Criteria for Recommending Hospitalization

Reproductive Function:
Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days.
Microscopic Examination of Vaginal Discharge
(-) yeast or hyphae
(-) flagellated microbes
(+) white blood cells
(+) gram-negative intracellular diplococci

Case Study Questions

1. According to the case presented, including the clinical manifestations and microscopic examination of the vaginal discharge, what is the most probably diagnosis for Ms. P.C.? Support your answer and explain why you get to that diagnosis.
2. Based on the vaginal discharged described and the microscopic examination of the sample could you suggest which would be the microorganism involved?
3. Name the criteria you would use to recommend hospitalization for this patient

Submission Instructions:

• APA style writing
• Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources (within the last 5 years). Your initial post is worth 8 points.

Based on the information provided in the case study, including the clinical manifestations and microscopic examination of the vaginal discharge, the most probable diagnosis for Ms. P.C. is likely to be pelvic inflammatory disease (PID).

1. Clinical Manifestations and History:

• Ms. P.C. is a sexually active young woman who reports lower abdominal pain, nausea, emesis, and a heavy, malodorous vaginal discharge.
• She has been sexually active with one partner for eight months and has had unprotected sex.
• Her last intercourse was eight days ago without the use of condoms.
• The abnormal vaginal discharge she describes as “thick, greenish-yellow in color, and very smelly” is concerning and indicative of an infection.

2. Microscopic Examination of Vaginal Discharge:

• The microscopic examination of the vaginal discharge shows the presence of white blood cells and gram-negative intracellular diplococci.
• The presence of white blood cells suggests an inflammatory response to an infection.
• The presence of gram-negative intracellular diplococci is highly indicative of Neisseria gonorrhoeae, the causative agent of gonorrhea.

3. Possible Microorganism Involved:

• The presence of gram-negative intracellular diplococci in the microscopic examination strongly suggests Neisseria gonorrhoeae as the microorganism responsible for Ms. P.C.’s symptoms.
• Gonorrhea is a sexually transmitted infection (STI) that commonly presents with symptoms such as lower abdominal pain, abnormal discharge, and can lead to pelvic inflammatory disease if left untreated.

4. Criteria for Recommending Hospitalization: The decision to recommend hospitalization for Ms. P.C. should be based on several factors, including the severity of her symptoms and the likelihood of complications. Some criteria for recommending hospitalization in this case may include:

• Severe Abdominal Pain: If Ms. P.C. experiences severe or worsening abdominal pain, it may be an indication of a more severe infection or potential complications, such as an abscess or tubo-ovarian abscess.
• High Fever: The presence of a high fever may suggest an advanced infection that requires intravenous antibiotics and close monitoring.
• Inability to tolerate oral medications: If the patient cannot tolerate oral medications due to vomiting or other reasons, hospitalization may be necessary to administer intravenous antibiotics.
• Evidence of Tubo-ovarian Abscess: If imaging studies or physical examination reveal the presence of a tubo-ovarian abscess, immediate hospitalization and surgical intervention may be required.
• Pregnancy: If Ms. P.C. is pregnant, the risk of complications and the impact on the fetus may necessitate hospitalization for appropriate treatment and monitoring.

In Ms. P.C.’s case, it is crucial to promptly diagnose and treat the underlying infection, likely gonorrhea, to prevent the development of pelvic inflammatory disease and its associated complications. Additionally, the patient’s symptoms and clinical condition should guide the decision regarding hospitalization to ensure she receives appropriate care and monitoring. Timely treatment is essential to prevent long-term complications and reduce the risk of further transmission of the infection to her partner.