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| Definition of Trichomoniasis |
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Definition
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Definition
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Definition
| More common in women, sexually active women age 16-35 years |
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Definition
| resource limited settings |
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Definition
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Definition
| Anaerobic protozoan parasite Trichomonas vaginalis |
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Definition
| Men Asymptomatic (15–50%); urethral discharge; dysuria. |
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Definition
| Take urethral swab and first-void urine for M,C&S and NAAT. DO NOT TAKE MIDSTREAM URINE |
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Definition
10–50% are asymptomatic. Symptoms: vaginal discharge,
vulval itching, dysuria, offensive odour, low abdominal discomfort,
vulval ulceration. |
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| Examination and investigation for Women |
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Definition
Examination: 5–15% have no abnormalities; common
findings include: vaginal discharge (770%; classical frothy yellow discharge
in 10–30%); vulvitis; vaginitis; 2% have classic ‘strawberry cervix’. Send
HVS from the posterior fornix at the time of speculum examination
for M,C&S and NAAT. TV may be detected incidentally on
cervical smear or self-taken swab |
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Term
| What is your immediate approach if male patient tells you he received a text from his girlfriend that she is diagnosed with trichomoniais? |
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Definition
Apply the EVE+ protocol.
Explore: "I can see how unsettling this news is for you"
Validate & Empathise: I think anyone in your position would be concerned after receiving such information.
Finish on a positive: I`m glad you came in today to seek the help you need. I would like to ask you a few questions to gain a better understanding of the situation we advise and manage you properly. Note Patient may be happy so use appropriate phrases. |
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Definition
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| Who`s symptoms to ask about? (if any) |
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Definition
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| What comes after symptoms? |
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Definition
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Term
| How do you approach asking about sexual health? |
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Definition
| Signpost: few personal but necessary questions about your sexual health. |
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| 6Ps framework of sexual history |
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Definition
| Partners, Practises, Protection, Past history of STI`s, Probing (is there anything else you feel I need to know)? |
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| History of sexual partners |
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Definition
| Currently sexually active, how long since your last sexual contact, with whom? genders of sexual partners, type of partnerships: steady committed relationship, new relationship, occasional or on off. sexual encounters in the last 3 months, can they be contacted?, Trichomonas were any of these n the last 4 weeks |
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Definition
| Vaginal, anal, oral, rimming, sex toys etc. |
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Definition
| When diagnosed, what sti?, what was done?, symptoms in partner. Testing for STI and HIV. offer the test. |
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Definition
Basic Obs (Pay attention to temperature)
Specific examination: Penis Look for frothy discharge, swelling, inflammation, ulceration or warts.
Glands in the groin: inguinal lymphadenopathy.
Beside test: Swab for NAAT |
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Term
| In this scenario what would be the provisional diagnosis and what explanation would you offer to the patient. |
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Definition
Suspected Asymptomatic trichomoniasis
Explanation Trichomoniasis: STI caused by germ trichomona vaginalis. Symptoms: can lead to pain and discharge from the penis but often assymptomatic in 15-50% of men and 50% of women.
Since you have had unprotected sex in the last few weeks and she is now infected there is a high chance you are now infected. since most patients are symptomatic there is a high chance she or you could have passed the infection along without realising it.
The good news is tha TV is not as serious as most other STIs and usually does not spread to other parts of the body and is quite treatable. |
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Term
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Definition
Offer referral to GUM clinic.
If GUM clinic denied:
- Diagnosis: urethral swab, first void urine mcs
- STI screening: Gonorrhea, Chlamydia, HIV, Syphillis, Hepatitis
- Treat against TV regardless of test results: Metronidazole 2g PO stat dose or
Metronidazole 400–500mg bd for 5–7 days
- Contact tracing and treatment of partners (any sexual contacts with the last 4weeks should be treated regardless of results) and avoid sexual intercourse for at least 1wk.
- Advise safe sex in the future to prevent further STI`s
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Definition
| Phone call: Find out how the patient is doing. If patient has taken antibiotics correctly there will usually be no need for further follow up or appointments. You do not routinely do test of cure for trichomoniasis. |
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Definition
| Report back if: UPS before completion of treatment, did not complete or did not take antibiotics correctly, vomited due to antibiotics, develop symptoms after treatment may need more antibiotics or a different form of treatment. |
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