Response to Shu Zhang’s Post

Case study:

 

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Susan Lang is a 24-year-old Caucasian female presenting to the clinic for regular care. She works full-time as an administrative assistant, and relates she loves her job. She has no medical or surgical history, takes no medication, and has no allergies. Family history is non-contributary. Social history is remarkable for cigarette smoking at a rate of ½ packs per day (PPD) since age 14, / EtOH only on weekends, 6-8 hard liquor/ daily, and marijuana smoking. Gyn history is onset of menses age 13, menses every 28-32 days, lasting 4-6 day and using 3 tampons daily. She has some cramping during her menses for which she takes otc Pamprin. She jogs 3-4 times a week, wears seatbelts when in the car, and “occasionally” uses sunscreen. Susan relates she has been having some postcoital bleeding for the past 6 weeks and has had a sore throat for past 3 weeks. She did have a fever for a day or two, but Tylenol took care of it and she thought it was allergies. 

 

Susan’s vital signs are taken and were temperature 97.8, pulse 68, BP 112/64, height 5’6” and weight 118 lbs. (which was the same as last year). BMI 19.04 

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·        HEENT: WNL except some anterior cervical adenopathy bilaterally, and throat appears reddened. 

·        Lung: clear to auscultation 

·        CV:  regular sinus rhythms without murmur or gallop 

·        Abd:  soft, non-tender, liver normal,  

·        Breasts:  fibrocystic changes bilaterally, no masses, dimpling, redness or discharge, no adenopathy, and bilateral nipple piercings. 

·        VVBSU: wnl, slight frothy yellow discharge by cervix, clitoral piercing noted 

·        Cervix:  friable, some petechia no cervical motion tenderness. 

·        Uterus: mid mobile, non-tender 

·        Adnexa: without masses or tenderness 

·        Perineum: wnl 

·        Rectum: wnl 

·        Extremities:  full rom, skin clear, no edema, reflexes 1+. 

·        Neurological:  CN II-12 grossly intact. 

 

QUESTIONS:

 

1.      What other information do you need? 

2.      What testing would you perform/order? 

3.      What are your initial thoughts for diagnosis? 

 

Please respond to this post: You can put recommendations, suggestions on diagnosis and treatment on common Gynecologic conditions.

 

(Shu Zhang’s Post)

 

Young adult is at increased risk of sexual transmitted infections (STIs) and should receive behavioral counseling interventions (USPSTF, 2020). The sexual history is important to ask. The questions should include:

Are you sexual active currently?

Do you have sex with man or women or both?

What type of intercourse are you using, oral, anal, vaginal?

How many partners do you have in the past 12 months?

Have you ever been exposed to STIs?

Do you use protections during sex, female/male condom?

Do you have any pain during sex?

Are you on any kind of contraceptives?

When was you last menstrual period? Is your cycle regular?

STD screening of C. Trachomatis, N. Gonorrhoeae is recommended annually for sexually active females under 25 years old. HIV screening is a one time screening. If the patient has sex with multiple partners without use of condom, some other bacterial cultures should be included, like syphilis, trichomonas, and hepatitis B virus. For this client, bacterial cultures including C. Trachomatis, N. Gonorrhoeae, Syphilis, trichomonas, HIV, hepatitis B will be ordered.

The vaginal pH testing for bacterial vaginosis, and the microscopic presentation of trichomonads or the “clue” cells of bacterial vaginosis should be done in the office before the samples are sent out for cultures.

The cervicitis is suspected due to the friable, petechia cervix with slight frothy yellow discharge as well as the bleeding of intercourse. Cervicitis is a common STI and delay in diagnosis can cause pelvic inflammation disease, endometritis (Allen, 2018).

The empiric therapy is used for treatment. The C. trichromatic and N. Gonorrhoeae are the two most common causes of cervicitis. CDC recommends cover for chlamydia at a minimum. Moxifloxacin 400mg for 14 days is suggested. Tell all patients to avoid sexual intercourse until treatment is complete and for 7 days after completing any single-dose regiment (Allen, 2018).

 

RESOURCES: Please use one of these resources on top of other resources you may use for references. Thank you!

Schuiling, K. D., & Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Jones and Bartlett Publishers.

  • Chapter 15: “Breast Conditions” (pp. 357-378)
  • Chapter 16: “Alterations in Sexual Function” (pp. 379-393)
  • Chapter 17: “Unintended Pregnancy” (pp. 397-414)
  • Chapter 18: “Infertility” (pp. 419-439)
  • Chapter 19: “Gynecologic Infections” (pp. 443-462)
  • Chapter 20: “Sexually Transmitted Infections” (pp. 465-508)

 

Reproductive Health Access Project (2020). Your birth control choices. https://www.reproductiveaccess.org/wp-content/uploads/2014/06/contra_choices.pdf

 

Office of Women’s Health: Womenshealth.gov. (2017). Birth control methods. https://www.womenshealth.gov/a-z-topics/birth-control-methods

 

Clinical Guideline Resources 

As you review the following resources

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