Your 33-year-old female patient reports the development of a cold ...

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Your 33-year-old female patient reports the development of a cold sore on her lower lip. She asks if this is the kind of sore that is transmitted during sex. The clinician should explain that:
 
  A. The sore can be either herpes type 1 or herpes type 2, and both can be transmitted during sex
  B. A cold sore in the oral region is caused by herpes type I, and this is not contagious
  C. Herpetic lesions on the lips and in the mouth are herpes type II and caused by oral sex
  D. A blood test is done to determine the specific type of virus because treatments for I and II differ

Question 2

A 23-year-old female presents to the emergency room with fever, pelvic pain, vomiting, and dysuria. She reports having had an abortion yesterday in an urban birth control clinic.
 
  On physical examination, there is a bloody vaginal discharge, tenderness of the left lower quadrant of the abdomen, and cervical tenderness on pelvic examination. The following is a likely diagnosis:
  A. Neisseria gonorrhea infection
  B. Chlamydia trachomatis infection
  C. Staphylococcal endometritis
  D. Fulminant candidiasis

[dudman123]

Answer to Question 1

ANS: A
The majority of genital herpes infections are due to HSV2, and approximately 10 are due to the HSV1 virus that has been transferred to the genital area either by sexual or oral contact. Although blood tests can be done to determine the presence or absence of antibodies to HSV1 and HSV2, it is mostly academic because the symptoms, transmission, and treatment are the same regardless of type.

Answer to Question 2

ANS: C
PID is defined as an infection of the uterus, fallopian tubes, and adjacent pelvic structures. It is often secondary to an STD or other infection of the lower reproductive tract that migrates upward into the uterus and tubes. N. gonorrhea and C. trachomatis are two of the commonly offending organisms. Pelvic infections can also occur postsurgery, postpartum, or postabortion but are generally caused from other organisms, such as staphylococcus or streptococcus. Abdominal pain, mucopurulent cervical discharge, and often fever are the more common presenting symptoms. Rebound tenderness indicates peritoneal irritation. Dysuria, nausea, and vomiting may also be present. The abdominal pain is midline and often accompanied by right and left lower quadrant pain, particularly when accompanied by salpingitis. During the pelvic examination, there is pain with cervical motion and with palpation of the uterus and ovaries.

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[Sarahjh]

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