HLTH 6362 Week 8 Positive Test Case Response Example

Case Response: A Client at 24 Weeks Says an Urgent Care Test for Syphilis Came Back Positive and Asks Whether She Can Wait for Her Next Prenatal Visit, Answered From Guidance and Bounded by the Health Educator's Role

Student Name

Walden University

HLTH 6362: Sexual Health and Well-Being

Instructor Name

Month Day, Year

Case Response: A Client at 24 Weeks Says an Urgent Care Test for Syphilis Came Back Positive and Asks Whether She Can Wait for Her Next Prenatal Visit, Answered From Guidance and Bounded by the Health Educator's Role

The Scenario

A health educator at a community health center in South Dakota meets with a client for a scheduled nutrition session. The client, who is 24 weeks pregnant, mentions that she was tested for syphilis at an urgent care clinic last week, that the clinic called to say the result was positive and that she was told to follow up. Her next prenatal visit is at 30 weeks. She asks whether she can wait until then.

The Question Actually Being Asked

The client's question is about timing, but the professional question underneath it is narrower: what must happen, and how soon, for a positive syphilis test in pregnancy to protect the baby, and what is the health educator's part in making it happen? The answer does not depend on the educator's opinion of the client's choices.

The Answer From Guidance

Timing matters. CDC's treatment guidelines describe adequate treatment in pregnancy as a penicillin regimen appropriate to the stage of infection, and for preventing congenital syphilis that treatment must begin at least 30 days before delivery (Workowski et al., 2021). At 24 weeks, there is time, but a six-week wait for the next routine visit would use much of it, and a positive screening test still has to be confirmed and staged before the right regimen can be chosen.

Delay is a known path to congenital syphilis. National analyses of congenital cases found that inadequate treatment despite timely diagnosis was the single most common missed prevention opportunity in 2018 (Kimball et al., 2020), and that gaps in timely testing and adequate treatment contributed to 88% of cases in 2022 (McDonald et al., 2023). A positive test that is not acted on is exactly the gap those analyses describe.

State guidance supports acting now. The South Dakota Department of Health asks providers to screen pregnant women three times and to extend screening to urgent care and emergency settings precisely so that infections are found and treated in time (South Dakota Department of Health, 2025).

The response to the client is therefore: no, it should not wait. The result needs clinical follow-up this week, not at 30 weeks.

What the Health Educator Does

The educator's actions are practical and within role:

1. Tell the client, plainly and without alarm, that the guidance is to follow up on a positive result promptly in pregnancy and that treatment works best when it starts early.

2. With the client's permission, contact the center's prenatal provider or nurse today to arrange an appointment, rather than leaving the client to call.

3. Ask whether the client can obtain the urgent care result or authorize the center to request it, so the provider has it before the visit.

4. Explain that partner testing and treatment are part of preventing reinfection and that the health department offers confidential partner services, without asking the client to name anyone to the educator.

5. Document the conversation and the referral according to the center's procedures.

Where the Educator's Role Ends

The educator does not interpret the test, determine the stage, choose or schedule treatment or advise on medication. Those decisions belong to the prenatal provider under CDC guidance. The educator also does not report the case to the health department; reporting is handled by the testing laboratory and the treating clinicians. The educator's responsibility ends once the client has a confirmed appointment and knows why it matters, with a note in the record that the referral was made.

What the Response Avoids

The response avoids any comment on how the client acquired the infection or on her decision to seek care at urgent care, and it does not frame the delay as her failure. The guidance concerns timing and access, and so does the answer.

References

Kimball, A., Torrone, E., Miele, K., Bachmann, L., Thorpe, P., Weinstock, H., & Bowen, V. (2020). Missed opportunities for prevention of congenital syphilis, United States, 2018. Morbidity and Mortality Weekly Report, 69(22), 661-665. https://doi.org/10.15585/mmwr.mm6922a1

McDonald, R., O'Callaghan, K., Torrone, E., Barbee, L., Grey, J., Jackson, D., Woodworth, K., Olsen, E., Ludovic, J., Mayes, N., Chen, S., Wingard, R., Johnson Jones, M., Drame, F., Bachmann, L., Romaguera, R., & Mena, L. (2023). Vital signs: Missed opportunities for preventing congenital syphilis, United States, 2022. Morbidity and Mortality Weekly Report, 72(46), 1269-1274. https://doi.org/10.15585/mmwr.mm7246e1

South Dakota Department of Health. (2025). Syphilis in South Dakota: 2024 data and health care guidance.

Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021). Sexually transmitted infections treatment guidelines, 2021. MMWR Recommendations and Reports, 70(4), 1-187. https://doi.org/10.15585/mmwr.rr7004a1