Chapter 136: Genital Herpes, Gonococcal, and Chlamydial Infections: Triple Threat Level II

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LEARNING OBJECTIVES

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.

PATIENT PRESENTATION

Chief Complaint

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

HPI

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.

PMH

• Recurrent UTIs; most recent 3 months ago

• Vaginal candidiasis; most recent 6 months ago

• Gonorrhea 5 years ago

• Trichomonas vaginalis 2 years ago

FH

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

SH

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

Meds

• 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

All

Penicillin (hives and tongue swelling)

ROS

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

Physical Examination

Gen

Thin, young woman in NAD

VS

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

Skin

Dry, no lesions, normal color and temperature

HEENT

PERRLA, EOMI without nystagmus

Neck

Supple; no adenopathy, JVD, or thyromegaly.

Chest

Air entry equal; no crepitations or wheezing

CV

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

Abd

Soft, mild tenderness to palpation in RLQ, (+) bowel ...