Set the scene for your readers. Give background on the body system under study and the specific pathophysiological state of your Case Study. Provide information that will assist your readers to understand your report, and point them down the road to logically assess and understand what you are writing about with regards to your patient, the disease, and treatment options available, and the likely outcome(s).Patient (Case Study) Outline (maximum 150 words)Quick summary of your Case Study. Link it to your introduction and your “discussion/conclusion” (ie the rest of your report).Critical Analysis – What is your diagnosis?The initial diagnosis is a sexually transmitted infection. More specifically, Chlamydia trachomatis, which is the most common sexually transmitted infection in Australia (AIHW 2018). Kerry is exposed some risk factors: multiple and new sexual partners and lack of regular use of barrier contraceptive devices (Malhotra et al. 2013). Demographically, young women carry the major burden of the disease (Malhotra et al. 2013). A new exposure to chlamydia will reinfect Kerry, even if it was successfully treated previously. Many as 70-80 per cent of women and 50 per cent men have asymptomatic infection (Malhotra et al. 2013). This means she may have had chlamydia for a while with no symptoms, transmitted from previous partners. However, when symptoms are present, they can include painful urination and pain during intercourse. The rough sex may have been masking her vaginal pain during intercourse. The other symptom is an odourless, mucoid vaginal discharge without itchiness. However, this diagnosis does not consider all symptoms in Kerry’s case, and so we must consider differential diagnoses.Type 2 diabetes can present with polyuria, and Kerry has a family history of this. Urethral syndrome describes lower urinary tract symptoms but presents with no recognised urinary pathogen cultured from urine or any other objective finding of urological abnormality (Tidy 2015). Candidiasis is an overgrowth of yeast within the vagina. Symptoms can include itch and discomfort on the vulva and vagina, a burning sensation and pain when passing urine and during sex and usually thick or milky white discharge from the vagina (Melbourne Sexual Health Centre 2017). Trichomoniasis is a common sexually transmitted infection caused by a parasite causing a foul-smelling vaginal discharge, genital itching, painful urination, and abdominal pain (Mayo Clinic 2020). Non-infectious causes of pyuria include uric acid and hypercalcemic nephropathy and lithium and heavy metal toxicity. However, the most likely diagnosis is a urinary tract infection (UTI).A UTI is caused by micro-organisms, usually a bacterium called Escherichia coli getting into the urethra, or the upper urinary tract in the bladder or kidneys (Department of Health & Human Services 2018) The symptoms of a UTI are wanting to urinate more often and urgently, burning pain when urinating, a feeling that the bladder is still full after urinating, pain above the pubic bone, and cloudy, bloody or smelly urine (Department of Health & Human Services 2018). The urinalysis dipstick tests of her mid-stream urine sample would show a raised nitrites or leukocyte esterase: a product of white blood cells level showing an active infection.Detailed Underlying Pathophysiology (maximum 400 words)Two significant routes from which microbial pathogens infect urinary tract include:i. Ascending spread of the faecal floralii. Hematogenous spread (blood-borne)In this case, the pathogen seems to have passed in the urinary system through ascending spread. There are mainly two types of normal floral residing near the opening of the urethra: Staphylococcus epidermidis and Escherichia coli.About 95% of urinary tract infection occurs when the organism migrates from perineum through to the urethra then bladder and ultimately towards the kidney. Therefore, the incidence of sexually active women is greater, where the microorganisms from the faecal flora can be physically translocated from the short female urethra infecting the sterile urinary pathway (Abhay & Dasgupta, 2013).With Kerry having a past medical history of chlamydia and Gonorrhoea, it may be one of the causes as these pathogens may have recurred and entered her urinary pathway during the sexual activity. Similarly, the risk of urinary tract infection increases with multiple sexual partners.The introduction of pathogen organisms may result in inflammation of different urinary organs such as urethra, bladder, ureter and kidneys (Bullock & Hales, 2018).The following symptoms seen in Kerry is usually due to upper urinary tract infection (Kidneys and ureters):- Difficulty in urinating: Normally, urine is acidic in nature. With the infection, bacteria cause the urine to become highly alkaline, resulting in pain and difficult to pass urine.- Fever: When the defence of the urinary system against the microorganisms becomes overwhelmed, there is an overgrowth of bacteria resulting in fever.Similarly, When the lower urinary tract (urethra and bladder) is infected, the following symptoms are inflicted:- Frequency and urgency of urination: The discomfort results in feeling pressure in the bladder, causing frequent and urgent urination.- Suprapubic tenderness: tenderness near the lower abdomen is often interconnected with painful urination.Almost one among two women and one in about twenty men have urinary tract infection in their lifetime (Kidney Health Australia, 2016). 73,277 cases were found for the kidney as well as urinary tract infection in the year 2014-15 meaning 286 hospitalisations in 100,000 individuals (Australian Commission on Safety and Quality in Health Care, 2017). a. Non-Modifiable Risk Factors Examples Gender Females are 30 times more prone to get UTI as compared to males as the female urethra is smaller. Also, there is a short distance between the anus and urethral opening, making women more likely to suffer from UTI, especially during sexual activity. Age With increasing aging, there are changes in oestrogen hormone in women also, the presence of age-related bladder disorder, urinary as well as faecal incontinent increasing the risk of UTI. b. Modifiable Risk Factors Examples Incomplete urinary voiding Unable to empty the bladder can lead to a proliferation of bacteria in the urinary tract causing infection. Behaviours Sexual intercourse, as the pathogens may have entered the urinary pathway during the sexual activity. Metabolic factors Factors like diabetes mellitus result in elevated glucose levels in urine and reduction in the immune system, which reinforces the infection. (Bullock & Hales, 2018) (Abhay & Dasgupta, 2013)Critical Analysis – What are the management options? (maximum 400 words)Kerry is a 24-year-old female who has been experiencing increased urgency to urinate. She has stated that she has the urge to urinate every 5 minutes and when doing so she seems to experience a painful/burning urination. Kerry mentioned that this started happening since yesterday and thought it would go away once she would rest. She thinks it is because of the rough sex she had last night. Kerry has been sexually active at 16 years of age with multiple previous partners, she has always practised “safe sex”. She has had a history of both chlamydia and gonorrhea which was successfully treated with on-going antibiotics 2 years ago. A urinary tract infection (UTI) generally causes frequent urination, this happens when bacteria is introduced within the bladder through the urethra (Byram Healthcare, 2020). Sexual intercourse is a common way of bacteria entering the urinary tract therefore causing a UTI (Healthline, 2019). The management for most UTI’s is antibiotics, ural sachet, urine alkalinization, drinking fluids. In Kerry’s case depending on the intensity of her situation I would suggest prescribing her antibiotics if her symptoms prove to be intense, as antibiotics are usually the first response to infections. The antibiotics possibly prescribed for Kerry’s situation may include amoxicillin + clavulanate, cephalexin, nitrofurantoin, norfloxacin and trimethoprim. I would further encourage her to drink more fluids in order to reduce the acidity in the urine. I can also recommend ural sachets or urine alkalinization as alternative treatments depending on the intensity of her situation. Recommendation to pausing any type of sexual activity in order to assist healing and treatment management and to not potentially transmit the UTI to her partner. Symptoms usually require 1-2 days to show improvement and may require 7-14 days to complete treatment (Medline Plus, 2019). Therefore, follow-ups for final check-up and analysis of treatment is recommended to be undertaken between or after 1-2 weeks since beginning treatment (Medline Plus, 2019). However, if symptoms persist or worsen, it is advised to seek immediate medical attention from the doctor (Medline Plus, 2019). The pain management includes medications such as paracetamol, ibuprofen or naproxen. These medications do not require prescription, as they are easily obtained over-the-counter (OTC) and are known to reduce the pain and discomfort of UTIs.Critical Analysis – What is the likely outcome? (maximum 250 words)Explain what would indicate a return to health for the patient; or other possible outcomes (if relevant).Conclusion (maximum 150 words)Quick conclusion. Link it all together – your introduction, case study (patient), diagnosis, and treatment regime.