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.)
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