Question

SS is a 16-year-old presenting with severe dysmenorrhea. She began menstruating at age 13. Her periods have been irregular. Each moth she misses a day of school because of severe cramps and heavy bleeding with her menses. She also has a moderate case of acne, which is very disturbing to her. She has tried topical preparations and antibiotic therapy for the acne without results. She has no history of gallbladder disease, migraine headaches, or chest pain.

Social history: SS is a sophomore in high school. She is sexually active but does not use condoms. She has had two sexual partners, although now she is in a monogamous relationship with a senior at her high school. She lives with her mother and younger brother. She does not smoke or drink.

Issues: SS has dysmenorrhea that affects her quality of life. In addition, she has acne, which is disturbing to her self-image. SS is sexually active and does not use condoms. This puts her at risk for pregnancy and sexually transmitted infections (STIs).

1) List specific goals for treatment.

2) What drug therapy would you prescribe? Why?

3) What are the parameters for monitoring success of therapy?

Answer 1

Ans:Treatments for Specific Types of Sexually Transmitted Diseases and Sexually Transmitted Infections (STDs/STIs)

• Gonorrhea and Chlamydia
• Genital Herpes
• Human Papillomavirus (HPV)
• Syphilis
• Bacterial Vaginosis
• Trichomoniasis
• Viral Hepatitis
• HIV/AIDS
• During Pregnancy

Gonorrhea and Chlamydia

Gonorrhea and chlamydia are bacterial STDs/STIs that can be treated with antibiotics given either orally or by injection. Because the infections often occur together, people who have one infection are typically treated for both by their health care provider.Recent sexual partners should be treated at the same time.

Genital Herpes

Genital herpes outbreaks can be treated with antiviral drugs. Although this medication can limit the length and severity of outbreaks, it does not cure the infection. In addition, daily suppressive therapy (daily use of antiviral medication) for herpes can reduce the likelihood of transmission to partners.A pregnant woman known to have the infection must take additional care because she can pass the infection to her infant during delivery. Women who first acquire genital HSV during pregnancy are at highest risk of transmission to their infants. If a pregnant woman has an outbreak when she goes into labor, she may need to have a cesarean section (C-section) to prevent the infant from getting the virus during birth.

Human Papillomavirus (HPV)

A person who has an HPV infection cannot be cured. However, many HPV infections can be prevented with vaccination.⁴ Furthermore, a health care provider can treat genital warts caused by the virus⁵ as well as monitor and control a woman's risk of cervical cancer through frequent screening with Pap smear tests.

Syphilis

If recognized during the early stages, usually within the first year of infection, syphilis can be treated with a singular intramuscular injection of antibiotic. A person being treated for syphilis must avoid sexual contact until the chancre sores caused by the bacteria are completely healed to avoid infecting other people.

If a person does not recognize the infection early, or does not seek treatment immediately, longer treatment with antibiotics may be required. If left untreated, the infection can progress even further and potentially cause death. Although antibiotics can prevent the infection from getting worse, they cannot reverse damage that has already occurred.

Bacterial Vaginosis

Bacterial vaginosis can be treated with antibiotics, typically metronidazole or clindamycin. Generally, male sexual partners of women with bacterial vaginosis do not need to be treated because treatment of partners has not been shown to reduce the risk of recurrence.

Treatment during pregnancy is recommended primarily for women at risk for preterm labor or having a low birthweight infant.

Trichomoniasis

Trichomoniasis can be treated with a single dose of an antibiotic, usually either metronidazole or tinidazole, taken by mouth. Often, Trichomonasinfection recurs, so it is important to make sure that both you and your sexual partners are treated if you are diagnosed with this infection.

Viral Hepatitis

• Hepatitis A virus (HAV) infects the liver and may cause abdominal pain, nausea, and vomiting. Usually the infection gets better on its own without requiring treatment. In some cases, however, individuals may have lasting damage to their livers or may have such severe nausea and vomiting that they must be admitted to the hospital.
• Hepatitis B virus (HBV) can cause a lifelong infection but can be treated with antiviral medications. People with HBV infection will need to see a liver specialist with experience treating individuals with chronic liver disease. These individuals need to take special care not to pass on the virus to their sexual partners, and sexual partners should receive hepatitis B vaccine if not already immune.
• Hepatitis C virus can cause immediate illness affecting the liver or, more commonly, it can be a silent, chronic infection. As with hepatitis B, individuals with HCV may have a lifelong infection and will always be at risk of passing the virus on to their sexual partners.New treatments are available that can clear the infection in some individual.

HIV/AIDS

There is no cure for HIV/AIDS. However, research into new treatments has improved outcomes for people living with the disease. A combination of antiretroviral drugs can be given in highly active antiretroviral therapy to control the virus, promote a healthy immune system, help people with the virus live longer lives, and reduce the risk of transmission.

During Pregnancy

Pregnant women who have certain types of STDs/STIs may pass them on to their infants during pregnancy or delivery. Therefore, it is important for women to be tested for such STDs/STIs as part of their early prenatal care to help ensure delivery of a healthy infant.

The specific treatment will depend on which STD/STI is involved.