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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 subjective and objective data consistent with genital herpes, gonorrhea, and chlamydia.

  • Recommend appropriate therapies for the treatment of genital herpes, gonorrhea, and chlamydia.

  • Provide effective and comprehensive counseling for patients with genital herpes, gonorrhea, and chlamydia.

  • Identify drug interactions of clinical significance and provide recommendations for managing them.

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PATIENT PRESENTATION

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Chief Complaint

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“I have painful sores in my genital area, and I have terrible headaches and muscle aches.”

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HPI

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Megan Thompson is a 19-year-old nulligravida woman who presents to the county health STD clinic for evaluation of genital lesions that have been present for 3 days. She has also noticed a white nonodorous vaginal discharge that has lasted 14 days. She admits to anal and vaginal intercourse with two regular partners in the last 60 days. It has been 5 days since her last sexual encounter.

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PMH

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  • Recurrent UTIs; most recent 3 months ago

  • Vaginal candidiasis; most recent 6 months ago

  • Gonorrhea 5 years ago

  • Trichomonas vaginalis 2 years ago

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FH

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Mother with type 2 DM; father died at age 50 of an acute MI

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SH

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Lives with her boyfriend and works at a local grocery store. She admits to occasional use of alcohol and marijuana.

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Meds

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  • Ethinyl estradiol and norethindrone (Junel) 21 1/20 one tablet PO daily

  • Multivitamin with iron one tablet PO daily

  • Ibuprofen 200 mg PO PRN

  • Ciprofloxacin 250 mg PO once daily

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All

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Penicillin (hives and tongue swelling)

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ROS

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(–) Cough, night sweats, weight loss, dysuria, or urinary frequency; (+) diarrhea and anorectal pain; LMP 6 weeks ago

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Physical Examination

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Gen
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Thin, young woman in NAD

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VS
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BP 136/71 mm Hg, P 78 bpm, RR 17, T 37.8°C; Wt 51 kg, Ht 5′5″

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Skin
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Dry, no lesions, normal color and temperature

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HEENT
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PERRLA, EOMI without nystagmus

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Neck
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Supple; no adenopathy, JVD, or thyromegaly.

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Chest
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Air entry equal; no crepitations or wheezing

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CV
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RRR, normal S1 and S2; no S3 or S4; no murmurs or rubs

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Abd
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Soft, mild tenderness to palpation in RLQ, (+) bowel sounds, no HSM

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Genit/Rect
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Tender inguinal adenopathy. External exam clear for nits and lice, several ...

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