ImportantQuestions to Include When Interviewing a Patient with This Issue
is a common sexually transmitted infection that is caused by thebacterium Neisseriagonorrhoeae(Workowski& Bolan, 2015). Notably, an interviewer should use the five P’sof sexual health to interview a patient. They denote Partners,Practices, Protection from STIs, Previous history of STIs andPrevention of pregnancy. Consequently, crucial questions to askinclude:
Have you had multiple sexual partners?
Do you use protection in case of sexual encounters?
Have you ever been diagnosed with a sexually transmitted disease (STI) before?
TheClinical Findings That May be Present in a Patient with This Issue
Apparently,clinical findings will differ from men to women. In men, the medicalpractitioner may note urethral discharge that is purulent ormucopurulent. Besides, this is often accompanied by dysuria, pain,swelling of the testes in men, and pain after spreading to other bodyparts (Unemo, 2015). In the ladies, the typical symptoms take longerto manifest compared to the case in men. They are commonly discoveredthrough a test, where a doctor may find that the patient hasrecurrent pain and tenderness in the lower abdomen, cervicaldischarge, and cervical bleeding is readily inducible (Workowski &Bolan, 2015). What is more, other findings include eye pain, lightsensitivity, and sore throats.
DiagnosticStudies That Should be Ordered on This Patient and Why
Inmen, a urethral swab is subjected to microscopic tests. In females,pelvic ultrasound and the high vaginal swab is recommended. A culturetest is then done to identify the type of bacteria amplifying thedisorder and resulting in uncontrollable spread (Unemo, 2015). Asensitivity study follows to determine the drugs necessary to dealwith the infection(Unemo& Shafer, 2014). Moreover, it is also vital since it leads tocrucial insights on whether the virus is resistant to the availabledrugs or multiple options are necessary for a synergy prescription.
ThePrimary Diagnosis and Three Differential Diagnoses for This Patientand a Reasoning for Each
Theprincipal diagnosis in male patients is urethritis whereas in femalesit is vaginosis. Notably, these show that the patient is sufferingfrom gonorrhea or chlamydia as the two infections usually occur inmany patients (Unemo, 2015). Differential diagnoses include:
Urinary tract infections, which imply that the patients have not exercised hygiene, in particular through cleaning and disinfection around their genitals, especially in females.
A pelvic inflammatory disease can be been due to an abortion or douching. Besides, untreated gonorrhea or chlamydia may recur back, necessitating the need for need for swift treatment (Lewis, 2014).
Epididymo-orchitis may be caused by a urinary tract infection through blockage of the urethra, a condition that can also occur in cases of post-prostatectomy.
TheManagement Plan for This Patient Including Pharmacologic Therapies,tests, Patient Education, Referrals, and Follow-Ups
Testingis ordered on the patient after which a syndromic approach managementof the infection is recommended. Pharmacologic therapies includeNorfloxacin 800mg, which is started immediately after a determinationthat the patient is infected with gonorrhea. Consequently, it isfollowed by doxycycline 100mg twice daily for one week, erythromycin500mg injections for pregnant women and some painkillers e.g. brufen400mg three times a day for three days (Workowski & Bolan, 2015).The patient is then counseled on the four C’s of management of theinfection namely: Compliance with the treatment, Condom use duringintercourse, Counseling and education on the infection andpreventative measures, including contacting their partners fortreatment(Lewis,2014). In most cases, gonorrhea will respond well to treatment. Incase there is no response, the patient should be referred fortreatment by a qualified specialist. Follow-up should be done after aweek to four weeks to ensure that there is no possibility ofrecurrence in future.
Lewis,D. A. (2014). Global resistance of Neisseria gonorrhoeae: when theorybecomes reality. Currentopinion in infectious diseases, 27(1),62-67.
Unemo,M. (2015). Current and future antimicrobial treatment ofgonorrhoea–the rapidly evolving Neisseria gonorrhoeae continues tochallenge. BMCinfectious diseases, 15(1),364.
Unemo,M., & Shafer, W. M. (2014). Antimicrobial resistance in Neisseriagonorrhoeae in the 21st century: past, evolution, andfuture. Clinicalmicrobiology reviews, 27(3),587-613.
Workowski,K. A., & Bolan, G. A. (2015). Sexually transmitted diseasestreatment guidelines (2015). ReproductiveEndocrinology,(24), 51-56.