Answer to Case Study #3:

Tell Clara that the vaginal discharge she is experiencing can have several different causes. Explain to Clara that vaginal discharge may or may not be a symptom of an STI. She needs to know that sometimes the normal vaginal environment can be disrupted, resulting in an overgrowth of bacteria or a change in the environment that leads to an RTI, such as BV or vaginal yeast infection. These infections are not necessarily transmitted sexually. In other cases, abnormal vaginal discharge may be caused by an STI.

Since the clinic follows syndromic management, if repeat visits are feasible for Clara, a good strategy might be to treat Clara for vaginitis first. If the symptoms do not go away, at her follow-up appointment, treat her for cervicitis with the assumption that she has an STI.

Tell Clara that it is not possible to know for sure what type of infection she has, and whether or not it was sexually transmitted. Explain to Clara that given her history, it is most likely her infection is not sexually transmitted. Stress the importance of her returning for the follow-up visit.

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