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More than a UTI?

This week I had a lot of different cases come through the clinic, with a good amount of patients presenting for urinary tract infection symptoms. In addition, we also had quite a few patients who requested to be screened for sexually transmitted diseases due to recent exposure or new partners.

One patient that stuck out to me however was a fifteen year old female who came to the clinic for UTI symptoms. The patient was accompanied by her mother, and they both seemed a little uncomfortable. When I began to interview the patient she informed me that she was diagnosed with a urinary tract infection two days prior, however she was still suffering from the painful urination and frequency. The patient reported she had been placed on nitrofurantoin, and had completed two days of therapy. To my surprise the patient’s mother then added that she recently found out the patient had been sexually active, and she was concerned she may have a sexually transmitted infection on top of her urinary tract infection. We did explain to the mother that it was the patient’s choice to be tested for any sexually transmitted infections, she verbalized understanding, but the patient agreed to have the testing.

When completing the interview with the patient we made sure to discuss her sexual health. We asked the patient about if she was participating in safe sex, which she replied she was using condoms to avoid contracting a STI. The patient is also on hormonal birth control pills to avoid pregnancy, and states she has been taking her pills as prescribed. On physical assessment the patient had an unremarkable exam with no observable signs of disease. Her vital signs were all within normal limits, and she stated her biggest complaint was the burning when she urinated.

We completed a urinalysis, physical exam, urine culture and urine GC and C to test for gonorrhea and chlamydia. Her urinalysis revealed that she was still positive for a UTI. According to recent guidelines nitrofurantoin (Macrobid) was repositioned as first-line therapy for uncomplicated lower urinary tract infections (Huttner et al., 2016). Due to the patient only completing two days of antibiotic therapy we advised her to continue the prescribed Macrobid and if the symptoms did not begin to improve in one to two days she should call and we could make a change to her antibiotic plan. She was also advised that her urine culture may not show a specific bacteria due to her already using the antibiotics for two days. The patient verbalized understanding. We also informed the patient we would have the results of her STI testing in approximately forty eight to seventy two hours. Differential diagnosis for this patient include gonorrhea and chlamydia.

One goal of Healthy People 2020 is to promote healthy sexual behaviors, strengthen community capacity, and increase access to quality services to prevent STDs and their complications (Office of Disease Prevention and Health Promotion, 2019). We are helping to achieve that goal by giving her education on the importance of safe sex and the importance of protecting herself against STDs.

Each clinical day I feel a little more confident working with the patients. Previous challenges have become successes. I am getting better at exams and learning appropriate diagnoses. I am still learning which medication, if any, are appropriate, but the more that I am at the clinic the better I feel. Challenges during this week were education points. Really being able to talk with each patient is difficult. Not that there is a time limit, but most people do not want to wait around all day at the providers office, so there is an expectation to be somewhat quick. This puts pressure to get all of the information out in a timely manner, which I think is difficult for a new practitioner. I think this is a learning point as well. There is so much information that we want to give, but there just is not enough time to give everything. It is important to understand what points are the most pertinent to discuss and how to do it in an organized, timely manner.

References

Huttner, A., Verhaegh, E., Harbarth, S., Muller, A., Theuretzbacher, U. & Mouton, J. (2016). Nitrofurantoin revisited: A systematic review and meta-analysis of controlled trials. Journal of Antimicrobial Chemotherapy. 70(9), 2456-2464. DOI: 10.1093/jac/dkv147 (Links to an external site.)

Office of Disease Prevention and Health Promotion. (2019). Healthy people 2020: Sexually transmitted diseases. https://www.healthypeople.gov/2020/topics-objectiv…