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Seth Lesperance Dupont Paurice

2 hours ago, at 7:50 PM

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 Bacterial Vaginosis – Case Study

Bacterial vaginosis is generally described as a common infection that occurs in the vagina due to the overgrowth of the natural bacterial flora in the vagina. This infection leads to the imbalance in the pH as well as enhances the growth of pathogenic organisms on the vagina. The global prevalence of bacterial vaginosis is generally high and this condition is widely prevalent among females who are between the ages of 14-49. Women being affected with bacterial vaginosis have a higher influence on their self-esteem due to the discomfort and irritations that this disease exerts on their routine activities (Tomás et al., 2020). Most of the women experiencing bacterial vaginosis do not exhibit any symptoms. However, the common symptoms include burning sensation during urination, foul smelling vaginal discharge, vaginal sores, emanation of fishy odor of discharge especially after having sexual intercourse, vaginal irritation, discomfort, itching, and change in the normal color of the vaginal discharge (Bautista et al., 2016).

The common risk factors that are associated with bacterial vaginosis includes smoking habits, frequent douching, performing sexual intercourse with different partners, use of scented soaps, bubble baths, vaginal sprays and deodorants, usage of sex toys, intra uterine devices, and so on. The complications that occur due to this bacterial condition on the vagina are premature birth, pregnancy complications, sexually transmitted infections, poor chance for success with treatments such as in-vitro fertilization, and so on. Bacterial vaginosis is diagnosed based on the medical history, overall physical examinations, vaginal swab test for microscopic examinations using Gram staining techniques, pelvic examination, and pH level assessments. Treatment for bacterial vaginosis is carried out by employing antibiotics such as metronidazole, tinidazole, secnidazole, and clindamycin. Administration of these medicines orally or in the form of creams help in relieving the symptoms of this disease condition in the patient. Apart from medications, this condition is also treated by taking certain preventive measures such as refraining from sexual activities and frequent douching (Redelinghuys et al., 2020).

This discussion is focused on a 32-year-old patient named R.S who is been diagnosed with bacterial vaginosis. For this patient, the specific goals of treatment are to reduce the symptoms of the disease condition and by bringing down the level of vaginal pH to the normal range between 3.8-4.5. The pH of the vagina is an essential condition that needs to be maintained normal always. An imbalance in the vaginal pH leads to various other health complications. The drug therapy that I would prescribe for R.S is the administration of metronidazole antibiotics. Metronidazole is an effective and a widely employed antibiotic that is provided to patients with vaginal infections. Intake of 500 mg dosage of metronidazole by mouth for seven days with two ties a day helps in reducing the symptoms and also manages the disease. This drug works by inhibiting the growth of the harmful bacteria and by enhancing the growth of the beneficial organisms. This prescribed drug also help in relieving the symptom more quickly within a short period of time thereby thus reducing the further complications of the disease conditions (Bautista et al., 2016).

Based on the prescribed therapy the patient education offered to R.S is regarding the importance of administering the drug at the right dosage and intervals without skipping the dose. The patient should be taught on the disadvantages of using douche frequently and be taught to cease from douching activities. R.S, in this case, is also advised on maintaining healthy feminine hygiene by using cotton undergarments and to avoid washing them with harsh soaps and detergents. The patient should also be taught on the importance of staying away from sexual activities for a couple of weeks. Apart from these, the patient should also be taught on the common side effects that occurs with the intake of the prescribed drug such as the dark colored urine, loss of control of certain movements in the body, furry tongue, neuropathy, seizures, brain disease, decreased libido, and low count of the white blood cells in the body. The adverse reactions for the selected agent are nausea, vomiting, hypersensitivity, dizziness, sense of metallic taste, loss of appetite, headache, dryness of mouth, and so on (Bautista et al., 2016).

According to the National Institute of Health, over-the-counter medicines for treating bacterial vaginosis are found to be less effective (NIH, 2021). The alternative medications that are appropriate for R.S includes the oral administration of tinidazole. Application of clindamycin cream or gel on the vaginal region for a consecutive period of seven nights also helps in treating the condition of bacterial vaginosis. Use of vaginal clindamycin cream is found to be an effective alternative for the oral administration of the prescribed metronidazole drug. The dietary or lifestyle changes that are recommended for R.S includes the intake of healthy foods that are rich in folic acid, vitamin A, and calcium as these nutrients help in decreasing the severity of the vaginosis conditions. Intake of probiotics and prebiotics helps in promoting the growth of normal vaginal flora thereby boosting the healthy condition of the vagina (Tuddenham et al., 2019). The patient should be encouraged to reduce the intake of dietary fat rich products as the intake of fat enhances the overgrowth of pathogenic bacteria thereby leading to an imbalance in the vaginal pH which in turn paves way for the occurrence of severe negative impacts. The patient should also be recommended to avoid frequent douching.

 

 References

Bautista, C. T., Wurapa, E., Sateren, W. B., Morris, S., Hollingsworth, B., & Sanchez, J. L. (2016). Bacterial vaginosis: A synthesis of the literature on etiology, prevalence, risk factors, and relationship with Chlamydia and gonorrhea infections. Military Medical Research, 3(1). https://doi.org/10.1186/s40779-016-0074-5

NIH. (2021, May 5). What are the treatments for bacterial vaginosis (BV)? Eunice Kennedy Shriver National Institute of Child Health and Human Development. Retrieved March 22, 2022, from https://www.nichd.nih.gov/health/topics/bacterialvag/conditioninfo/treatments

Redelinghuys, M. J., Geldenhuys, J., Jung, H., & Kock, M. M. (2020). Bacterial vaginosis: Current diagnostic avenues and future opportunities. Frontiers in Cellular and Infection Microbiology, 10. https://doi.org/10.3389/fcimb.2020.00354

Tomás, M., Palmeira-de-Oliveira, A., Simões, S., Martinez-de-Oliveira, J., & Palmeira-de-Oliveira, R. (2020). Bacterial vaginosis: Standard Treatments and Alternative Strategies. International Journal of Pharmaceutics, 587, 119659. https://doi.org/10.1016/j.ijpharm.2020.119659

Tuddenham, S., Ghanem, K. G., Caulfield, L. E., Rovner, A. J., Robinson, C., Shivakoti, R., Miller, R., Burke, A., Murphy, C., Ravel, J., & Brotman, R. M. (2019). Associations between dietary micronutrient intake and molecular-bacterial vaginosis. Reproductive Health, 16(1). https://doi.org/10.1186/s12978-019-0814-6

 

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Adelisa Bencomo

6 hours ago, at 3:13 PM

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The patient’s symptoms and results from the microscopic examination reveal that she has bacterial vaginosis. Therefore, the treatment goals should be stopping the white vaginal discharge and odor after sexual intercourse and reducing the vaginal pH to 4.5 or lower. A low pH inhibits bacteria growth, slowing down aerobic bacteria metabolism, which is the primary cause of the odor (Paavonen & Brunham, 2018). As a women’s health practitioner, I would recommend a seven-day oral metronidazole (Flagyl) course to manage this condition. Research shows that metronidazole effectively treats bacterial vaginosis (Paladine & Desai, 2018). Consequently, metronidazole is recommended as an initial regimen.

The gynecologist should provide the patients with information on the appropriate dosage, foods, or drinks to avoid when taking the drugs and the medication’s side effects to achieve the treatment goals. Metronidazole’s proper dosage is 500mg orally twice daily for seven days. Meanwhile, metronidazole’s adverse effects include headache, diarrhea, nausea, constipation, dizziness, and loss of appetite. Metronidazole may also have a disulfiram-like reaction with alcohol consumption (Paladine & Desai, 2018). Therefore, patients on this medication should avoid alcohol for a day after finishing the oral regimen. Finally, repeated and prolonged use of metronidazole may result in a change in vaginal discharge.

Although metronidazole’s adverse effects are usually mild, some effects can be severe and may warrant a change of therapy. These side effects include severe gastrointestinal symptoms and a change in vaginal discharge. In the event of these reactions, the gynecologist may recommend intravaginal metronidazole (Metrogel), tinidazole, or intravaginal clindamycin. Furthermore, R.S. should make a few lifestyle changes. For instance, she should avoid vaginal douching since regular douching causes irritation and disrupts the microbiomes in the vagina, increasing the risk of developing vaginal infections (Kaambo et al., 2018). Finally, R.S. should avoid perfumed soaps, fabric softeners, and other hygienic products that cause abnormal discharge or act as irritants.

 

References

Kaambo, E., Africa, C., Chambuso, R., & Passmore, J. A. S. (2018). Vaginal Microbiomes Associated with Aerobic Vaginitis and Bacterial Vaginosis. Frontiers in Public Health6, 78-83.

Paavonen, J., & Brunham, R. C. (2018). Bacterial Vaginosis and Desquamative Inflammatory Vaginitis. New England Journal of Medicine379(23), 2246-2254.

Paladine, H. L., & Desai, U. A. (2018). Vaginitis: Diagnosis and Treatment. American Family Physician97(5), 321-329.

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JEAN OMEGA FLEURGIN

15 hours ago, at 6:09 AM

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1.     List specific goals of treatment for this patient.

Goals of treatment include:

      ●Relief of symptoms (if present).

         ●Reduction of postoperative infection – For individuals with asymptomatic infection prior to surgical abortion or hysterectomy, treatment can reduce the risk of postoperative infection.

 ●Reduction of sexually transmitted infections – Treatment of BV may reduce the risk of acquiring sexually transmitted infections (STIs), including HIV . For this reason, some experts support the concept of treating all patients with BV regardless of presence or absence of symptoms. However, we agree with recommendations to not treat asymptomatic individuals who are not pregnant. Asymptomatic pregnant individuals with previous preterm births may benefit from treatment, but screening and treatment of these individuals are controversial.

 

2. What drug therapy would you prescribe? Why?

Metronidazole, which you are to take 1 Tablet (500mg) 2 times each day (morning and evening) for 7 days, will decrease the overgrowth of this bacteria, which commonly lives in women’s reproductive organs. Signs of this infection include painless, foul-smelling discharge without itching or burning with urination. Bacterial vaginosis should not cause pain or discomfort during intercourse and cannot be transmitted between male/female sexual partners.

These types of organisms often cause infections in areas of the body such as the gums, pelvic cavity and tummy (stomach or intestines) because they do not need oxygen to grow and multiply.

3. Discuss specific patient education based on the prescribed therapy. It’s generally not necessary to treat an infected woman’s male sexual partner, but bacterial vaginosis can spread between female sexual partners. Female partners should seek testing and may need treatment. It’s especially important for pregnant women with symptoms to be treated to help decrease the risk of premature delivery or low birth weight.

Take the medicine or use the cream or gel for as long as prescribing even if your symptoms go away. Stopping treatment early may increase the risk of recurrence.

Recurrence.It’s common for bacterial vaginosis to recur within three to 12 months, despite treatment. Researchers are exploring treatments for recurrent bacterial vaginosis. If your symptoms recur soon after treatment, talk with your doctor about treatments. One option may be extended-use metronidazole therapy.

A self-help approach is lactobacillus colonization therapy which attempts to boost the number of good bacteria in your vagina and re-establish a balanced vaginal environment — possibly accomplished by eating certain types of yogurt or other foods containing lactobacilli. While current research shows there may be some benefit to probiotic therapy, more research is needed on the subject.

4. List one or two adverse reactions for the selected agent that would cause you to change therapy.

 -Transient neutropenia (7.5 percent) and prolongation of international normalized ratio in patients taking vitamin K antagonists .

5. What OTC or alternative medications would be appropriate for this patient?

The role of probiotics is not known yet in the treatment .

Alternative drugs — Oral 
tinidazole
 and secnidazole have demonstrated efficacy similar to that of oral 
metronidazole
 and may be more convenient as they have five- and one-day dosing, respectively.

6.What dietary or lifestyle changes should be recommended?

When 
vaginal pH becomes too alkaline
 — above 4.5 — it creates a favorable environment for the overgrowth of bad bacteria 
2
. This proliferation causes an infection that could potentially lead to complications in the uterus and fallopian tubes. Although bacterial vaginosis is typically treated with antibiotics, diet changes can also help manage bacterial overgrowth in your vagina.

Whether you currently have BV or want to avoid an infection, there are specific foods to avoid to help keep a healthy ecosystem of flora throughout the body. These foods include alcohol; coffee; fast foods; saturated fats; foods that contain molds, such as peanuts; citrus fruits; fruits with a high 
glycemic index
, such as bananas; fermented foods; processed foods; breads and pasta made with refined white flour; and anything high in carbohydrates. Avoid Food Allergens.

In addition to eating a diet rich in whole foods and avoiding sugars, refined carbohydrates and food allergens, it’s also important to drink adequate amounts of 


filtered water


 every day as part of your bacterial vaginosis diet.

References :

1. Bacterial vaginosis — CDC fact sheet. Centers for Disease Control and Prevention. https://www.cdc.gov/std/bv/STDFact-Bacterial-Vaginosis.htm. Accessed April 22, 2019.

2. AskMayoExpert. Vulvovaginitis. Mayo Clinic; 2020.

3. Pruthi S (expert opinion). Mayo Clinic, Rochester, Jan. 13, 2016.

4. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Gynecology. ACOG Practice Bulletin No. 72. Vaginitis. Obstetrics and Gynecology. 2006;107:1195. Reaffirmed 2017.

5. Frequently asked questions. Gynecologic problems FAQ028. Vaginitis. American College of Obstetricians and Gynecologists. https://www.acog.org/Patients/FAQs/Vaginitis. Accessed April 22, 2019.

6. Sexually transmitted diseases treatment guidelines, 2015. Centers for Disease Control and Prevention. https://www.cdc.gov/std/tg2015/default.htm. Accessed April 22, 201Bottom of Form

7.

Joscelyne Lastra

22 hours ago, at 11:05 PM

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Vaginitis

R.S. is a 32-year-old woman who seeks treatment for a vaginal discharge that she has had for the past month. She is sexually active and has had the same partner for the past six months. She reports noticing an odor, especially after sexual intercourse. Her history reveals that she has been using a commercial douche on a biweekly basis during the past year for hygienic purposes to prevent vaginal infections. She denies any other associated symptoms. The physical examination reveals a white vaginal discharge. Microscopic examination of the vaginal discharge shows clue cells, and the pH is 5.5. She is diagnosed with Bacterial Vaginosis.

Question 1

The specific goal of treatment for the 32-year-old woman is to alleviate the symptoms and indications of infection in the genital area.

Question 2

The best drug therapy for this patient would be Secnidazole, a nitroimidazole antibiotic. This drug therapy is more effective than other drugs because it has a longer half-life (Jack, 2022). Also, this drug has been approved for the treatment of thiscondition by the US Food and Drug Administration.

Question 3 

Secnidazole is a medication used to manage vaginosis in adult women caused by a bacterium. Secnidazole is an antibiotic, and it acts by either killing or inhibiting the development of bacteria. It is important to take medicine as prescribed by the practitionerand follow the instructions on the patient education leaflet. Granules can be sprinkled on soft food and swallowed (Jack, 2022). Also, the granules should not be dissolved in any liquid. The patient should continue using this medication for the duration of the therapy, even if they feel better after the first few dosages. If they discontinue using the medication too soon, their condition may not disappear.

Question 4

This drug therapy is associated with some adverse effects. Secnidazole therapy is associated with an increased risk of vulvovaginal candidiasis, headaches, nausea, diarrhea, and stomach discomfort (Mayo Clinic, 2021).

Question 5

Metronidazole is an appropriate alternative medication for the patient to control the condition. This drug therapy is effective in fighting vaginosis symptoms.

Question 6

The patient can observe a diet with citrus fruits, like oranges and lemons. These fruits are high in vitamin C, which is beneficial for preventing recurrent bacterial infections and unusual vaginal secretions. Also, taking yogurt or probiotic supplements is a relatively safe way to treat bacterial vaginosis.

References

Jack, D Sobel, (2022). Bacterial vaginosis: Treatment 
https://www.uptodate.com/contents/bacterial-vaginosis-treatment#H872658162
.

Mayo Clinic, (2021), Bacterial vaginosis – Diagnosis and treatment – Mayoclinic.org. 
https://www.mayoclinic.org/diseases-conditions/bacterial-vaginosis/diagnosis-treatment/drc-20352285
.

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Villelixe Soto

23 hours ago, at 10:59 PM

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List specific goals of treatment for this patient

           Nurses should be aware that the most common causes of vaginal discharge are physiological, for example BV and candida, but STIs should also be considered. The treatment goals are to get rid of the bacteria, which will get rid of offensive fishy smelling, vaginal discharge, generally no signs of inflammation, eliminating soreness, itching or irritation (Collins, 2019).     

What drug therapy would you prescribe? Why?

Treatment for bacterial vaginosis is generally very effective if taken according to instructions:

Metronidazole 400mg twice daily for five to seven days, or

   Metronidazole 2g as a single dose, or

   Intravaginal metronidazole gel (0.75%) once daily for five days, or

   Intravaginal clindamycin cream (2%) once daily for seven days.

           Oral metronidazole is usually well tolerated and an inexpensive therapy. While intravaginal metronidazole gel and clindamycin cream have similar efficacy, both are more expensive (Duncan, 2019).

Discuss specific patient education based on the prescribed therapy

           Patient education includes advising the patient not to drink alcohol during metronidazole therapy and for at least 48 hours afterwards because of the possibility of a disulfiram-like (an abuse effect) reaction (Duncan, 2019). Metronidazole enters the breast milk and may affect the taste. Women should be advised of this. Woman should be advised that following treatment, bacterial vaginosis may recur (Collins, 2019).

List one or two adverse reactions for the selected agent that would cause you to change therapy.

           Metronidazole may cause adverse reactions such as dizziness, headache, stomach upset, nausea, vomiting, loss of appetite, diarrhea, constipation, or metallic taste in the mouth may occur.

What OTC or alternative medications would be appropriate for this patient?

           Taking probiotics can be an effective way to maintain a healthy balance of bacteria in the vagina. Specifically, vaginal probiotics of at least 8 billion units of Lactobacillus rhamnosus, Lactobacillus acidophilus and Streptococcus thermophilus per capsule. 

What dietary or lifestyle changes should be recommended?

           Some lifestyle changes should include not douching. Douching with vinegar or antiseptics causes inflammation and can increase the risk of infections. This also can eliminate some good bacteria. Diet change. Anything that affects the gastrointestinal tract or internal body system can affect the normal balance of bacteria (Collins, 2019). Also, a poor diet can affect the ability of the body to return to normal state. Nylon underwear/tight yoga pants. Wearing nylon underwear or tight yoga pants can block air movement in the vaginal area, which can cause increased bacteria growth. Heavily perfumed/antibacterial soaps. Using soap with a lot of scent or an antibacterial agent spurs bacteria growth.

References

Collins, L. (2019). Diagnosis and management of a bacterial vaginosis. British Journal of Nursing, 28(2), 84–88. https://doi.org/10.12968/bjon.2019.28.2.84

Duncan, D. (2019). Alternative to antibiotics for managing asymptomatic and non-symptomatic bacteriuria. British Journal of Community Nursing, 24(3), 116–119. https://doi.org/10.12968/bjcn.2019.24.3.116

 

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Vianet Blanco

3/22/22, 7:36 PM 

NEW

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Specific Goals of Treatment and Drug Therapy

The primary goal of bacterial vaginosis treatment is to relieve the patient with vaginal symptoms that include vaginal discharge and odor. The other goal is to minimize vaginal infections signs that can cause pain. The patient requires metronidazole such as Metrogel-vaginal or Flagyl antibiotic that has a high response against bacteria. Prescription of oral metronidazole 500 mg bid for 7 days has a better clinical rate in eradicating bacterial infections (Abd El Aziz et al., 2019). The patient can also use vaginal metronidazole gel that is applied daily and has high effectiveness in controlling the vagina’s odor and white vaginal discharge.

Patient Education and Adverse Reactions

The patient must be educated on the drug uses, adverse effects, and mode of usage for a specific period. Antibiotic stewardship is needed to teach the patients on indications of metronidazole, its mechanisms of action, and dosing for bacterial vaginosis. Metronidazole may require therapy change due to specific adverse effects that could worsen bacterial vaginosis. The drug tends to cause peripheral neuropathy, diarrhea, and vomiting in some patients. Weir & Le (2021) further noted that metronidazole could cause confusion, severe headaches, dizziness, abdominal pain, and urinary track information if used without proper prescriptions. 

OTC, Alternative Medications and Dietary or Lifestyle Changes

The patient may use alternative oral treatments such as secnidazole or tinidazole in the event of unavailability of metronidazole. Metronidazole gel can also be substituted with clindamycin vaginal cream that has efficacy against bacterial vaginosis. The patient should consume less fatty food, use vitamin A, and take more calcium-rich diets. Bacteria and inflammations are also reduced by having a balanced diet rich in folic acid and beta carotene (Mizgier et al., 2020). The patient should avoid alcohol consumption, practice effective hygiene and sexual practices, and use soap-free washes while frequently changing clothes.

References


Abd El Aziz
, M. A., Sharifipour, F., Abedi, P., Jahanfar, S., & Judge, H. M. (2019). Secnidazole for treatment of bacterial vaginosis: a systematic review. BMC women’s health19(1), 1-12.

 Mizgier, M., Jarzabek-Bielecka, G., Mruczyk, K., & Kedzia, W. (2020). The role of diet and probiotics in prevention and treatment of bacterial vaginosis and vulvovaginal candidiasis in adolescent girls and non-pregnant women. Ginekologia Polska91(7), 412-416.


Weir, C. B., & Le, J. K. (2021). 
Metronidazole. StatPearls [Internet]

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n the next dose is less than an hour away. It is very important to include in the education that you should never double a dose, just as you should not crush the medicine and while you are taking said medicine you should eliminate alcohol consumption.