Case Study Analysis: Womens Health
Summary of the Case Study
A 32-year-old woman arrives at the emergency department with a 3-day history of vaginal discharge, fever, chills, nausea, and vomiting. She, however, denies dysuria, foul urine odor, and increased urine frequency. Physical examination reveals left lower quadrant pain and a copious foul-smelling greenish discharge.
Further pelvic examination reveals cervical motion tenderness and bilateral adnexal tenderness. The laboratory results are as follows: Leukocytosis with predominant neutrophils and lymphocytes, elevated CRP and ESR, Gram staining, and microscopy reveal Gram-negative diplococci.
Analysis of the Symptoms
The patient’s symptoms, as described in the case study, are consistent with a definitive diagnosis of pelvic inflammatory disorder (PID). PID is an upper genital tract infection usually resulting from an untreated sexually transmitted infection (STI). PID microbiology, or etiology, is attributed to STI pathogens such as N. gonorrhoeae and C. trachomatis, and there is also growing evidence linking PID to M. genitalium (Mitchell et al., 2021).
The most common presenting symptom of PID is lower abdominal pain, which the patient describes as pain in the left lower quadrant. Other symptoms include vaginal discharge, as well as systemic symptoms such as fever, nausea, and vomiting, as seen in the patient. Cervical motion tenderness/chandelier sign is a distinguishing feature of PID on physical examination (Curry et al., 2019).
PID is almost always an acute process, only a few people present with obvious laboratory findings. However, the results are typically non-specific and can be attributed to another illness. As seen, the patient’s findings include leukocytosis, elevated ESR, and CRP, which are typically non-specific findings, but the confirmation of Gram-negative diplococci makes a PID diagnosis definitive.
Factors that affect Fertility, with reference to STDS, and PIDs
In most societies, the value of women is equated with their youth and ability to bear children, and if either of these two is lost, the value depreciates exponentially. Fertility is the ability to conceive and bear children, and it is affected by a variety of factors, including gynecological conditions such as STIs and PIDs (Liu et al., 2022). PID, whether asymptomatic or symptomatic, causes permanent damage to the upper genital tract, particularly the fallopian tube, which leads to infertility.
The mechanisms underlying this include cilia dysfunction, inflammation-induced fibrosis, and tube occlusion, which results in tubal infertility (Jennings & Krywko, 2022). To better understand the fertility implications of PID, Greydanus et al. (2022) conducted a prospective Swedish study of 2501 Swedish women with suspected PID who underwent diagnostic laparoscopy and were followed for 25 years.
Of those who desired a pregnancy, 16% of those with laparoscopically confirmed PID and 2.7% of those with normal laparoscopic findings failed to conceive. Tubal factor accounted for 67.6% of the infertility diagnoses among the 16% of patients who failed to conceive in the laparoscopically confirmed PID group but was not a single cause of infertility in the other group.
Few studies have delved into the specific risk factors for PID-related infertility. Chlamydial infection carries the greatest risk of infertility, with one study finding that one out of every four women with tubal factor infertility has serum antibodies to C. trachomatis and serum titers of C. trachomatis (Johnson et al., 2018). Delay in seeking care for PID is also a significant risk factor, with one study finding that women with PID who delay seeking medical care for three or more days have a threefold risk of infertility when compared to women who seek timely care (Platt et al., 2021).
A high number of PID episodes also reduces women’s chances of conceiving dramatically, according to a study that found that the pregnancy rates after one, two, three, or more episodes of PID were 89%, 77%, and 46%, respectively (Scheidell et al., 2022). Finally, the severity of the infection influences the likelihood of a subsequent pregnancy, as evidenced by a study that found that the cumulative proportions of women achieving a live birth after mild, moderate, and severe PID were 90%, 82%, and 57%, respectively (Sharma et al., 2020). It is thus clear that, while PID is a primary risk factor for infertility, a variety of other factors influence an individual’s chances of achieving pregnancy after a PID infection.
Why Inflammatory Markers Rise in STD/PID
Since PID is an infectious disease process, the initial insult is a microorganism. As previously stated, the microorganisms in the majority of cases are STI pathogens, and in a few cases, they may originate from the gastrointestinal and respiratory tracts. Inflammation is defined by Kumar et al. (2020) as a protective response involving the host cell, blood vessels, proteins, and other mediators intended to eliminate the initial cause of the injury as well as the necrotic tissue that results from the insult, and to initiate a repair process, provides a significant explanation for why inflammatory markers rise.
In PID, microorganisms are the initial insult to the upper genital tract tissues, triggering an inflammatory response to eliminate them. As a result, components of the inflammatory reaction are produced, which can be injurious or beneficial to the repair process. CRP, which is produced by the liver as an acute phase reactant in response to inflammation, enhances pathogen elimination (Kumar et al., 2020). CRP aids in complement binding to foreign and damaged cells, enhancing macrophage phagocytosis (Kumar et al., 2020). As a result of the inflammatory response, CRP and other inflammatory cells rise in STD or PID.
PID is an infective gynecological disease most commonly caused by sexually transmitted agents. While lower abdominal pain is the most common presenting symptom, it can also manifest as vaginal discharge, dyspareunia, abnormal uterine bleeding, and systemic symptoms such as fever. Early PID treatment predicts good outcomes and is also an essential milestone in preventing long-term sequelae such as infertility. Because of the devastating consequences of PID, it is critical to detect it early and initiate treatment. Also, primary prevention, such as the use of protective contraceptive methods, is advocated; however, this usually depends on the appropriate use.
Curry, A., Williams, T., & Penny, M. L. (2019). Pelvic inflammatory disease: Diagnosis, management, and prevention. American Family Physician, 100(6), 357–364. https://www.aafp.org/pubs/afp/issues/2019/0915/p357.html
Greydanus, D. E., Cabral, M. D., & Patel, D. R. (2022). Pelvic inflammatory disease in the adolescent and young adult: An update. Disease-a-Month: DM, 68(3), 101287. https://doi.org/10.1016/j.disamonth.2021.101287
Jennings, L. K., & Krywko, D. M. (2022). Pelvic inflammatory disease. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499959/
Johnson, R. M., Yu, H., Strank, N. O., Karunakaran, K., Zhu, Y., & Brunham, R. C. (2018). B cell presentation of Chlamydia antigen selects out protective CD4γ13 T cells: Implications for genital tract tissue-resident memory lymphocyte clusters. Infection and Immunity, 86(2). https://doi.org/10.1128/IAI.00614-17
Kumar, V., Abbas, A. K., Aster, J. C., & Deyrup, A. T. (2020). Robbins essential pathology E-book. Elsevier. https://books.google.at/books?id=3OreDwAAQBAJ
Liu, L., Li, C., Sun, X., Liu, J., Zheng, H., Yang, B., Tang, W., & Wang, C. (2022). Chlamydia infection, PID, and infertility: further evidence from a case-control study in China. BMC Women’s Health, 22(1), 294. https://doi.org/10.1186/s12905-022-01874-z
Mitchell, C. M., Anyalechi, G. E., Cohen, C. R., Haggerty, C. L., Manhart, L. E., & Hillier, S. L. (2021). Etiology and diagnosis of pelvic inflammatory disease: Looking beyond gonorrhea and chlamydia. The Journal of Infectious Diseases, 224(12 Suppl 2), S29–S35. https://doi.org/10.1093/infdis/jiab067
Platt, L., Elder, H., Bassett, I. V., Molotnikov, L., Klevens, M., O’Connor, E., Leach, D., Roosevelt, K., & Hsu, K. (2021). Chlamydia treatment practices and time to treatment in Massachusetts: Directly observed therapy versus pharmacy prescriptions. Journal of Primary Care & Community Health, 12, 21501327211044060. https://doi.org/10.1177/21501327211044060
Scheidell, J. D., Ataiants, J., & Lankenau, S. E. (2022). Miscarriage and abortion among women attending harm reduction services in Philadelphia: Correlations with individual, interpersonal, and structural factors. Substance Use & Misuse, 57(6), 999–1006. https://doi.org/10.1080/10826084.2022.2046100
Sharma, S., RoyChoudhury, S., Bathwal, S., Bhattacharya, R., Kalapahar, S., Chattopadhyay, R., Saha, I., & Chakravarty, B. (2020). Pregnancy and live birth rates are comparable in young infertile women presentings with severe endometriosis and tubal infertility. Reproductive Sciences (Thousand Oaks, Calif.), 27(6), 1340–1349. https://doi.org/10.1007/s43032-020-00158-x
Case Study Analysis Instructions: Womens Health
Module 7 Assignment: Case Study Analysis Scenario 1: A 32-year-old female presents to the ED with a chief complaint of fever, chills, nausea, vomiting, and vaginal discharge. She states these symptoms started about 3 days ago, but she thought she had the flu. She has begun to have LLQ pain and notes bilateral lower back pain. She denies dysuria, foul-smelling urine, or frequency. States she is married and has sexual intercourse with her husband. PMH negative. Labs: CBC-WBC 18, Hgb 16, Hct 44, Plat 325, Â Neuts & Lymphs, sed rate 46 mm/hr, C-reactive protein 67 mg/L CMP wnl Vital signs T 103.2 F Pulse 120 Resp 22 and PaO2 99% on room air. Cardio-respiratory exam WNL with the exception of tachycardia but no murmurs, rubs, clicks, or gallops. Abdominal exam + for LLQ pain on deep palpation but no rebound or rigidity. Pelvic exam demonstrates copious foul-smelling green drainage with reddened cervix and + bilateral adenexal tenderness. + chandelier sign. Wet prep in ER + clue cells and gram stain in ER + gram negative diplococci. An understanding of the factors surrounding womenâ€™s and menâ€™s health, infections, and hematologic disorders can be critically important to disease diagnosis and treatment in these areas. This importance is magnified by the fact that some diseases and disorders manifest differently based on the sex of the patient. Effective disease analysis often requires an understanding that goes beyond the human systems involved. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.. An understanding of the symptoms of alterations in systems based on these characteristics is a critical step in diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans. In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health. To prepare: By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the â€œCourse Announcementsâ€ section of the classroom for your assignment from your Instructor. Assignment (1 to 2-page case study analysis) In your Case Study Analysis related to the scenario provided, explain the following as it applies to the scenario you were provided (not all may apply to each scenario): The factors that affect fertility (STDs). Why inflammatory markers rise in STD/PID. Why prostatitis and infection happens. Also explain the causes of systemic reaction. Why a patient would need a splenectomy after a diagnosis of ITP. Anemia and the different kinds of anemia (i.e., micro and macrocytic). Day 7 of Week 10 Submit your Case Study Analysis Assignment by Day 7 of Week 10 Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates). All papers submitted must use this formatting.