Question

Suzy Jones is an 18-year-old college student who presents to the Student Health Center seeking advice. • White female college student - Seeking advice about contraception and a current problem down there about a slight discharge - Shy talking about her sexual practices - Has never had a pelvic exam - Has had 2 sex partners in past 4 months - Does not use condoms or any other contraceptives Her periods have been regular, but she has recently noted some spotting between periods. Last menstrual period was 4 weeks ago - Denies dysuria, genital lesions or sores, but does mention occasional vaginal itching Physical Exam -Vital signs: blood pressure 118/68. pulse 74.respiration 18, temperature 37.1°C - Breast, thyroid, and abdominal exam within normal limits - The pelvic exam reveals normal vulva, and vagina. - The cervix appears inflamed, bleeds easily, with a purulent discharge coming from the cervical os. A slight amount of vaginal discharge is noted. The bi-manual exam is normal without cervical pain, uterine or adnexal tenderness. Suzy's cervix at pelvic exam Questions 1. Based on Suzy's history and physical exam, what do you suspect? 2. Which laboratory tests should be ordered or performed? 3. What is the appropriate treatment at the initial visit? Laboratory Results The test results are back from the laboratory for Suzy Jones: Serological test for syphilis - negative Serological test for Neisseria gonorrhea - negative • Direct Unstained Wet mount-pH 4.2.no abnormal epithelial cells trichomonas or excessive bacterianoted But numerous white blood cells are present • KOH (potassium hydroxide) wet mount screening for Candida albicans yeast-negative • HIV antibody test-negative • Pregnancy test - negative Suzy is coming in later today to discuss her lab results. What are you going to tell her? After reviewing these results are there any additional laboratory tests you believe are appropriate to look for other pathogens?

Answer 1

1.The history and physical examination of the patient leads to suspecting cervicitis.(spotting between periods,vaginal discharge,virulent discharge from cervix,active and unprotected sexual life)

2.The following laboratory tests can be ordered

• Infectious disease (HIV,HCV)
• Veneral disease screening
• Pregnancy test
• Wet mount test
• Cervical swab test

3.The appropriate treatment are

• Antifungal to treat any fungal infection.
• Symptomatic treatment ti relieve inflammation

The patient has to be informed the laboratory tests vales are within normal limits and no suspected infection

• Human papillomavirus test
• Cervical swab
• CBC to rule out any infection
• Urine test to confirm no urinary tract problems