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 the 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. The last menstrual period was 4 weeks ago.
· Denies dysuria, genital lesions, or sores, but does mention occasional vaginal itching.
· 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 Jones’ cervix as revealed during the pelvic exam
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?
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 bacteria noted. 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?