Case Study

You are the nurse in the walk in clinic P.A is being seen this morning for a 2-day history of a
diffuse but severe abdominal pain. She has complaints of nausea without vomiting, she denies vaginal
bleeding or discharge. P.A claims to have had an unprotected sex with several partners recently, two of
whom have penile discharge. Her last menstrual period ended three days ago. She has no known drug
allergy and denies previous medical or psychiatric problems. Vital signs are 106|60, 110, 20, 100.6°
F(38.1) (tympanic).

Physical examination finds that her abdomen is very tender. The slightest touch of her abdomen
causes her to winch with pain. Bowel sounds are normal. Pelvic examination finds purulent material
pooled in the vaginal vault, which appears to be coming from the cervix. A sample of vaginal drainage is
obtained and sent for culture. A pregnancy test is negative, a rapid diagnostic test for chlamydial
infection is positive.

The physician has the option of treating A.P. by one of two different methods. First, the
physician could prescribe treatment over a period of one week. A. P would be given first dose of
Doxycycline( Monodox) 100 mg PO, and then prescribe the same dose to be taken PO bid for 7 days.
Second, the physician could prescribe one time dose of Azithromycin ( Zithromax) 1g PO which could be
administer in the clinic. A.P returns to the clinic in one week for HIV test result which is negative. Her
culture result confirms the diagnosis of chlamydial infection.