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INTRODUCTION

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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

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PATIENT PRESENTATION

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Chief Complaint

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"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."

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History of Present Illness

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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.

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Past Medical History

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HTN diagnosed 7 years ago

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Type 2 DM diagnosed 5 years ago

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Hyperlipidemia diagnosed 1 year ago

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Back pain from car accident that occurred 3 months ago

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Family History

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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.

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Social History

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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 ...

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