Patient complains of urinary frequency

Patient complains of urinary frequency

Internal Medicine 14: 18-year-old female for pre-college physical.

What is (are) the most likely diagnosis (diagnoses)? What were the clinical findings that confirmed the diagnosis (diagnoses)?

The most likely diagnosis is cystitis. Patient complains of urinary frequency, dysuria, bladder pain and hematuria. On physical exam there is mild midline suprapubic tenderness . Her urine dipstick was Urine dipstick: positive for leukocyte esterase, nitrites, and hemoglobin (Kovach, 2020).

The next diagnosis is chlamydia. Women with Chlamydia usually present with symptoms such as vaginal discharge, postcoital or intermenstrual bleeding, lower abdominal pain, pelvic pain

painful intercourse and dysuria (DynaMed, 2018). The patient in the case study presented with suprapubic pain,hematuria and dysuria. The test of choice is Nucleic acid amplification testing (NAAT) for N. gonorrhea and C. trachomatis. “The best way to test for chlamydia and gonorrhea during a pelvic exam is nucleic acid amplification testing (NAAT) for N. gonorrhea and C. trachomatis. NAAT is a sensitive and specific assay and has replaced culture methods. It can be used on urine specimens as well” (Kovach, 2020).

How is it (are they) treated according to the most recent clinical guidelines? Cite the guidelines.

Cystitis: Infectious Diseases Society of America/European Society for Microbiology and Infectious Diseases (IDSA/ESCMID) recommend first-line empiric agents for acute uncomplicated cystitis include nitrofurantoin (Macrobid) 100 mg orally twice daily for 5 days (DynaMed, 2018).

Chlamydia: Centers for Disease Control and Prevention (CDC) 2021 treatment guidelinesChlamydia- first-line treatment for suspected or confirmed infections is doxycycline 100 mg orally twice daily for 7 days (DynaMed, 2018).The World Health Organization (WHO) recommends  azithromycin 1 g orally as single dose or doxycycline 100 mg orally twice daily for 7 days for uncomplicated chlamydial genital infection (DynaMed, 2018).

Describe a plan of care for the patient, including patient education, and additional tests.

In the setting of complicated  cystitis, CT scan or renal ultrasound is recommended as a first step to rule out nephrolithiasis or obstruction prior to urologic evaluation. Urologic evaluation, including cystoscopy, should also be performed in those with persistent hematuria after infection has been eradicated (Kovach, 2020).

· Symptomatic relief: hot sitz baths or urinary analgesics (phenazopyridine, 200 mg three times daily orally).

· Drinking plenty of fluid and completely emptying the bladder frequently can reduce risk of developing infection

· Advised to void before, and especially after intercourse, and may benefit from a postcoital single dose of antibiotic (Papadakis, et al., 2021).

In the setting of Chlamydia-screening for reinfection recommended for all patients 3 months after treatment regardless of whether sex partners were treated (DynaMed, 2018).

· Return for evaluation if the symptoms persist or return after therapy is completed.

· Abstain from sexual intercourse until 7 days after starting therapy, symptoms have resolved, and sexual partners have been adequately treated.

· Undergo testing for other STDs, including HIV and syphilis.

· Advise sexual partners of the need for treatment and/or take medications directly to them using EPT (Chumle & Usatine, 2019).

 

References

Chumley H.S., & Usatine R.P. (2019). Gonococcal and chlamydia urethritis. Usatine R.P., & Smith M.A., & Mayeaux, Jr. E.J., & Chumley H.S.(Eds.), The Color Atlas and Synopsis of Family Medicine, 3e. McGraw Hill.  https://accessmedicine-mhmedical-com.su.idm.oclc.org/content.aspx?bookid=2547&sectionid=206781922

DynaMed (2018). Chlamydia Genital Infection. Retrieved from  https://www.dynamed.com/condition/chlamydia-genital-infection#GUID-01D45C2C-C757-41E9-92E8-1F14756F3632

DynaMed (2018). Uncomplicated Urinary Tract Infection (UTI) (Pyelonephritis and Cystitis). Retrieved from  https://www.dynamed.com/condition/uncomplicated-urinary-tract-infection-uti-pyelonephritis-and-cystitis#GUID-24894AB7-5876-45E1-9D45-55C4F7053231

Kovach, R.,A (2020).Internal Medicine 14: 18-year-old female for pre-college physical.Retrieved from  https://southu-nur.meduapp.com/document_set_document_relations/90971

Papadakis, M.A., McPhee S.J., & Bernstein J (2021). Cystitis, acute (urinary tract infection).  Quick Medical Diagnosis & Treatment 2021. McGraw Hill.  https://accessmedicine-mhmedical-com.su.idm.oclc.org/content.aspx?bookid=2986&sectionid=251090639