CASE SCENARIO FOR INFECTIOUS/SEXUALLY TRANSMITTED INFECTIONS

Maria Angelica Aquino is a 40-year-old solo parent. She is a mother of two, ages 15 and 10. She
used to be a show biz personality but has since retired from the industry. She comes to the
reproductive clinic appearing anxious. She says she is experiencing a brown vaginal discharge
that started 2 days ago accompanied by burning sensation when urinating, hypogastric pain and
fever. When interviewed, she states that her past pelvic examination was 6 months ago. She
denies any history of pelvic cancer or abnormal Pap smear results. Her last menstrual period
was normal and ended 1 week ago. She has had several sexual partners but was never tested
for HIV. Three weeks ago, she had unprotected sexual intercourse with her current boyfriend.
A Norplant birth control device was placed in her arm 1 year ago.

Your physical assessment reveals normal hair distribution, and no lesions, masses, or swelling.
The labia majora and labia minora are pink, moist, and free of lesions. A small amount of
malodorous brown discharge is noted at the vaginal orifice. There is no bulging at the vaginal
orifice.
Internal examination reveals cervix to be slightly anterior and pink, with a slit-like os, and free
of lesions. Bimanual examination reveals a mobile, firm but tender cervix. The fundus is at the
level of the symphysis pubis. The right ovary is very tender on palpation.
A routine Pap smear is performed and culture specimens are taken.

The medical practitioner ordered Doxycycline 5oo mg BID x 7 days.

PRE- WORK:
1. Review of anatomy and physiology of the female reproductive organs.
2. Read about sexually transmitted diseases

GUIDE QUESTIONS:

1. On the basis of the assessment information, identify abnormal data, cluster cues, draw
inferences, make possible nursing diagnoses.
2. What can be differential medical diagnoses? Support your answer.
3. What assessment data is needed to confirm your ‘initial diagnosis?’
4. What diagnostic examination/tests would be relevant? Why?
5. Explain briefly how bimanual examination is done.
6. What do you think will the result of Pap smear be? Of culture?
7. Discuss medical treatment.
8. Create a teaching plan for your patient
Teacher’s Guide/Use

Diagnosis: Chlamydia

Differential Diagnosis

 Bacterial Vaginosis- not considered STI but if untreated

may lead to STI; an imbalance in vaginal bacteria
 Pelvic inflammatory disease (PID) is an infection of the cervix and uterus that
can cause brown discharge. Other symptoms may include:

 pain in the pelvis and lower abdomen

 pain during sex
 fever
 smelly vaginal discharge
 burning sensation when urinating

Retained foreign body

Bad-smelling brown discharge can occur if a foreign object gets left in the vagina
accidentally. Objects that can cause this might include:

 tampons
 condoms
 vaginal contraceptive sponges, diaphragms, or cervical caps
 contraceptive rings
Anyone who notices a brown discharge with an odor should see their doctor, as they
may have a retained object or vaginal infection.

Polycystic ovary syndrome (PCOS)

PCOS is a hormonal imbalance. It may cause a brown discharge from irregular, light
bleeding. Other symptoms can include:

 irregular periods
 no longer having periods
 very heavy periods
 excess hair on the face or body
 acne or oily skin
 pelvic pain
 difficulty getting pregnant
 patches of dark, discolored skin

PCOS is not uncommon. According to the National Institutes of Health (NIH),

between 8 and 20 percent of reproductive-age women worldwide have PCOS.

Cervical cancer

Brown discharge may be a symptom of cervical cancer, but this is extremely rare.