Identify data provided in your chosen case and any additional data needed.

Objective findings.

Identify findings provided in your chosen case and any additional data needed.

Describe the rationale for each test or intervention with supporting references.

Describe the rationales for your choice of each diagnosis with supporting references.

Describe rationales and supporting references for each.

Social Determinants of Heath (SDoH) for your chosen case.

Describe rationales and supporting references for each.

Her sexual history is significant for multiple partners (four in six months) without documented STI screening.

Previous medical history includes depression managed with unknown medications, confirmed HSV-2 diagnosis, and surgical pregnancy termination one year ago. She has never received cervical cancer screening despite being sexually active.

Current contraceptive use includes Lo Loestrin Fe since her pregnancy termination.

The patient denies alcohol, tobacco, or recreational drug use and works full-time as a waitress while living with her parents. Her last menstrual period was two weeks prior and reported as normal.

Abdominal examination reveals a soft, non-tender abdomen without masses or hepatosplenomegaly.

Gynecological examination demonstrates no external lesions or erythema, however, mucopurulent endocervical exudate is visible within the endocervical canal.

The cervix appears friable upon examination, and mild cervical motion tenderness is present. Notably, there is no uterine tenderness, adnexal tenderness, or palpable masses, which helps differentiate from more severe pelvic inflammatory conditions.

Additional STI screening should encompass syphilis serology (RPR or VDRL), HIV testing, and hepatitis B surface antigen, given her high-risk sexual behavior.

Wet mount microscopy and KOH preparation of vaginal discharge should be performed to evaluate for bacterial vaginosis, trichomoniasis, and candidiasis.

Complete blood count with differential may be indicated if systemic infection is suspected.

Pregnancy testing should be conducted despite recent normal menses and current contraceptive use.

Cervical cytology (Pap smear) is recommended given her age and sexual activity history, though treatment should not be delayed pending results (Schuiling & Likis, 2022).

The primary differential diagnosis is chlamydial cervicitis, supported by mucopurulent discharge, cervical friability, and mild cervical motion tenderness in a sexually active young woman with multiple partners.

Gonococcal Cervicitis:

Secondary consideration includes gonococcal cervicitis, which presents similarly and often co-occurs with chlamydial infection.

Pelvic Inflammatory Disease (PID):

The third differential diagnosis encompasses pelvic inflammatory disease (PID), though the absence of significant uterine or adnexal tenderness makes this less likely but still possible, given the cervical motion tenderness and risk factors present.

For suspected chlamydial cervicitis, first-line treatment includes azithromycin 1g orally as a single dose or doxycycline 100mg orally twice daily for seven days, with azithromycin preferred for compliance concerns (Centers for Disease Control and Prevention, 2021).

Gonococcal Cervicitis:

If gonococcal infection is suspected or confirmed, treatment requires ceftriaxone 250mg intramuscularly as a single dose plus azithromycin 1g orally for dual therapy addressing potential resistance patterns.

Pelvic Inflammatory Disease (PID):

For confirmed or suspected PID, outpatient treatment includes ceftriaxone 250mg IM plus doxycycline 100mg orally twice daily for 14 days with metronidazole 500mg orally twice daily for 14 days to cover anaerobic organisms (Workowski et al., 2021).

Partner notification and treatment are essential for all sexually transmitted infections to prevent reinfection and transmission.

Her employment as a waitress may indicate lower socioeconomic status, potentially affecting healthcare access and health literacy. Living with her parents at age 19 while working full-time also suggests financial constraints that may impact her ability to access regular healthcare services.

Her history of depression may influence health-seeking behaviors and medication compliance.

The absence of higher education (not attending college) may correlate with limited health knowledge and resources.

Geographic factors and transportation access from her work schedule could create barriers to follow-up care and partner notification processes.

Partner services coordination through local health department resources is essential for contact tracing and treatment of sexual partners to prevent reinfection cycles.

Patient education must emphasize proper medication compliance, including completion of full antibiotic courses, even if symptoms resolve early.

Comprehensive safer sex counseling should address consistent condom use, regular STI screening recommendations, and discussion about reducing the number of concurrent sexual partners (Lockwood, 2019).

Schedule a follow-up appointment in one week to assess treatment response and ensure symptom resolution. Provide written information about her STI diagnosis, treatment, and prevention strategies. Discuss the importance of routine gynecological care, including annual cervical cancer screening and contraceptive counseling, to ensure optimal reproductive health outcomes.