of sexually transmitted diseases. I would provide education regarding the proper use of condoms. I would also urge her to be tested for other sexually transmitted diseases such as HIV, Hepatitis C, and Syphilis. If she had no medication allergies, I would treat her with 1 gram of oral Azithromycin for the recurrent Chlamydia infection (Shaw, Coleman, O’Sullivan, & Stephens, 2011). I would urge her to refrain from engaging in sexual activity with the partner she likely contracted the infection from. I would explain that she is at a high risk of being re-infected. I may also consider performing a pelvic exam on this patient to assess for possible trauma. Due to the nature of the infection, this result would require mandatory reporting to the local health department. Due to this patient experiencing a recurrent sexually transmitted infection, she will be at a higher risk for developing pelvic inflammatory disease and experiencing infertility (Satterwhite, Gottlieb, Romaguera, Bolan, Schuler, & Popovic, 2011).

References

Satterwhite, C L, Gottlieb, S. L., Romaguera, R., Bolan, G., Burstein, G., Schuler, C., P., & Popovic, P. (2011). CDC grand rounds: Chlamydia prevention: Challenges and strategies for reducing disease burden and sequelae. (). Atlanta: U.S. Center for Disease Control.

Shaw, K., Coleman, D., O’Sullivan, M., & Stephens, N. (2011). Public health policies and management strategies for genital chlamydia trachomatis infection. Risk Management and Healthcare Policy, 4, 57-65.

Eric’s Response

#2 Recurrent Chlamydia

So, in the case of this patient the question is why the chlamydia is recurrent? There are several possible reasons which include that the initial treatment did not completely treat the chlamydia, the patient may not have properly taken her antibiotics or she may have stopped them early, the patient may have been re-infected by her sexual partner or risky sexual practices.

If the symptoms suggest that there is recurrent persistent urethritis, the recommendation of the CDC is to treat with 2g Flagyl (metronidazole) orally in a single dose followed by 500mg erythromycin base orally four times per day for seven days, or 800mg erythromycin ethylsuccinate orally four times a day for seven days (cdc.gov, 2014).

As far as future prevention there are many things to consider: primary prevention begins with changing the sexual behaviors that increase the risk of contracting STIs; secondary prevention consists of the standardized detection and treatment of STIs; each of the prevention methods need to be individually tailored and based on the patients development and understanding of sexual issues in a form that is nonjudgmental (cdc.gov, 2014). Performing counseling and discussing behavioral interventions that have been shown to reduce the likelihood of STIs and reduction of risky behavior; one such intervention is the utilization of the Sexual Awareness For Everyone (SAFE) behavioral intervention; which is a culture and gender specific intervention for adolescent women who are at high risk for STIs that is based around three objectives: recognition of personal susceptibility, commitment to behavior changes and acquisition of STI risk-reduction skills (childtrends.org, 2012). A study performed showed that teens who had SAFE training had up to a 52% reduction in the reoccurrence of gonorrhea and trachomatis in 6 months than the teens who did not receive the interventions.

For this teen it is really about learning preventative lifestyle changes before she contracts an STI that is untreatable or life altering, but these changes can only be made by the individual, we are there to help paint a picture of how to achieve this goal while also explaining to them the risks and detriment involved if they choose to persist down the road that they are already heading.

References

STD Facts – Chlamydia. (2014, January 13). Retrieved from https://www.cdc.gov/std/chlamydia/stdfact-chlamydia.htm (Links to an external site.)

Sexual Awareness for Everyone (Project Safe and Project Safe 2). (2012, November 6). Retrieved from https://www.childtrends.org/programs/project-safe-…

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