CASE LEARNING OBJECTIVES
Recognize the signs and symptoms of gonorrhea, chlamydia, and type 2 herpes simplex
Identify the pertinent diagnostic techniques and goals of therapy
Develop an appropriate treatment and monitoring plan for the infection(s)
Select an appropriate pharmacologic agent to treat the infection(s)
Educate the patient regarding the administration of medications and the importance of self-care
"I have been having pain when I urinate. I tried an over-the-counter drug, but it didn't help. I just can't take it anymore. And please don't forget to refill all of my narcotics. Last time, the nurse only called in one of them."
History of Present Illness
Carmen Rodriguez is a 47-year-old Latin American female who regularly visits the local community health center for a myriad of health reasons, with the latest visit revolving around complaints of a purulent, vaginal discharge and pain on urination. After self-testing with an OTC urinary tract infection testing kit and detecting a positive result, she subsequently began orally taking phenazopyridine for 4 days with minimal relief. She admits that her dysuric symptoms commenced approximately 10 days prior and have worsened over the past 2 days. Additionally, she admits to observing a cluster of small, painful, itchy bumps in her vaginal area. When asked by the clinician to describe her recent sexual history, she acknowledged that she does not have a steady boyfriend and that she currently engages in frequent sexual activity with 2 men, one of which she traveled to Hawaii with last week for vacation. Finally, as she requested a refill on her narcotics and her BP, cholesterol, and diabetic medications, she divulged that she felt "tingling" in her hands and feet and that she has been constipated for 3 days although she has been taking docusate sodium for 2 consecutive days.
HTN diagnosed 7 years ago
Type 2 DM diagnosed 5 years ago
Hyperlipidemia diagnosed 1 year ago
Back pain from car accident that occurred 3 months ago
The patient's father had CAD and died of an MI at age 70. Her mother is alive at age 64 with HTN, diabetes, and osteoporosis. She has 2 sisters, one of whom was recently diagnosed with diabetes.
The patient migrated to the United States at age 16 from Mexico. She speaks fluent Spanish and English, and is a single mother, who lives alone with one son, age 20, from a previous marriage. As a result of the recession, her original job as a receptionist for a car dealership was terminated 4 months ago. She was recently hired (3 weeks prior to her visit) as a receptionist for a prominent law ...