labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Wednesday, November 28, 2007

Firestarter

You know what totally sucks for all involved? Telling a woman that she has a sexually transmitted infection. And she's married. And she wasn't sleeping with anyone but her husband.

My clinical this semester has provided me with some extraordinary experiences in this technique. Once was with my preceptor as we examined a 30-something with numerous herpes lesions. As she lay on the exam table in lithotomy position, she burst into tears. We cultured the lesions and confirmed the diagnosis. Another was a 23 year old, fresh out of college and newly engaged. She came in complaining of an increase of vaginal discharge. It wasn't really bothering her, it just didn't "seem right". We offered her the whole work up, and chlamydia was the culprit.

But nothing compares with the 50 year old woman who just learned that her husband of 32 years was involved in some weird underground S&M ring and had a hunkering for one night stands. She wasn't having any symptoms, she just wanted to get checked out. She had several small warts on her labia. Everything else checked out fine, but needless to say, genital warts aren't fun either. They were so small she hadn't even noticed them. We applied tricholoroacetic acid (TCA) and sent her home seething. She said her next stop was the lawyer's office. She had already made an appointment.

One the other end of the spectrum, I've had a 40 year old hyperventilating in the exam room because she was petrified she was going to learn she had an STI. Based on her symptoms, it sounded like good ol' yeast. And on exam, it was classic for it. A wet mount proved good ol' Yeasty Pants was paying a visit. It took my preceptor and I a good 15 minutes convincing her that it was just yeast.

Oh, the adventures of student midwifery! I am sure the best is yet to come.

5 comments:

Anonymous said...

It's easy to see that you enjoy your work.

Not Afraid to Use It said...

How awful for those women. I am sure this is just one aspect of your job that is disturbing. I am sure they appreciate your compassion.

Di said...

A married friend of mine told me she presented with herpes after her two children were born. She had never had an outbreak. She said her doctor said it could have been dormant for years. I had never heard that...wondering if you agree.

Labor Nurse said...

di, I have heard of dormant infection. A classmate was telling me a physician informed her that a person can become infected with herpes but not have an outbreak for many years, or even never. A few textbooks of mine state that some women with HSV are never aware of the initial infection and primary lesions because they are so mild. Subsequent outbreaks, if there are any, are even more mild. The CDC states that up to 50% of people with HSV have no idea they have it, but I can't find anything specific saying that a primary outbreak occurs many years later. If anyone can point me to a resource that states this, I'd appreciate it! When I have a situation like this in the clinical arena, I'd love to tell women that the outbreak was from an old infection if in fact that can happen.

Jack and Lexi's Mom said...

My patients are moer disturbing. Frequently, I tell a woman she has an STI and she says, "oh, okay." No tears. No anger. So then I explain that she must have been exposed by a sexual partner and that all her partners should be tested and treated. "Okay." Then her test of cure comes back positive. So I ask if she took her medicine. "Oh, yes. My boyfriend didn't though. He doesn't have money/insurance/medicaid and doesn't like condoms."