The school nurse could advise Megan to visit a nurse practitioner or a gynecologist, to drink a lot of water as suggested by some practitioners, and to urinate as often as possible. She could also advise her not to have sexual intercourse until her symptoms are gone, or the illness is cured.
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The information that the nurse practitioner should consider is the possible non-sexually transmitted infections that can cause the change in the vaginal discharge and the urge to urinate frequently. For example, bacterial vaginosis and candidal infections might be considered. Full clinical history of the patient should be obtained together with the information about medications that Megan takes (e.g., antibiotics). Potential allergic reactions are also possible and need to be discussed with the patient. The recommended treatment for C.trachomatis is azithromycin (1 g in a single dose) or doxycycline (100 mg, twice a day x 7 days) (CDC, 2015).
Erythromycin (500 mg, four times per day x 7 days) or levofloxacin (500 mg, 1 x 7 days orally) are also possible regimens. Additional recommendations include prescribing a single-dose therapy with azithromycin onsite if there is a concern about the adherence to multi-day dosing (CDC, 2015). Furthermore, to exclude the transmission of the disease to sex partners, Megan needs to abstain from sexual intercourse for seven days after a single dose treatment or during the multi-day treatment (CDC, 2015). It is also advisable to wait for the resolution of symptoms. Her partner(s) should also be treated to ensure that the risk of a reinfection is minimal.
As stated in the case study, Megan was tested for HIV and GC (Harkness & DeMarco, 2015). A testing for syphilis is also necessary (CDC, 2015). As patients with C.trachomatis are often coinfected with N.Gonorrhoeae, it is advisable to follow the same prescriptions related to the abstinence from sexual intercourse during treatment and to ensure that other sexual partners are treated as well. In this case, Megan needs to notify her recent sex partners about the illnesses so that they can seek treatment too (Harkness & DeMarco, 2015). N.Gonorrhoeae is treated with ceftriaxone (250mg x single dose) and azithromycin (1 g orally, single dose) or doxycycline (100 mg orally, twice a day x 7 days) (Harkness & DeMarco, 2015). Gonorrhea is a disease that needs to be reported to local health authorities (mandatory written reporting is required) (Medline, 2017). C.trachomatis does not need to be reported.
Primary prevention for HIV includes the use of condoms during sexual intercourses, testing for HIV, and undergoing behavior changes that will help decrease the risk of being infected with HIV (e.g., engage in protected sexual intercourse only and be aware of your partner’s HIV status). It is necessary to use a new condom every time a person has sex with a partner whose HIV-status is unknown to them (Megan, in this case).
Condoms need to be used during anal and vaginal sex to avoid being infected. If Megan takes any drugs by injecting, it is important for her to use clean needles that are not shared with others. In this case, it is also necessary for Megan to seek help if she acknowledges drug use (or abuse). If it is impossible for her to use new condoms every time she has sex with a partner with unknown HIV status, she needs to abstain from having sexual intercourse with this person. If she has oral sex, the use of a condom is necessary too (it can be cut-open). Female condoms are also an option.
CDC. (2015). Chlamydial infections. Web.
Harkness, G. A., & DeMarco, R. F. (2015). Community and public health nursing evidence for practice. Philadelphia, PA: Lippincott Williams & Wilkins.
Medline. (2017). Reportable diseases. Web.