A 16-year-old girl presents with frequent need to urinate, a

Discussion in 'USMLE Step 2 CK' started by Guest, Jan 3, 2009.

  1. Guest

    Guest Guest

    A 16-year-old girl presents with frequent need to urinate, a burning sensation upon urinating, and the accompaniment of a purulent, mildly odorous urethral discharge. The symptoms started during her last menstrual period. She said that in her whole life she has only had sex once with the captain of her high school football team after he led the team to the conference championship. That event took place about the week before her period.

    A: Herpes simplex virus-2 (HSV-2)
    B: Neisseria gonorrhea
    C: Haemophilus ducreyi
    D: Chlamydia trachomatis immunotypes D–K
    E: Treponema pallidum
    F: Granuloma inguinale
    G: Lymphogranuloma venereum (LGV
  2. Guest

    Guest Guest

    This young woman most likely has gonorrhea caused by Neisseria gonorrhea (choice B). Diagnosis can be confirmed by a Gram's stain of a smear, culture, or DNA analysis based on the ligase chain reaction. Although culture is the classic “gold standard,” DNA analysis is quicker, is more sensitive, and also identifies chlamydial coinfection. Although the annual incidence has decreased since the 1970s, in 2002 it was estimated to be about 700,000 cases, 75% of which occurred in females between the ages of 15 and 19 years or in males between the ages of 20 and 24 years. Females are first infected in the cervix and can remain symptomless. Symptoms are sometimes provoked by the onset of a period, but they can also be very mild and be overlooked. Infection can then spread from the cervix into the uterus and upward into the fallopian tubes causing pelvic inflammatory disease (PID). The patient with PID has crampy or constant pelvic pain and menorrhagia or intermenstrual irregular bleeding and may have fever and nausea. Ectopic pregnancy can result because of a blocked fallopian tube, and infertility is the usual outcome. Treatment with penicillin or tetracycline is no longer recommended because of microbial resistance. Instead, oral cefixime, ceftriaxone, ciprofloxacin, or ofloxacin is used, generally with doxycycline or azithromycin to treat possible coinfection with chlamydia.

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