NU 641 Week 12 Discussion: Bacterial Vaginosis List specific goals of treatment for this patient. R.S. has been diagnosed with bacterial vaginosis, which is characterized by the normal hydrogen peroxide-producing lactobacilli that are present in the vaginal flora being replaced by an overgrowth of anaerobic organisms, such as Mycoplasma hominis

Sample Answer for NU 641 Week 12 Discussion: Bacterial Vaginosis

1. List specific goals of treatment for this patient.

R.S. has been diagnosed with bacterial vaginosis, which is characterized by the normal hydrogen peroxide-producing lactobacilli that are present in the vaginal flora being replaced by an overgrowth of anaerobic organisms, such as Mycoplasma hominis, Gardnerella vaginalis, Prevotella spp., or Mobilucus spp (Woo & Robinson, 2020, p. 1289). This condition is associated with a biofilm that strongly adheres to vaginal epithelial cells, which promotes the growth and adherence of other offending organisms (Tomás et al., 2020). The first goal of treatment is to eliminate the symptoms that R.S. is experiencing, such as the foul-odored and high pH discharge (Woo & Robinson, 2020, p. 810). In order to do this, some of the other specific main goals of treatment for bacterial vaginosis include the destruction of biofilms, a reestablishment of the healthy vaginal flora, and the eradication of the associated pathogens (Tomás et al., 2020). In addition, bacterial vaginosis that goes untreated has been associated with adverse effects such as pelvic inflammatory disease, abnormal Pap smear results, and pregnancy complications for women who are pregnant (Woo & Robinson, 2020, p. 810). Therefore, another goal would be to avoid these complications through the treatment of this condition.

1. What drug therapy would you prescribe? Why?

According to the International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guidelines for treating bacterial vaginosis, 5-7 days of topical or oral metronidazole or 7 days of intravaginal clindamycin are both considered to be first-line treatments for uncomplicated bacterial vaginosis (Sherrard et al., 2018). Cost-effectiveness, the individual circumstances, and the personal choice of the patient should be the main factors in considering the treatment regime (Sherrard et al., 2018). Both of these treatments have equal efficacy, but clindamycin tends to have fewer side effects than metronidazole (Sherrard et al., 2018). However, oral metronidazole is cheaper than the other options (Sherrard et al., 2018). Therefore, I would let R.S. know the cost and common side effects that may be expected with both of these treatments and use her personal input in my decision. However, for the purposes of this post, I will assume that that cost is the most important factor for R.S., and therefore I would prescribe seven days of oral metronidazole 500mg twice daily (Sherrard et al., 2018). This drug is available in 500mg tablets (Vallerand & Sanoski, 2020, p. 865).

Below is my prescription for R.S.:

Downey Family Practice

1234 Health Road

Richmond, VA 23223

(555) 555-5555

Nicole Downey, BSN, DNP, FNP-C Date: March 21, 2022

Patient: R.S.  DOB: 02/19/90 Weight: 50 kg Phone: (628) 456-4567

Metronidazole 500mg tablets

Disp: 14 tablets

Sig: Take one tablet by mouth twice a day for 7 days to treat bacterial vaginosis. Please finish the entire course of this medication even if symptoms resolve.

No refills.

1. What are the parameters for monitoring the success of the therapy?

The parameters for monitoring the success of therapy involve the resolution of R.S.’ symptoms. For example, treatment would be successful if she is no longer experiencing white, foul-smelling discharge.

1. Discuss specific patient education based on the prescribed therapy.

A major point of education that I would provide to R.S. would be to ensure that she finishes the entire course of therapy and takes the medication as directed (Vallerand & Sanoski, 2020, p. 865). In addition, it is important that she understands the need to avoid alcohol intake for at least 72 hours after treatment with metronidazole, as the concurrent use of both may cause a disulfiram-like reaction consisting of nausea, vomiting, abdominal cramping, headache, and flushing (Vallerand & Sanoski, 2020, p. 866). I would tell R.S. that she may take this drug on an empty stomach, or if she is experiencing gastrointestinal discomfort, she may take it with food or milk (Vallerand & Sanoski, 2020, p. 865). In addition, I would let her know that this medication has the potential to cause a metallic taste that may be unpleasant and can also cause dry mouth (Vallerand & Sanoski, 2020, p. 866). To combat this, I would advise her to use sugar-free gum, candy, mouth rinses, and overall good oral hygiene (Vallerand & Sanoski, 2020, p. 866). Further, I would ask R.S. to inform her provider of any new rash, fever, blisters, or muscle or joint aches that d