Acute Illness: Bacterial Vaginosis
Bacterial vaginosis is one of the most prevalent causes of virginal complaints across the globe in women in the reproductive age group. While the etiology remains unknown, the disease is related to changes in the vaginal ecology which influences the increase in certain bacteria such as Gardnerella vaginalis that often replace the lactobacillus dominated flora of the healthy vagina (Nasioudis, Linhares, Ledger, & Witkin, 2017). The infection is characterized by thin, off-white, uniform, foul-smelling adherent vaginal discharge. The discharge is especially noticeable after menstruation or sexual intercourse. BV is related to various severe health conditions including adverse pregnancy outcomes such as low weight infants and increased risk for the pelvic inflammatory disease. BV is also associated with an increased risk of HIV contraction (Verstraelen & Verhelst, 2009). The extensive adverse health and social outcomes related to the disease warrants an analysis of diagnostic, treatment, preventative and promotional aspects associated with the disease.
While the exact prevalence rate remains unknown, BV is reported at almost 20 percent in sexually active women and a higher rate in women receiving treatment for different sexually transmitted diseases or termination of pregnancy (Nasioudis, Linhares, Ledger, & Witkin, 2017). Research indicates that infection is three times more likely to occur in infertile women compared to fertile women (Ranjit, Raghubanshi, Maskey, & Parajuli, 2018). Additionally, the disease is associated with a double rate of risk of preclinical loss in the event of an in-vitro fertilization-embryo transfer.
The infection is diagnosed using either Amsel’s clinical criteria or the Gram test. The Amsel criteria are grounded on fulfilling various outlined symptoms including the vaginal PH of more than 4.7, the presence of clue cell on wet mount, homogenous discharge and a fishy odor upon the addition of potassium hydroxide. The gram stain, on the other hand, encompasses two distinct procedures, the Nugent’s and the Spiegel’s both are applied as scoring systems. However, Amsel’s criterion is sometimes preferred in many health organizations since it allows for quantification and classification of the bacterial load in the body. However, in recent years the Nugent criteria are gaining popularity, and it relies on the microscopic observation of Gram-stained vaginal secretions (Ranjit, Raghubanshi, Maskey, & Parajuli, 2018). Since it analyzes bacteria based on morphology, a woman may test negative for BV in the Amsel’s criterion and positive using the Nugent criterion.
Two of the most commonly used medical interventions in the treatment of BV are metronidazole and clindamycin. Both of the drugs are prescribed for several days are taken in pill form in the mouth or as a cream that is usually inserted in the vagina (Verstraelen & Verhelst, 2009). Since the condition can recur after treatment, it is essential for any woman who notices the symptoms to visit a healthcare facility for treatment. This is especially true for pregnant women who often suffer complications such as premature delivery.
Majority of the preventive interventions focus on the risk factors and behaviors associated with the disease. Research indicates BV is linked to various factors including but not limited to age, marital status, antibiotic usage, employment, sexual activity, the age of first engagement in intercourse and estrogen production. Other behaviors associated with the illness include; the rate of involvement in oral sex, building a career in sex working, the presence of STDs. Health promotion and education associated with the condition discusses various aspects of the disease from the causes, the symptoms, the diagnostic procedures and complications associated with the disease.
Additionally, health promotion committed to the disease emphasizes the importance of safe sex including taking caution in all the sexual activities that one is involved in and avoiding douching among others. Health education associated with BV is recognized as sexual health education which emphasizes the importance of having one sexual partner and remaining faithful to that particular pattern. Similar to many illnesses that affect the vaginal region, it is essential to emphasize the importance of self-care in the management of BV. Medical experts also insist it is vital for the society to acknowledge other complications associated with the condition. For instance, women with BV are at an increased risk for developing other pelvic inflammatory diseases and STIs. In pregnant women, the disease is particularly threatening since pregnant women who develop BV are predisposed to preterm delivery and low birth weight (Nasioudis, Linhares, Ledger, & Witkin, 2017). Additionally, there is a risk of a miscarriage, especially during the first trimester. Considering the complications associated with the condition, it is crucial for the government and society as a whole to facilitate health promotion dedicated to bacterial vaginosis.
Chronic Illness: Interstitial Cystitis(IC)
Interstitial cystitis(IC) is a bladder disorder characterized by pain and affects young and middle-aged women across the globe. The average onset age of IC is forty years (Whitmore & Theoharides, 2011). Unlike bacterial vaginosis that only affects the female gender, men can also develop IC as is the case of women of any age. IC is linked to major chronic pelvic pain that can proceed to a disability. Indeed, the terms interstitial cystitis and bladder pain syndrome are currently used synonymously by the American Urological Association (AUA) among other experts to describe the disease and associated health consequences. One of the core management interventions is early diagnosis and treatment (Whitmore & Theoharides, 2011). However, in most cases, the disease is either misdiagnosed or under-diagnosed as such necessitating analysis of the diagnosis, treatment and management options associated with the disease.
The prevalence rates among women in the USA is between one and six percent across the country. In recent years, the number of diagnosed and reported cases has increased owing to the efforts of greater awareness coupled with improved tests, which are grounded in symptoms rather than relying on criteria alone (McKerman, Walsh, Reynolds, Crofford, Dmochowski, & Williams, 2018). The disease is characterized by at least three months of pain, pressure and a feeling of discomfort in the suprapubic region. IC is linked to frequent urination especially in patients that have not been diagnosed with UTI. Unfortunately, despite extensive research in the disease for the past two decades, there are no known etiologies or cure. However, studies indicate that genetic predisposition to IC plays a role in the occurrence of the disease (Whitmore & Theoharides, 2011). Whitmore and Theoharides (2011)assert that more than 90 percent of all affected individuals are female, many medical providers consider bacterial prostatitis as the male version of the disease thus argue that the percentage of men with the disease may be relatively higher than expected.
Chronic pain is the most common symptom of the disease. The pain can be severe and diffuses over the lower pelvic area with time. The common regions of pain are the lower abdomen, the urethral area, and the lower back. There is no established pathogenesis associated with the disease. Conversely, an increase in the number of the bladder mast cells has been previously reported in patients with IC. Indeed, research links pain to the rise in the number of the mast cells in the bladder. The condition is also related to variable degrees of inflammations in some patients. Other studies suggest that bladder glycosaminoglycan, which forms a coating on the luminal region of the bladder creating an impermeable barrier is evident in IC patients (McKerman, Walsh, Reynolds, Crofford, Dmochowski, & Williams, 2018). The coating influences the harmful molecules in the urine to activate the sensory nerves which may also explain the chronic pelvic pain associated with the disease.
One core issue associated with IC is the fact that overlapping symptoms and comorbidities are a common occurrence. Signs of the disease overlap with those of other conditions such as UTI, sensory urgency, recurrent cystitis a factor that complicates diagnosis, treatment and subsequently the health outcomes (Whitmore & Theoharides, 2011). The diagnosis procedures encompass ruling out UTIs and an over-reactive bladder before proceeding with other tests such as digital and monometric pelvic floor muscle examination, potassium sensitivity test, Kaufman Q-tip touch sensitivity test, and cystoscopy after hryro-distension. Similarly, treatment of IC is multimodal. The American Urological Association (AUA) recommends treatment, to begin with, conservative interventions such as but not limited to stress management, patient education and dedication to patients’ self-care (Whitmore & Theoharides, 2011). Other interventions include; dietary changes such as eliminating caffeine and alcohol which are common bladder irritants, medication, yoga, deep breathing, and physical therapy to the pelvic floor myofascial regions among others. Since the disease has no cure, the intervention techniques are linked to the management of the symptoms and improving the patients’ quality of life.
Health promotion is an important aspect not only in the societal management of the disease but also in the treatment and pain management interventions undertaken. Health education linked to IC illustrates that disease treatment is individual. Therefore health educational and promotional strategies are grounded on the lifestyle of an individual from nutrition to exercise the emotional freedom. Moreover, health promotion linked to IC emphasizes that the disease is associated with common symptoms such as chronic pain in the pelvic region. Medical providers dedicate to health promotion often encourages the society that the aspect of pain in the lower abdomen, the urethra region, and the lower back is associated with various underlying problems such as IC (McKerman, Walsh, Reynolds, Crofford, Dmochowski, & Williams, 2018). Additionally, current health promotion associated with IC encourages medical care providers to be diligent in diagnosis since the symptoms of the disease overlap with those of various diseases that may adversely affect not only the testing but also the treatment interventions. The society today encourages the concept of self-care an essential factor in preventing and managing interstitial cystitis.
References
McKerman, L. C., Walsh, C. G., Reynolds, W. S., Crofford, L. J., Dmochowski, R. R., & Williams, D. A. (2018). Psychosocial co-morbidities in interstitial cystitis/ Bladder pain syndrome (IC/BPS): A systematic review. Neurourol Urodyn.
Nasioudis, D., Linhares, I. M., Ledger, W. J., & Witkin, S. S. (2017). Bacterial vaginosis: A critical analysis of current knowledge. An International Journal of Obstetrics and Gynaecology, 61-69.
Ranjit, E., Raghubanshi, B. R., Maskey, S., & Parajuli, P. (2018). Prevalence of bacterial vaginosis and its association with risk factors among nonpregnant women: A hospital-based study. International Journal of Microbiology.
Verstraelen, H., & Verhelst, R. (2009). Bacterial Vaginosis: An update on diagnosis and treatment. Expert Review of Anti-infective Therapy, 1109-1124.
Whitmore, K. E., & Theoharides, T. (2011). When to suspect interstitial cystitis. The Journal of Family Practice, 340-348.
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