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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.


Chief Complaint

“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

Physical Examination


Thin, young woman in NAD


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 ...

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