STIs 4: Case Studies

Case Studies

These case studies are designed to be completed after you have studied the content in each section, but you can complete them any time you feel ready. Case studies allow you to apply what you have learned in this course to real-world situations.

Case Study #1:

Isabel is a health care provider at a small rural clinic. One day, Sarah, a woman whom she knows as an acquaintance through their husbands (both of whom work on the same farm), comes to the clinic. Sarah, a 35-year-old married woman with five children, has come to see Isabel because she has unusual symptoms (vaginal discharge and bleeding after intercourse). Tests are run that indicate that she is infected with gonorrhea. Sarah is deeply religious and monogamous. She tells Isabel that she believes that her husband is faithful to her. Isabel decides that she will offer Sarah treatment for her “infection,” without telling her exactly what it is and how it was caused. Isabel does this to “save” the marriage and to spare Sarah the pain of learning that her husband has had at least one other sexual partner. Isabel inquires about Sarah’s use of family planning and when she learns that Sarah does not currently use a method but would not like to have any more children right now, recommends that Sarah and her husband consider using condoms. Isabel gives Sarah a condom demonstration, has her practice putting one on a penis model, talks about strategies for encouraging her husband to use them, and sends her on her way with some free samples of condoms to try, plus the treatment regimen for her “infection.”

Has Isabel handled this interaction with Sarah appropriately? Why or why not?

Answer

Case Study #2:

The scenario below has three different endings. Based on the way the provider treats Alepha in each scenario, indicate which approach (clinical, etiologic, syndromic) to STI management the provider has followed.

Scenario: Alepha, a 26-year-old woman, comes into your clinic for a family planning method. During a family planning counseling session with a nurse, Alepha mentions that she has been having unusual vaginal discharge. The nurse refers Alepha to the clinic’s doctor.

The doctor asks Alepha to describe the color and odor of the discharge. She indicates that it has a fishy odor. The doctor treats Alepha for BV.
The doctor asks Alepha to describe the color and odor of the discharge. She indicates that it has a fishy odor. The doctor treats Alepha for BV, vaginal yeast infection, and trichomonas infection.
The doctor asks Alepha to describe the color and odor of the discharge. She indicates that it has a fishy odor. The doctor examines Alepha and takes samples for tests, including a wet mount and a whiff test. Based on these test results, the doctor diagnoses Alepha with BV and treats her with metronidazole (Flagyl).

Answer

Case Study #3:

Caroline, a 27-year-old woman, uses condoms consistently as her method of family planning with her boyfriend, her only sexual partner. Caroline develops genital ulcers, and when she is diagnosed with chancroid, she is confused because she thought that condoms would prevent both infection and pregnancy. She did not think that her boyfriend had other partners, but now she is not so sure.

What is going on here? How do you support Caroline’s continued use of condoms?

Answer