Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis, and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.
Microscopic Examination of Vaginal Discharge
(-) yeast or hyphae
(-) flagellated microbes
(+) white blood cells
(+) gram-negative intracellular diplococci
Case Study 2 Questions:
According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probable diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.
Based on the vaginal discharge described and the microscopic examination of the sample, could you suggest which would be the microorganism involved?
Name the criteria you would use to recommend hospitalization for this patient.
Diagnosis and Microorganism Involved in Ms. P.C.'s Case
Based on the clinical manifestations and microscopic examination of the vaginal discharge, the most probable diagnosis for Ms. P.C. is gonorrhea. The presence of lower abdominal pain, nausea, emesis, and a heavy, malodorous vaginal discharge, along with the absence of yeast or hyphae, flagellated microbes, and the presence of gram-negative intracellular diplococci, strongly suggest a gonorrheal infection.
Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The symptoms described by Ms. P.C., such as the abnormal vaginal discharge (thick, greenish-yellow, and foul-smelling), are consistent with the characteristic discharge seen in gonorrhea cases.
The microscopic examination revealing gram-negative intracellular diplococci further supports the diagnosis. This finding is highly specific to Neisseria gonorrhoeae, as it tends to invade and multiply within the epithelial cells of the genitourinary tract.
Criteria for Recommending Hospitalization
In Ms. P.C.'s case, hospitalization may be recommended based on the following criteria:
Severe Symptoms: If the patient's symptoms, such as lower abdominal pain and nausea, are severe and indicate a potential complication of gonorrhea, hospitalization may be necessary for closer monitoring and more aggressive treatment.
Inability to Tolerate Oral Medications: If Ms. P.C. is unable to tolerate oral medications due to persistent vomiting or inability to keep anything down, hospitalization may be required to administer intravenous (IV) antibiotics and ensure adequate hydration.
Systemic Signs of Infection: If there are signs of systemic infection, such as high fever, elevated heart rate, or low blood pressure, hospitalization may be necessary for prompt intervention and management of potential complications.
Pregnancy: If Ms. P.C. is pregnant, hospitalization may be recommended to closely monitor both her health and the health of the fetus. Gonorrhea can lead to serious complications during pregnancy if left untreated.
Patient Non-Compliance: If there is concern about the patient's ability to adhere to outpatient treatment plans, including taking medications as prescribed or attending follow-up appointments, hospitalization may be considered to ensure proper treatment and minimize the risk of complications.
Hospitalization would provide a controlled environment where Ms. P.C.'s condition can be closely monitored, and appropriate medical interventions can be administered promptly. It would also facilitate patient education on safe sexual practices and partner notification strategies to prevent further transmission of the infection.