Community Nursing

Respond to 2 Peer Based on APA Guidelines. Work must be supported by peer-reviewed article published within 5 years.

 

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Case Study on Bacterial Vaginosis

Marisel Trista

Florida National University

 

Case Study on Bacterial Vaginosis

​Bacterial vaginosis (BV) is the common cause of vaginal discharge among women of childbearing age. The condition occurs when the lactobacillus domination of the vaginal biome is surpassed by Gardnerella vaginalis and anaerobic bacteria, leading to lower levels of hydrogen peroxide and organic acids and thus raising the vaginal pH and production of amines. Women with the condition can be asymptomatic or report an atypical vaginal discharge with an unpleasant, fish-like odor, especially after sexual intercourse. Vaginal douching makes women vulnerable to infections, such as bacterial vaginosis.

Treatment Goals for the Patient

​The principal goal for treating bacterial vaginosis are two. These are to relieve vaginal symptoms and signs of infections (Redelinghuys et al. 2020). In treating the patient, the therapy course will seek to relieve any vaginal symptoms manifesting, such as vaginal discharge, and odor after sexual intercourse, and the same signs of infection.

Drug Therapy for the Patient

​Despite the limitations of the current therapeutic approaches in managing bacterial vaginosis, pharmacological measures are usually the first-line treatment for the condition. In this case, for a woman who is not pregnant, which is the case for the R.S., treatment will involve metronidazole 500 mg PO b.i.d. for 7 days, or metronidazole gel 0.75 percent, 1 full applicator (5 g) intravaginally once a day for 5 days, or clindamycin cream 2 percent, 1 full applicator (5 g) intravaginally at bedtime for 7 days (Bradshaw & Sobel, 2016).

Patient Education

​Patient education will require creating awareness of how the patient and her partner can prevent recurrences or infections. First, patient education will involve educating R.S. against subsequent vaginal douching. Gondwe et al. (2020) explain that vaginal douching increases the risk of vaginal infections because of altering its pH. Accordingly, the patient will be made aware of this risk and the reality that the vagina can clean itself inside with natural vaginal secretions. Second, the patient will be educated about the need to use protection with her partner during treatment period. It will be necessary to inform the patient that the partner will not require treatment for the condition. Third, the patient will be educated on the adverse reactions that can necessitate stopping the therapy. These include confusion, diarrhea, vomiting, nausea, peripheral neuropathy, and metallic taste. Lastly, the patient will be encouraged to maintain a single sexual partner (Buttaro et al., 2020). Bacterial vaginosis makes one vulnerable to sexually transmitted infections (STIs), such as herpes simplex virus, human immunodeficiency virus (HIV), chlamydia, and gonorrhea. This will also extend to his partner to reduce the risk of STIs.

Adverse Reactions for Therapy Change

​The first-line course of treatment metronidazole is associated with several adverse reactions. The adverse reactions are confusion, diarrhea, vomiting, nausea, peripheral neuropathy, and metallic taste (Buttaro et al., 2020). And so, the patient will be advised to stop the medication in the face of any aggravated adverse reactions mentioned.

Alternative Medications for the Patient

​While no over-the-counter medications are available for bacterial vaginosis, several alternative medications are used. Tomas et al. (2020) identify the following alternative medications for bacterial vaginosis. These substances aim to reestablish the physiologic vaginal environment, including probiotics, prebiotics, acidifying agents, or antimicrobial substances, such as antiseptics and natural compounds.

Recommended Dietary or Lifestyle Change

​The necessary dietary changes for the patient will entail discouraging the patient against a fat-orient diet. Buttaro et al. (2020) explain that diets rich in fats are associated with an increased risk of bacterial vaginosis and severe bacterial vaginosis. Therefore, R.S. will be encouraged to observe a diet rich in folate, calcium, and vitamin A, which reduces the risk of severe bacterial vaginosis.

 

References

Bradshaw, C. S., & Sobel, D. J. (2016). Current treatment of bacterial vaginosis-limitations ​and need for innovation. The Journal of Infectious Diseases, 214(S1), 14-20. ​doi:10.1093/infdis/jiw159

Buttaro, T. M., Polgar-Bailey, P., Sandberg-Cook, J., & Trybulski, J. A. (2020). Primary ​care: Interprofessional collaborative practice. Elsevier Health Sciences.

Gondwe, T., Ness, R., Totten, P. A., Astete, S., Tang, G., Gold, A. M.,…Haggerty, L. C. ​(2020). Novel bacterial vaginosis-associated organisms mediate the relationship ​between vaginal douching and pelvic inflammatory disease. Sexually Transmitted ​Infections, 96(6), 439-444. http://dx.doi.org/10.1136/ sextrans-2019-054191

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(354), 1-20. doi:10.3389/fcimb.2020.00354

Tomas, M., Palmeira-de-Oliveira, A., Simoes, 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

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Reply

Liliana Acosta

20 hours ago, at 9:38 PM

 

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Week 12 Discussion

Liliana Acosta

Advanced Pharmacology

 

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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