A 23-year-old female is informed by one of her sexual partners that he was recently treated for gonorrhea. They have had unprotected intercourse on many occasions in the past few months. Her last menstrual period was 6 weeks ago. Testing for chlamydial infection is negative, but her gonococcal culture is positive and a pregnancy test is positive.
According to guidelines, the best treatment plan for the gonococcal infection is:
Correct Answer B:
For patients with uncomplicated gonococcal infections of the cervix, urethra, and rectum, it is recommended treatment with cefixime, cefrtiaxone, ciprofloxacin, ofloxacin, or levofloxacin. If chlamydial infection has not been ruled out, or if the likelihood of chlamydial infection is high, azithromycin or doxycycline should also be given.
Because this patient is pregnant, she should not receive quinolones or tetracyclines. She should receive a cephalosporin, and ceftriaxone would be the best choice because it provides higher, more sustained levels of bacterial activity. If chlamydial infection had not been ruled out, erythromycin or amoxicillin would also be recommended.
You have just diagnosed and treated gonorrheal cervicitis in a 24-year-old female who is in her second trimester of pregnancy. The patient has a friend who had a stillborn infant and she is concerned that the gonorrhea may predispose her to stillbirth.
Which one of the following would be most appropriate in this situation?
Correct Answer A:
Gonorrhea is a rare cause of stillbirth, probably because it is unusual for the gonorrhea organism to ascend into the uterus. The organism lacks affinity for fetal membranes. Since gonorrhea is easily and effectively treated with ceftriaxone or cefixime, follow-up cultures and monitoring are not needed unless symptoms persist. Quinolones (including ciprofloxacin) and tetracycline, which are indicated in nonpregnant patients, are contraindicated in pregnancy.
A 20-year-old patient has urinary frequency and dysuria. Pelvic examination reveals a yellow discharge at the cervix and mild adnexal tenderness.
The best test to aid your diagnosis is:
Correct Answer C:
If cervicitis is suspected or mucopurulent cervicitis is observed, then endocervical and vaginal swab specimens are collected. Nucleic acid amplification testing (NAAT) (choice C) is the most sensitive and specific for gonorrheal and chlamydial infections.
→ The presence of >10 polymorphonuclear cells per oil immersion field (choice A) is indicative of mucopurulent cervicitis and suggests chlamydia or gonorrhea infection. However, this information is of limited value since a specific diagnosis requires identification of an organism. Furthermore, sensitivity of Gram's stain for diagnosis of chlamydia or gonorrhea is low, the definition of a positive test has not been standardized.
→ Often with a gonococcal cervicitis, the peripheral white blood cell count (choice B) is normal.
→ Cervical culture on Thayer Martin medium (choice D) is confirmatory, but is not an immediate test.
→ The urinary symptoms most likely are due to gonococcal urethritis as well as a cervicitis. Routine dipstick urinalysis (choice E) will not identify the pathogen involved.
A pregnant woman comes to you for her first prenatal visit at 36 weeks gestation.
What is an appropriate test at this time?
Correct Answer D: Routine prenatal care begins at the onset of pregnancy. By 36 weeks gestation the majority of the tests that are usually done are no longer able to be done since they fall well outside the recommended time frame for the test results.
The following is a brief summary of the approximate time for some of the prenatal tests:
Which event is matched with the correct timing?
Maternal serum triple marker screening is done between 15-18 weeks. Post partum visit happens 6 weeks after delivery. CVS can be done between 10-12 weeks. Oral glucose challenge test is done between 24-28 weeks. Rhogam is given at 28 weeks to RH negative women.
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