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Ms. P. C., a young white female patient, reported a history of a heavy, malodorous vaginal discharge, lower abdominal pain, emesis, and nausea. On the basis of patient data, patient intake, clinical manifestations, and the vaginal discharges microscopic examination, it is possible to conclude that the most probable diagnosis for Ms. P.C. is a pelvic inflammatory disease (PID). It is defined as an infection-induced inflammation of the female upper reproductive tract (the endometrium, fallopian tubes, ovaries, or pelvic peritoneum) predominantly caused by sexually-transmitted pathogens (Brunham, et al., 2015, p. 2039). There are several signs that help to diagnose this case in the patient.
First of all, the patients recent unprotected sex with a partner whose health condition is unknown may be indicative of sexually transmitted disease. During the microscopic examination of the patients vaginal discharge, white blood cells and gram-negative intracellular diplococci were detected. This combination reveals the presence of the bacterium Neisseria gonorrhoeae that causes gonorrhea or gonococcal infection (Banasik, 2018). In fact, the highest rates of this sexually transmitted disease are currently detected among young females and adolescents (ages 15 to 24 years) (Banasik, 2018). However, the symptoms mentioned by Ms. P. C. are not fully corresponded with the typical symptoms of gonorrhea that may include fever, the joints pain and swelling, and skin rashes.
At the same time, a gonococcal infection may spread to other organs and cause localized infections as well. In the case of Ms. P. C., the infection of the oviducts or other organs of the female upper reproductive tract led to PID (Banasik, 2018). Moreover, the risk of PID after a gonococcal infection is considerably high (Brunham, et al., 2015). It is possible to suppose the previous occurrence of clinically silent gonococcal infection, however, the patients potentially retrograde menstruation and sexual intercourse provoked the pathogens movement from the lower to the upper genital tract (Brunham, et al., 2015).
According to Brunham, et al. (2015), PID is particularly common among sexually active young and adolescent women, who are most often treated in ambulatory clinics, physician offices, or emergency departments (p. 2040). Lower abdominal pain may be regarded as the PIDs classic symptom, and other evidence traditionally include abnormal yellow-green malodorous vaginal discharge, nausea, and emesis. However, a substantial number of women have an asymptomatic course of PID.
The symptoms of Ms. P. C. indicate severe inflammation and require antibiotic treatment. As a matter of fact, PID may have multiple negative consequences for womens health, including reproductive disability, chronic pelvic pain, and infertility (Brunham, et al., 2015). In addition, the PIDs clinical diagnosis is frequently imprecise and inadequately treated (Das, et al., 2016). A patient may require additional analysis and interventions, such as MRI, transvaginal ultrasonography, and transcervical endometrial aspiration (Brunham, et al., 2015). If PID is suspected, a patient should undergo cervical or vaginal nucleic acid amplification tests to confirm the presence of Neisseria gonorrhoeae infection (Brunham, et al., 2015). Laparoscopy is generally considered the standard and most efficient method of PID diagnosis. However, this invasive surgical procedure is not available in multiple clinical settings, and it is not used for patients with mild-to-moderate symptoms. In addition, the patients hospitalization is highly recommended in the case of her pregnancy in order to minimize the risk of infection for a fetus.
References
Banasik, J. L. (2018). Pathophysiology (6th ed.). Saunders.
Brunham, R. C., Gottlieb, S. L., & Paavonen, J. (2015). Pelvic inflammatory disease. The New England Journal of Medicine, 372, 2039-2048.
Das, B. B., Ronda, J., & Trent, M. (2016). Pelvic inflammatory disease: Improving awareness, prevention, and treatment. Infection and Drug Resistance, 9, 191-197. Web.
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