Week 7 Assignment 1: Discussion: iHuman Case Study-Gonorrhea
**Discuss the questions that would be important to include when interviewing a patient
with this issue.
Why are you seeking help today? I have been having burning when I pee and vaginal discharge
for a few days. I was worried that I had another bladder infection, but these symptoms are a little
When did your pain with urination start? About three days ago
What are the events surrounding the start of your pain with urination? Well, it came on
pretty much with the discharge. It was hard to tell what’s what
Does anything make your pain with urination better or worse? Soaking in a warm bath helps
Do you have any other symptoms associated with painful urination? Well, yeah. The discharge I
told you about.
Have you had problems with painful urination like before? Yes, with my bladder infection
last year. But I’m wondering if this is really the same thing.
How often do you have pain with urination? Every time I pee.
What is the appearance, smell, texture and quantity of the vaginal discharge? Oh boy…I hate
having to answer these questions. Yellow, kind of mucousy, kind of creamy. Not too smelly.
Is there vaginal discomfort or itching? No, nothing like a yeast infection.
Are you sexually active? Yes, I am.
How often are you having intercourse? Well, let’s just say I like men and they like me. I’ve
been with a few different guys over the last 6 months. I haven’t done it with anyone since this
started a few days ago. The last time was maybe a week ago?
Are you having or have you had unprotected sex? Yeah, I guess so. Sometimes I forget about
condoms if I’ve been drinking. I’m on the pill, so I guess I’m protected that way.
Do you use precautions to prevent the transmission of sexual diseases? Nothing but the pill.
Do you have more than one sexual partner? Yes
Do you have new or multiple sexual partners with similar symptoms? Well, no one has told
me he has any problem.
Have you had any sexually transmitted disease? Not that I know of.
Do you have sex with men, women, or both? I’m heterosexual.
Are you taking any prescription medications? No, other than the pill.
Are you taking any over the counter medications? Yeah, sometimes I take ibuprofen with my
period. You know, like for cramps and headaches.
Do you have any pelvic pain? No
Do you have any blood in your urine? No
Do you have any genital sores or discharge? No sores, but I do have some vaginal discharge.
**Describe the clinical findings that may be present in a patient with this issue.
Symptoms are often nonspecific and may include increased vaginal discharge, dysuria,
urinary frequency, and intermenstrual or postcoital bleeding. If the infection has been longstanding,
symptoms can include low abdominal or low back pain (Dowell & Kirkcaldy, 2013)
**Are there any diagnostic studies that should be ordered on this patient? Why?
The Centers for Disease Control and Prevention (CDC) recommends testing on self- or
clinician-collected endocervical and vaginal swab specimens, as well as on urine
specimens. Nucleic acid amplification testing (NAAT) is the most sensitive and specific for
gonorrheal and chlamydial infections, and it also allows for testing on the widest variety of
specimen types (“Cervicitis Workup,” 2017).
**List the primary diagnosis and three differential diagnoses for this patient. Explain your
reasoning for each.
Primary diagnosis – Cervicitis: Culture-proven, uncomplicated gonorrhea
Candida vaginitis is a vaginal yeast infection that is caused by the organism
Candida albican that is a naturally occurring microorganism in the vaginal
area. Lactobacillus bacteria keeps its growth in check although if there’s an imbalance in your
system, these bacteria won’t work effectively (Martin Lopez, 2015). This leads to an overgrowth
of yeast, which causes the symptoms of vaginal yeast infections. Clinically a diagnosis is made
by the presence of external dysuria and vulvar pruritus, pain, swelling, and redness. Signs also
include vulvar edema, fissures, excoriations, and thick curdy vaginal discharge. This is not
supported by clinical & physical assessment.
Pelvic inflammatory disease (PID) is an infection of the upper part of the female reproductive
system namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis (Brunham,
Gottlieb & Paavonen, 2015). Signs and symptoms, when present may include lower abdominal
pain, vaginal discharge, fever, burning with urination, pain with sex, or irregular menstruation.
Untreated PID can result in long term complications including infertility, ectopic
pregnancy, chronic pelvic pain, and