tailieunhanh - Tình huống sản khoa - Tình huống 10

Tham khảo tài liệu 'tình huống sản khoa - tình huống 10', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 9 A 22-year-old nulliparous woman complains of a 2-week history of vaginal discharge and vaginal spotting after intercourse. She denies a history of sexually transmitted diseases and currently does not use any contraceptive agents. Her past medical history is unremarkable. Her last menstrual period began 1 week ago and was normal. On examination. her BP is 100 60 HR 80 min and temperature is 99 F. The heart and lung examinations are normal. Her abdomen is nontender and without masses. 1 ler pelvic examination shows purulent vaginal discharge which on Gram s stain shows intracellular gram-negative diplo-cocci. Her pregnancy test is negative. What is the most likely diagnosis What is the next step in therapy What are the complications of this problem NS cASE EILES OBSTETRICS AND GYNECOLOGY ANSWERS TO CASE 9 Gonococcal Cervicitis Summary A 22-ycar-old nonpregnant nulliparous woman complains of a vaginal discharge and postcoital spotting. A purulent vaginal discharge on Gram s stain shows intracellular gram-negative diplococci. Most likely diagnosis Gonococcal cervicitis. Next step in therapy Intramuscular ceftriaxone for gonorrhea and oral azithromycin or doxycycline for chlamydial infection. Complications of this problem Salpingitis which may lead to infertility or increased risk of ectopic pregnancy. Disseminated gonorrhea is also possible. Analysis Objectives 1. Know that gram-negative intracellular diplococci are highly suggestive of Neisseria gonorrhoeas. 2. Know the clinical presentation and treatment of gonococcal cervicitis. 3. Understand the complications of gonococcal cervicitis. Considerations This 22-year-old nulliparous woman complains of a vaginal discharge and postcoital spotting. The first disease that should be ruled out with abnormal vaginal bleeding is a pregnancy-related disorder such as ectopic pregnancy or threatened abortion. In this case the patient s pregnancy test is negative. The purulent vaginal discharge is found to be diagnostic of .