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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Identify relevant information from patient history, physical examination, and laboratory data suggestive of the diagnosis of a sexually transmitted infection (STI).

  • List major complications of STIs and appropriate strategies for prevention and/or treatment.

  • Discuss other health issues that may be present in patients referred for treatment of STIs, including immunization needs and risk reduction.

  • Provide appropriate treatment plans for patients with STIs, including drug(s), dosage form, doses, route of administration, frequency, duration, and monitoring.

  • Compare and contrast criteria and options for ambulatory and inpatient treatment of women with pelvic inflammatory disease (PID).

  • Recognize opportunities and provide appropriate recommendations for immunizations, including human papillomavirus (HPV) vaccine.

  • Develop patient counseling strategies regarding drug treatment and possible adverse effects.

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PATIENT PRESENTATION 1

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Chief Complaint

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“My lady and I don’t feel good.”

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HPI

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Frankie Mason is a 20-year-old man who presents to a health clinic with complaints of 5 days of painful urination and increasing amounts of discolored urethral discharge. Today, he noted four painful blisters on the penis. He is single, heterosexual, sexually active with two to three concurrent partners, and admits to unprotected sex “at least once” in the past 2 weeks. He does not know the sexual histories of his current or past sexual partners or their sexual partners and he admits to over 15 lifetime sexual partners. He denies oral or rectal intercourse.

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PMH

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History of genital herpes 2 years ago. He has not undergone testing for HIV. He has been immunized against hepatitis B but has not been immunized against HPV as “it’s only for women.” He is unaware of hepatitis A or C as infectious diseases, asking “Do you get that from sex or restaurant food?” No active medical problems.

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FH

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Noncontributory

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SH

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Denies IV drug and cigarette use; has two to four beers “on weekends”; may be unreliable in keeping follow-up appointments because he states, “I don’t like doctors.”

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Meds

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None

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All

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Ciprofloxacin (“makes me dizzy”)

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ROS

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Occasional headaches; denies stomach pain, constipation, vision problems, night sweats, weight loss, or fatigue

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Physical Examination

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Gen
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Patient is a well-developed male in NAD, very talkative

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VS
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BP 104/80, HR 72, RR 12, T 37.6°C; Wt 78 kg

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Skin
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No rashes or other lesions seen

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HEENT
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No erythema of pharynx or oral ulcers

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Neck/Lymph Nodes
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No lymphadenopathy; neck ...

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