H.R. is an 18-year-old Caucasian female college student who presented to the University clinic seeking advice regarding methods of contraception. Data collected during the interview revealed:
- shy talking about her sexual practices;
- no history of a pelvic exam;
- had three sexual partners in the past 6 months;
- no use of contraceptives;
- periods have been regular, but she has recently noted some spotting between periods;
- last menstrual period 4 weeks prior; and
- denies vaginal discharge, dyspareunia, genital lesions or sores.
Physical Exam:
- Vital signs: blood pressure 118/68, pulse 74 beats per minute, respirations 18 breaths per minute, and temperature 37.1° C.
- Breast, thyroid, and abdominal exam with expected findings.
- The genital exam reveals normal vulva and vagina.
- The cervix appears inflamed, bleeds easily, and has a purulent discharge coming from the cervical os.
- The bimanual exam is normal without cervical motion pain, uterine or adnexal tenderness.
Questions:
- Based on the patient’s history and physical exam, what diagnostic tests would you recommend? (Discuss at least three.)
- What teaching strategies would you recommend for this patient to promote healthy behaviors?
- What methods of sexually transmitted disease (STD) prevention and types of contraception would you suggest for this patient?
- What treatments would you recommend for this patient? (Identify at least two.)
