Question

Case Study #1 (1 of 3)

V.Q., a 20-year old woman with no denies any previous history of Urinary Tract Infection, complains of burning on urination, frequent urination of a small amount, and bladder pain. She has no fever or pelvic area tenderness. A
clean-catch midstream urine sample shows Gram negative rods on Gram stain. A culture and sensitivity test are ordered. Our patient is presumed to have a lower UTI.

Question #1 What are some goals of the treatment plan at this time? (What should happen here.)

Question #2 What information should you obtain from the patient before starting any drug therapy?

Question #3 How long should the patient optimally be on antibiotic therapy?

Question #4 The lab results are not back yet, but what classes of antibiotics should be considered for therapy based on the Gram Stain?

Question #5 Very Important: What education and counseling to you provide to the patient on prevention of UTIs?

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CASE STUDY #2 of 3

Suzy Jones is an 18-year-old college student who presents to the Student Health Center seeking advice.

• White female college student
  · Seeking advice about contraception and a current problem "down there" about a slight discharge.
  · Shy talking about her sexual practices
  · Has never had a pelvic exam
  · Has had 2 sex partners in past 4 months
  · Does not use condoms or any other contraceptives
  · Her periods have been regular, but she has recently noted some spotting between
  periods. Last menstrual period was 4 weeks ago.
  · Denies dysuria, genital lesions, or sores, but does mention occasional vaginal itching.

Physical Exam
· Vital signs: blood pressure 118/68, pulse 74, respiration 18, temperature 37.1° C
· Breast, thyroid, and abdominal exam within normal limits
· The pelvic exam reveals normal vulva, and vagina.
· The cervix appears inflamed, bleeds easily, with a purulent discharge coming from
the cervical os. A slight amount of vaginal discharge is noted.
· The bi-manual exam is normal without cervical pain, uterine or adnexal tenderness.

Suzy Jones' cervix as revealed during pelvic exam

Questions
1. Based on Suzy’s history and physical exam, what do you suspect?  
2. Which laboratory tests should be ordered or performed?
3. What is the appropriate treatment at the initial visit?

Laboratory Results
The test results are back from the laboratory for Suzy Jones:
· Serological test for syphilis - negative
· Serological test for Neisseria gonorrhea – negative

• Direct Unstained Wet mount – pH 4.2, no abnormal epithelial cells, trichomonas, or excessive bacteria noted. But numerous white blood cells are present.  

• KOH (potassium hydroxide) wet mount screening for Candida albicans yeast – negative
• HIV antibody test – negative
• Pregnancy test – negative

Suzy is coming in later today to discuss her lab results. What are you going to tell her? After reviewing these results, are there any additional laboratory tests you believe are appropriate to look for other pathogens?

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Case Study #3 of 3

J.R., a 28 yr old, sexually active male, complains of painful penile lesions and
tender inguinal adenopathy. The lesions are vesicular and limited to the

shaft of the penis. The onset of the lesions was preceded by a one-week period of
fever, malaise, headache, and itching in the genital region.

Question #1 - What do you think is the problem?

Question #2 - What laboratory tests would help you confirm your diagnosis?

Question #3 - How should the patient's lesions be treated? With what type of medications are indicated?

Question #4 - What education do we give the patient going forward?

Question #5 - B.J. asks you "Will this ever go away?" What do you tell him?

Answer 1

Case study #1

1.The main goal of the treatment plan is

• to prevent the infection spreading to the renal system.
• Preventing entering of bacteria into blood stream and causing sepsis

2.Before starting the drug therapy for UTI the most important things which has to be clarified and prevent drug reactions are

• To get information about any history of drug allergy
• Drug allergy in the family members should also be collected

3.The usual course of antibiotic for a very mild infection is infection is for three days.In case of bacterial infections the treatment course lasts for seven to ten days.

4.The preferred antibiotics for gram negative bacteria are

• Cephalosporins
• Aminoglycoside
• Broad spectrum penicillin with beta lactate inhibitors

5.The following counseling and education should be provided

• Complete the antibiotic course to prevent rebound
• Encourage to drink plenty of water to flush out toxins and bacteria
• To maintain perineal hygiene especially after maturation and defecation
• Observe and report on case of severe abdominal pain, hematuria, vomiting high grade fever to get treated and lo eevent complications