A teenage female patient tells the nurse that she has been sexually active with her boyfriend for ...

The answer to question 1

Correct Answer: 4
Chlamydia is the most commonly reported STI in the United States, affecting more than 2.8 million people each year (CDC, 2014a). Of that number, more than half of reported cases occurred in women ages 15 to 25 years. While the incubation period is from 1 to 3 weeks, chlamydia may be present for months or years without producing noticeable symptoms in women. HPV may be considered but chlamydia would be the priority. If genital herpes were present, the patient would have reported painful herpetic lesions. If condyloma were present, the patient would have reported cauliflower-shaped lesions that appear on moist skin surfaces such as the vagina or anus.

The answer to question 2

Correct Answer: 4, 1, 2, 3, 5
Chlamydia trachomatis is an intracellular bacterial pathogen that resembles a virus and a bacterium. The organisms enter the body as an elementary body, a form in which it is capable of entering uninfected cells. The infection begins when the organism enters a cell and changes into a reticulate body. The reticulate body divides within the cell, bursting the cell and infecting adjoining cells.

The answer to question 3

Correct Answer: 1
Candidiasis (moniliasis, or yeast infection) is caused by the organism Candida albicans, which has several strains of different virulence. Candida organisms are part of the normal vaginal environment in up to 50 of women, causing problems only when they multiply rapidly. When factors alter the normal vaginal flora, the organism proliferates, resulting in a yeast infection. The manifestations include an odorless, thick, cheesy vaginal discharge. This is often accompanied by itching and irritation of the vulva and vagina, with dysuria, and dyspareunia. This patient was using an over-the-counter vaginal cleanser that altered the normal flora of the vagina and allowed Candida albicans to overgrow in the vaginal environment. Syphilis is not characterized by discharge. The patient with syphilis may have a painless chancre at the site of inoculation. The discharge of gonorrhea is usually a milky white and there is not any itching present. Genital herpes presents with lesions and pain at the site and is not accompanied by discharge.

The answer to question 4

Correct Answer: 1, 3, 4
The most important part of the treatment process is the immediate medical treatment of the syphilis in order to contain it in the first stage. The preferred treatment is the injection of the penicillin G. In order to prevent further spread of the disease and risk reinfection, abstinence from all sexual activity is required until cured. In order to determine that the disease is eradicated, follow-up testing is required at three months and six months. Partners should be referred for treatment; however, marriage counseling is not specifically identified. Handwashing is not an identified intervention for this disease process.

The answer to question 5

Correct Answer: 2
The primary stage of syphilis is characterized by the appearance of a chancre. There is little or no pain with this warning sign. The chancre appears at the site of inoculation 3 to 4 weeks after the infectious contact. Condyloma acuminata are cauliflower-shaped lesions that appear on moist skin surfaces such as the vagina, perineum, penis, urethra, and anus. The male patient that presents with gonorrhea or chlamydia does not have lesions on the penis.

The answer to question 6

Correct Answer: 1.5

The answer to question 7

Correct Answer: 4
Genital herpes may occur with 2 to 10 days after exposure to the herpes virus. Painful red papules appear in the genital area. Syphilis is characterized in the early stage of the disease by a painless chancre. The chancre appears at the site of inoculation. Gonorrhea is characterized by dysuria and a milky white discharge in the male. Women may be asymptomatic until the disease is advanced but may experience dysuria, abnormal menses, increased vaginal discharge and dyspareunia. Chlamydia may also be asymptomatic and not become symptomatic until the disease is advanced.

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