From the Guidelines
The patient should undergo comprehensive STI testing, including gonorrhea, chlamydia, trichomoniasis, syphilis, HIV, and hepatitis, due to her symptoms and history of occasional unprotected sex, despite the negative urine dip and pregnancy test. The patient's symptoms of lower abdominal cramping, frequent urination, delayed menses, and increased vaginal discharge, combined with her history of occasional unprotected sex, warrant this testing 1. For gonorrhea and chlamydia, we should collect both vaginal/cervical swabs and urine samples, as nucleic acid amplification tests have high specificity and sensitivity when used as screening tests for chlamydial infection 1. Blood tests should be performed for syphilis, HIV, and hepatitis. While waiting for results, the patient should abstain from sexual activity or use condoms consistently. If she tests positive for any STI, appropriate treatment would be initiated based on the specific infection, and partner notification and treatment would be recommended.
Some key points to consider in this patient's evaluation include:
- The patient's age and sexual activity increase her risk for STIs, particularly chlamydia and gonorrhea 1
- The patient's symptoms could be caused by various STIs, and early detection and treatment are crucial to prevent complications like pelvic inflammatory disease, which can affect fertility
- The negative urine dip suggests against a bacterial UTI, but STIs can sometimes present with similar symptoms
- Comprehensive STI testing is necessary to determine the cause of the patient's symptoms and to guide treatment
It's also important to note that the patient's history of occasional unprotected sex increases her risk for STIs, and that consistent condom use can help reduce this risk 1. Additionally, the patient's symptoms and test results should be monitored closely, and she should be educated on the importance of safe sex practices and regular STI testing.
From the Research
Patient Presentation and Symptoms
- The patient is a 21-year-old female presenting with light lower abdominal cramping and frequent urination, suspecting a urinary tract infection (UTI) 2.
- She reports being sexually active in a monogamous relationship, using condoms as birth control, but with instances of unprotected sex.
- Her menses are approximately 4 weeks late, which she claims is common for her.
- She also reports a mild increase in vaginal discharge without any vaginal itching or irritation.
Diagnostic Testing and Results
- A urine dip test was negative in the clinic.
- A urine pregnancy test was also negative.
- The patient has requested testing for sexually transmitted diseases (STDs) given her symptoms and sexual history.
STD Screening and Diagnosis
- According to the American Family Physician, all sexually active people with a cervix who are younger than 25 years should be screened annually for chlamydial and gonococcal infections 3.
- The JAMA review highlights the importance of diagnosing and treating STDs, including gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes, due to their increasing rates and potential for asymptomatic infections 4.
- For the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, a meta-analysis suggests that vaginal swabs have higher diagnostic sensitivity compared to urine specimens 5.
Comprehensive Patient History
- Taking a comprehensive patient history is crucial for accurate diagnosis and effective management of health conditions, including STDs 6.
- This involves active listening, empathetic communication, and cultural sensitivity to gather relevant information from patients.
Association Between STDs and Urine Culture
- A study published in The Western Journal of Emergency Medicine found no association between having a concurrent STD (gonorrhea, chlamydia, or trichomoniasis) and bacterial UTI, as indicated by urine culture results 2.