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After completing this case study, the reader should be able to:
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.
“I have painful sores in my genital area, and I have terrible headaches and muscle aches.”
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.
Recurrent UTIs; most recent 3 months ago
Vaginal candidiasis; most recent 6 months ago
Gonorrhea 5 years ago
Trichomonas vaginalis 2 years ago
Mother with type 2 DM; father died at age 50 of an acute MI
Lives with her boyfriend and works at a local grocery store. She admits to occasional use of alcohol and marijuana.
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
Penicillin (hives and tongue swelling)
(–) Cough, night sweats, weight loss, dysuria, or urinary frequency; (+) diarrhea and anorectal pain; LMP 6 weeks ago
BP 136/71 mm Hg, P 78 bpm, RR 17, T 37.8°C; Wt 51 kg, Ht 5′5″
Dry, no lesions, normal color and temperature
PERRLA, EOMI without nystagmus
Supple; no adenopathy, JVD, or thyromegaly.
Air entry equal; no crepitations or wheezing
RRR, normal S1 and S2; no S3 or S4; no murmurs or rubs
Soft, mild tenderness to palpation in RLQ, (+) bowel ...