Laboratory Test Results:
Chlamydia 8 Negative urine pregnancy test. Wet Mount Prep (saline and KOH) – Normal transparent, clear epithelial cells with distinct borders, moderate amount of lactobacilli present. No pseudohyphae, yeast buds, clue cells, leukocytes or flagellate protozoan. Whiff test – Negative Vaginal pH – 4.0 Urine dip – Negative for protein, nitrates, leukocytes and glucose Decision Point 2: Differential Diagnosis: The differential diagnoses associated with intermenstrual bleeding include Chlamydia, Gonorrhea, Trichomonas, Pelvic inflammatory disease, appendicitis, urinary tract infection and interstitial cystitis. Five of these diagnoses can be eliminated based on the patient’s history, physical exam and laboratory findings. Trichomonas is eliminated because the patient denies any itching or the presence of a thin and frothy discharge. There was also an absence of flagellate protozoan on the wet mount prep. Pelvic inflammatory disease and appendicitis can be excluded because the patient denies fever, rebound tenderness, cervical motion tenderness, nausea or vomiting. The patient also denies adenexal tenderness on palpation, which is common with PID (Loyd, Malin, Pugsley, Garcea, Garcea, Dennison et al, 2006). The absence of urinary frequency, urgency and chronic pelvic pain eliminates the diagnosis of interstitial cystitis. The patient also denies any increase in symptoms preceding menstruation which also helps to exclude this diagnosis.
Chlamydia 9 The urinary tract infection can be eliminated as a possible diagnosis based on the results of the urine dip test. The patient stated she had burning with urination but denied frequency or urgency. These findings exclude this diagnosis. The remaining two differential diagnoses are gonorrhea and Chlamydia. Both diagnoses carry similar signs and symptoms and therefore must be closer evaluated. Chlamydia - Is the most commonly diagnosed sexually transmitted infection worldwide with the highest rates of diagnosis between the ages of 16 and 24 (Flannigan, 2006). It is caused by a bacterium called Chlamydia trachomatis that is transmitted via oral, vaginal or anal intercourse. If left untreated Chlamydia infections can lead to serious sequelae of infections such as pelvic inflammatory disease, infertility and ectopic pregnancy (Grimshaw-Mulcahy, 2008). When the infection spreads to the uterus and fallopian tubes it can cause pelvic inflammatory disease which if left untreated will lead to infertility. During pregnancy Chlamydia can cause premature rupture of membranes, preterm birth or even spontaneous abortion during the first trimester of pregnancy (Grimshaw-Mulcahy, 2008). Due to the severity of complications it is imperative that a diagnosis is correctly made and treatment is facilitated.
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- Spring '17
- Chlamydia infection, chlamydia, Pelvic inflammatory disease