Diagnosis and Differentials
Diagnostic labeling or diagnosis may be initial, subsequent, or final, implying that it might alter over time. The first impression or diagnosis is formed at the first contact with a patient. Gonorrhea is a disease caused by Neisseria gonorrhoeae that causes a purulent infection of the mucous membrane surface (Montaño et al., 2019). Sexual contact is the primary mode of transmission. The center for disease control advises that every patient presenting with gonorrhea be medicated for suspected Chlamydia trachomatis coinfection.
Chlamydial infection may manifest itself clinically in a variety of organ systems, including the genitourinary tract. Chlamydiae are obligatory intracellular bacteria that invade squamocolumnar epithelial cells selectively (Montaño et al., 2019). C trachomatis infection is the most often reported bacterial sexually transmitted illness, affecting the cervix, urethra, salpinges, uterus, nasopharynx, and epididymis.
What Other Information do you Need?
It is critical to get a thorough account of the chief complaint, with a particular focus on the chronology (when the issue began and how it progressed over time) and the severity of the symptoms (how much the problem is affecting the patient). Endometriosis and pelvic inflammatory disease are the two most common causes of persistent gynecological pain (Glynn and Drake, 2018). As a result, it is critical to get a thorough history of lower abdominal discomfort. Assess the location, onset, nature, recurrence, related, aggravating, and time of pain.
Menstrual history is required in premenopausal women. Inquire about menarche, menstrual loss days, and the length of the gap, as well as any bleeding issues that are not associated with periods. Even if vaginal discharge is not a chief complaint, inquire about it. If there is a troubling discharge, inquire about its color, smell, quantity, and existence of blood and if there is an accompanying vulval irritation, and, if so, whether there are other irritating locations.
A comprehensive sexual history would be relevant since this is a primary complaint. Ascertain if the patient has ever had a sexually transmitted infection in the past. Enquire whether the sexual symptoms are accompanied by vaginal bleeding.
In the past medical and surgical history, numerous patients would state unequivocally that they have had specific diseases or have had certain symptoms using medical language. It is usually necessary to establish prior hospitalizations and therapy or surgical operations performed in the hospital (Glynn and Drake, 2018). Enquire about any previous instances where the patient underwent a blood transfusion. Familiarity with previous medicines, their success or failure, is a beneficial observation. Inquire about any herbal medications used and also about any adverse responses to any medicine.
During the review of systems, ask the patients questions that will help to fill in any symptoms that may have been missed during the history section. If the specific questions have already been addressed in the history, there is no need to mention them again in the review.
During the general examination, make a rapid evaluation of the patient’s disease severity by determining whether he or she seems to be healthy, moderately unwell, or seriously ill. Please inquire about the patient’s posture and demeanor; this provides insight into their disease. Assess the patient’s consciousness; use the Glasgow coma scale to determine if the patient seems aware, disoriented, sleepy, or profoundly unconscious (Glynn and Drake, 2018). Finally, ensure that you have information about the general parameters; pallor, jaundice, cyanosis, lymphadenopathy, edema, and dehydration levels.
Next Steps
Culture is the most often used diagnostic test for gonorrhea, followed by a DNA probe and a polymerase chain reaction (PCR) assay. The gold standard for diagnosing bacterial infections in all conceivable sites is a particular culture from the site of illness. To treat minor vaginal, anorectal, or oral gonococcal infection, a drug regimen including ceftriaxone and either azithromycin or doxycycline may be utilized.
The basics of managing chlamydial infections are first to make an accurate diagnosis and ensure that the patient adheres to therapy. Chlamydia infection that is left untreated may develop to pelvic inflammatory disease (PID), which can result in relative or total infertility (In Bickerstaff and In Kenny, 2017).
Commence antibiotic treatment immediately and explore treatment for potential gonorrhea coinfection.
Ceftriaxone 500 milligrams intramuscularly is used to treat mild vaginal, anorectal, and gonococcal throat infections. To treat gonococcal coinfection with Chlamydia trachomatis, one can use oral doxycycline (100 mg 12 hours for seven days). Cefixime 400 mg oral dose did not reach the same level of bactericidal activity or duration as ceftriaxone 250 mg oral dose, resulting in a decreased cure rate for pharyngeal gonorrhea (In Bickerstaff and In Kenny, 2017). Advise the patient to schedule an appointment with a primary care physician or a public health expert to reduce the chance of recurrence.
Antibiotic treatment is 95 percent successful when used for the first time. If therapy is started early and the full course of antibiotics is finished, the prognosis is good. While treatment failures with main treatments are uncommon, relapses with relative therapies are possible (In Bickerstaff and In Kenny, 2017). Reinfection is frequent and is associated with the failure to treat infected sex encounters or acquire a new partner; thus, all sex partners should be treated if possible.
References
Glynn, M. & Drake, W. M. (2018). Hutchison’s clinical methods: An integrated approach to clinical practice (24th edition.). Edinburgh: Elsevier.
In Bickerstaff, H., & In Kenny, L. C. (2017). Gynecology by ten teachers.
Montaño, M. A., Dombrowski, J. C., Dasgupta, S., Golden, M. R., Duerr, A., Manhart, L. E.,… & Khosropour, C. M. (2019). Changes in sexual behavior and STI diagnoses among MSM initiating PrEP in a clinic setting. AIDS and Behavior, 23(2), 548-555. Web.