The priority diagnosis is Chlamydia trachomatis, a widespread disease that can hurt the reproductive health of the patient. The disease can go unnoticed but can cause severe damage to the reproductive system of a woman.
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Patient’s CC/HPI: symptoms similar to UTIs, started two days ago; severe lower abdominal pain, brown fouls smelling discharge (after unprotected sexual intercourse).
Current medications: none. Past medications: Trimethoprim, Sulfamethoxazole (SMX) rash. Claims to have no drug allergies. Review of systems WNL, except for increased suprapubic tenderness, cervical motion tenderness, adnexal tenderness, foul-smelling vaginal drainage. Family History: single, has three children, had multiple male sexual partners, lives with her new partner and children. PMH: Recurrent UTIs, chlamydia X 1, Gravida IV Para III, gonorrhea X2. PSH: Tubal ligation (two years ago).
BP: 100/80. HR: 80. RR: 16. T: 99.7 F. Wt: 120. Ht: 5’ 0”.
Laboratory/diagnostic tests: Lkc differential: Neutrophils 68%, Bands 7%, Lymphs 13%, Monos 8%, EOS 2%. UA: Straw colored; Sp gr 1.015; Ph 8.0. Protein, Glucose, Ketones negative. Bacteria – many; Lkcs 10- 15, RBC 0-1. Urine gram stain: Gram-negative rods. Vaginal discharge culture: Neisseria gonorrhoeae and Gram-negative diplococci pending; positive monoclonal AB for Chlamydia. KOH preparation/ Wet preparation/ VDRL – negative.
Three priority diagnoses: Neisseria gonorrhoeae, Chlamydia trachomatis, and UTI.
If the patient has Neisseria gonorrhoeae, it does not mean that all the symptoms specific to this disease will appear. Most women do not have any symptoms (“CDC fact sheet”, 2014). Symptoms of gonorrhea include painful urination, vaginal discharge (strong odor), also vaginal bleeding (“CDC fact sheet”, 2014). These symptoms correspond with the patient’s chief complaints (brown vaginal discharge and pain when urinating). The laboratory tests do not yet confirm that the patient has Neisseria gonorrhea.
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Chlamydia trachomatis is one of the most widespread sexual diseases in the United States. It can be transmitted through oral, vaginal, and anal sex. The symptoms in women include abnormal vaginal discharge, a sensation of “burning” during urination (“Chlamydia fact sheet”, 2014). The laboratory tests confirm that the patient has Chlamydia.
UTIs (urinary tract infections) are common disorders among the United States population, both in adults and children. Symptoms can vary, but are usually acute and severe, can include abdominal pain, burning sensations during urination, pain during urination (Olsen & Rizk, 2016). Moreover, any urogenital surgeries can be linked to these infections (Olsen & Rizk, 2016).
Plan of Care
C. trachomatis is a urogenital infection that can be treated in various ways with different medicine. To avoid any adverse impact on the reproductive health of the patient, C. trachomatis needs to be treated immediately. Moreover, the patient’s partner (or partners) needs to be tested as well. In case if the partners are infected too, they need to be treated as well. Pharmacological treatment of C. trachomatis can include azithromycin (1 g orally; single dose), erythromycin (500 mg, orally, 4 x day, 7 days), doxycycline (100 mg orally, 2 x day, 7 days) (“Chlamydial infections”, 2015). Both azithromycin and doxycycline are considered highly effective and were trialed in 12 randomized studies (“Chlamydial infections”, 2015). It is also advisable for the patient to be tested for other STDs, such as HIV and syphilis. Test-of-cure is not advisable if the patient has followed all recommendations and used the prescribed medicine.
Evaluation of Priority Diagnosis
The demands for the patient are the following: as she confirms having multiple sexual partners, she needs to be tested for C. trachomatis every year. To reduce and lower the risk of getting STDs, the patient should either have a long-term (mutually) monogamous relationship with a partner who is not diagnosed with STDs or use condoms whenever having sex (“Chlamydial infections”, 2015).
Although the patient had a tubal ligation, she should be warned that Chlamydia can have an extremely adverse impact on the fetus if the patient is infected during pregnancy.
To be sexually active, the patient should wait at least seven days after the treatment is fully finished (“Chlamydial infections”, 2015). If the partner of the patient was diagnosed with Chlamydia as well, she should wait until the partner’s treatment is fully completed.
Facilitators and Barriers
Understanding of facilitators and barriers in STDs management is crucial for successful treatment. The facilitators may be the following: one-to-one consultations with a physician, the right amount of time for a consultation, proactive and welcoming style of discussion. If such an approach is chosen, the patient will have the chance to discuss the treatment more freely. Moreover, the probability of mistrust between the patient and their physician will be lower.
Barriers to disorder treatment can be inaccurate information about the patient’s sexual and medical history and lack of feedback both from the physician and from the patient. These barriers can lead to misdiagnosis and unsuccessful, unnecessary treatments that can worsen the patient’s condition and lead to complications.
C. trachomatis is a widespread disease that can be transmitted through oral, vaginal, and anal sex. It can be cured with antibiotics; no follow-up is needed if the symptoms do not persist.
CDC fact sheet. (2014). Web.
Chlamydia fact sheet. (2014). Web.
Chlamydial infections. (2015). Web.
Olsen, M., & Rizk, B. (2016). Office care of women. Cambridge, UK: Cambridge University Press.