A 17-year-old girl, gravida 0 para 0, comes to the office for routine examination and an oral contraception prescription. Her menses occur every 28 days and her last menstrual period was 3 weeks ago. She is feeling well and is preparing to leave for college in 5 months. The patient has no chronic medical conditions or previous surgeries. She has no history of migraine headaches or thromboembolism. The patient is up to date on all vaccinations. Her maternal grandmother has hepatitis B; family history is otherwise noncontributory. The patient currently takes no medications and does not use tobacco, alcohol, or illicit drugs. She has no known drug allergies. She has been sexually active with one partner for the past 2 years and uses condoms for contraception. Temperature is 37.2 C (99 F), blood pressure is 110/70 mm Hg, and pulse is 72/min. Weight is 60 kg (132.3 lb) and height is 162.5 cm (5 ft 4 in). Cardiopulmonary examination is normal. The abdomen is soft and nontender with no hepatosplenomegaly. On pelvic examination, no vulvar or cervical lesions and no cervical discharge are present. On bimanual examination, the uterus is small and without cervical motion tenderness. Bilateral adnexa are small, mobile, and nontender. In addition to an oral contraception prescription, which of the following is the best next step in management of this patient?

Question

A 17-year-old girl, gravida 0 para 0, comes to the office for routine examination and an oral contraception prescription.  Her menses occur every 28 days and her last menstrual period was 3 weeks ago.  She is feeling well and is preparing to leave for college in 5 months.  The patient has no chronic medical conditions or previous surgeries.  She has no history of migraine headaches or thromboembolism.  The patient is up to date on all vaccinations.  Her maternal grandmother has hepatitis B; family history is otherwise noncontributory.  The patient currently takes no medications and does not use tobacco, alcohol, or illicit drugs.  She has no known drug allergies.  She has been sexually active with one partner for the past 2 years and uses condoms for contraception.  Temperature is 37.2 C (99 F), blood pressure is 110/70 mm Hg, and pulse is 72/min.  Weight is 60 kg (132.3 lb) and height is 162.5 cm (5 ft 4 in).  Cardiopulmonary examination is normal.  The abdomen is soft and nontender with no hepatosplenomegaly.  On pelvic examination, no vulvar or cervical lesions and no cervical discharge are present.  On bimanual examination, the uterus is small and without cervical motion tenderness.  Bilateral adnexa are small, mobile, and nontender.  In addition to an oral contraception prescription, which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bf14_bada_8f63_a52295363135_MD0005_00 Chlamydia trachomatis is a common sexually transmitted infection with clinical manifestations that range from asymptomatic infection to cervicitis and pelvic inflammatory disease. Because of reproductive complications from pelvic inflammatory disease due to untreated C trachomatis infection (eg, tubo-ovarian abscess, ectopic pregnancy, infertility), detection of asymptomatic infection with routine screening is performed as part of preventive care. Sexually active women age <25 should be screened annually for gonorrhea and chlamydia with either vaginal or endocervical nucleic acid amplification testing (NAAT). Women age ≥25 with risk factors (eg, multiple sexual partners, sex workers) should also be screened. Treatment of C trachomatis infection is with azithromycin or doxycycline. In addition, patients are instructed to have either partner testing or empiric expedited partner treatment; they are also advised to abstain from sexual intercourse for at least 7 days after completion of therapy to avoid reinfection. If NAAT testing for C trachomatis is positive, screening for other sexually transmitted infections (eg, HIV, syphilis) is also indicated. (Choice A) One-time screening for hepatitis C virus is recommended in adults age 18-79 and for patients at high risk for infection (eg, injection drug users, blood transfusion recipients prior to 1992). (Choice B) In patients who are not sexually active, screening for C trachomatis may be omitted. This patient is sexually active. (Choice D) Pap testing screens for cervical dysplasia and cervical cancer. Screening is initiated at age 21 regardless of age of onset of sexual activity. This patient is age 17. (Choice E) Routine screening for syphilis with rapid plasma reagin (RPR) is indicated for high-risk individuals: men who have sex with men, patients with co-existing HIV infection, individuals with a history of incarceration, and sex workers. Pregnant women are also routinely screened. This patient has no risk factors. Educational objective: Untreated Chlamydia trachomatis infection in women can lead to complications (eg, pelvic inflammatory disease, tubo-ovarian abscess, ectopic pregnancy, infertility). Routine screening with nucleic acid amplification testing is required in sexually active women age <25. References: Sexually transmitted infections: recommendations from the U.S. Preventive Services Task Force. (http://www.ncbi.nlm.nih.gov/pubmed/27929270) CDC recommendations for hepatitis C screening among adults - United States, 2020. (http://www.ncbi.nlm.nih.gov/pubmed/32271723)

A 17-Year-Old Girl, Gravida 0 Para 0, Comes to the Office