Sexually transmitted diseases are a common occurrence in reproductive-aged populations. Clinical presentation varies from asymptomatic to severe types, and complications depend on the type of causative organism. STD pathogens can be viruses, bacteria, or fungi; thus, specific laboratory tests are crucial in diagnosis. This paper analyses the case of a 36-year-old woman who presents with signs indicative of an STI. It also elucidates on inflammatory markers and infertility in the context of STDs and briefly discusses anemia types and splenectomy in ITP.
The patient presents with non-specific symptoms like fever (103.2 F), chills, and vomiting in this clinical case. However, the presence of abnormal vaginal discharge points to a gynecological issue. The patient confirms she is sexually active, which increases the probability of a sexually transmitted infection. Complaints of LLQ pain and bilateral back pain correspond to an STD infection but are not diagnostic. Notably, the patient’s lab values indicate ESR and C-reactive protein (CRP) levels are above normal. CRP and ESR are inflammatory markers, and their elevation is connotative of systemic inflammation (Azizia et al., 2018).
The patient also has concurrent conditions, that is, anemia and immune thrombocytopenia (ITP). Pelvic examination results provide a more comprehensive picture of the patient’s condition. The presence of copious amounts of foul-smelling green cervical discharge is consistent with bacterial STIs. The wet prep test confirms this diagnosis as it shows clue cells (bacterial vaginosis) and gram-negative diplococci (Neisseria gonorrhoeae) (Wang et al., 2020). A reddened cervix is also a consistent finding in gonorrhea. The patient also presents with a positive Chandelier sign and bilateral adnexal tenderness, which is diagnostic of pelvic inflammatory disease (PID) (Cortes & Adamski, 2020). PID can emanate from infection by Neisseria gonorrhea and also presents with abdominal pain.
Infertility is a common complication of STIs in both men and women. Empirical evidence consistently demonstrates the role of Neisseria gonorrhoeae and Chlamydia trachomatis in causing infertility (Tsevat et al., 2017). These pathogens cause tubal inflammation, scarring, and damage, which subsequently leads to infertility. Similarly, gonorrhea infections cause PID, which is strongly linked to tubal factor infertility (TFI) (Tsevat et al., 2017). Lack of treatment or poor management of STIs also contributes to infertility. An essential clinical finding in STI and PID is the elevation of inflammatory markers (ESR and CRP). The inflammation process increases the entry of fibrinogen in the bloodstream, which then causes adhesion between RBCs, subsequently leading to raised ESR (Azizia et al., 2018). Similarly, disease activity in STIs increases the production of proinflammatory cytokines (IL6 and IL-1) that stimulate the liver to synthesize more CRP. This, therefore, explains why CRP levels rise in PID and consequently fall when the disease resolves.
ITP treatment involves medical therapies and splenectomy in cases whereby medication is ineffective. The spleen is the primary site for autoantibody production and platelet clearance (Chaturvedi et al., 2018). Therefore, spleen removal relieves symptoms and reduces the progression of ITP. Since the patient is anemic, identifying the type of anemia is instrumental in determining the mode of treatment. Anemia can be broadly classified as macrocytic, microcytic, or normocytic. Microcytic include iron-deficiency anemia, sideroblastic anemia, thalassemia, and anemia of chronic diseases. The macrocytic group comprises megaloblastic and pernicious anemia, while the normocytic category consists of all conditions associated with increased intravascular and extravascular hemolysis. Complications of STIs are detrimental; therefore, accurate diagnosis and treatment are crucial. Medication therapy should also consider other concurrent diseases that the patient may have.
References
Azizia, M. M., Irvine, L. M., Coker, M., & Sanusi, F. A. (2018). The role of c-reactive protein in modern obstetric and gynecological practice. Acta Obstetricia et Gynecologica Scandinavica, 85(4), 394–401.
Chaturvedi, S., Arnold, D. M., & McCrae, K. R. (2018). Splenectomy for immune thrombocytopenia: down but not out. Blood, 131(11), 1172–1182.
Cortes, E. G., & Adamski, J. J. (2020). Chandelier Sign. PubMed; StatPearls Publishing.
Tsevat, D. G., Wiesenfeld, H. C., Parks, C., & Peipert, J. F. (2017). Sexually transmitted diseases and infertility. American Journal of Obstetrics and Gynecology, 216(1), 1–9.
Wang, Q.-Q., Zhang, R.-L., Liu, Q.-Z., Xu, J.-H., Su, X.-H., Yin, Y.-P., & Qi, S.-Z. (2020). 2019 National guidelines on diagnosis and treatment of gonorrhea. International Journal of Dermatology and Venereology, 3(3), 1.