Concepts of Women’s and Men’s Health, Infections and Hematologic Disorders

Case Study Analysis 

In our case study, we encounter a 32-year-old female patient who presents with fever, chills, nausea and vomiting as well as vaginal discharge. The patient goes further to state the duration of the symptoms, clearly indicating that they had lasted for three days. She reports new-onset left lower quadrant pain with low back pain felt bilaterally. In addition to this, further probing on the genitourinary system is conducted, laboratory work-ups are requested and results availed and the patient is then examined physically. A keen assessment and evaluation of these signs and symptoms clearly demonstrate that an infectious process is going on. 

Factors in the Diagnosis 

The elements within the case which lead us to the diagnosis of a Sexually Transmitted Infection include the complaint of vaginal discharge and a history of coitus given that she is a married woman. Another symptom that might point to this diagnosis is the report of left lower quadrant pain that’s associated with low back pain. On physical and pelvic examination, we narrow down our diagnosis to STD with much certainty given our findings of tender LLQ palpation with respective demonstration of a large amount of malodorous green vaginal discharge, associated with an erythematous cervix, tenderness of the adnexa bilaterally and a positive Chandelier sign. 

Implications to Patient Health 

Sexually Transmitted Diseases can have serious implications on the health of the patient. The most fatal of these consequences is death (World Health Organization, 2018). Furthermore, if chlamydia or gonorrhea go untreated, they can have the adverse outcome of causing Pelvic Inflammatory Disease (PID), which has been shown to eventually cause chronic pain or infertility (Low & Broutet, 2017). Ectopic pregnancy, with consequent maternal death can also be caused by PID. Some types of Human Papilloma Virus are associated with the causation of cervical cancer (Small et al., 2017). Other STDs, including herpes and syphilis, may cause spontaneous abortion, premature delivery or even stillbirths. Herpes has the potential of causing mental retardation in babies (Genz et al., 2018). In our case study, prompt treatment of the patient and education on how to prevent sexually transmitted diseases will go a long way in ensuring that she does not have to face these dire consequences. 

Factors that Affect Fertility 

There are a number of factors which have an effect on fertility. STDs are just one of these many factors. STDs have the potential of causing infertility by first causing PID which results in damage to fallopian tubes, the uterus together with its surrounding structures (Low & Broutet, 2017). Other factors that have been implicated in this are age (with the female age being the most important in our case), previous pregnancy (whether successful or not), the timing of and frequency of coitus, the length of time a couple has been sub fertile as well as other lifestyle factors that comprise smoking, consumption of alcohol, one’s weight and other underlying medical conditions (Vander Borght & Wyns, 2018). In our case analysis, the age factor takes central stage due to the fact that females’ ova show a gradual decline in number right from the time they are born. 

Inflammatory Markers and their Rise in STD/PID 

Inflammatory markers are biomarkers that are used in evaluating a patient to determine the presence or absence of an inflammatory disease process. Inflammatory markers rise when one is infected with a sexually transmitted disease or Pelvic Inflammatory Disease due to the fact that these ailments evoke an immense inflammatory reaction with the pathology being manifested in the genital tract. This inflammation results in increase in protein (biomarkers) in the blood, signifying an infection (McCance & Huether, 2019). Our case analysis demonstrates an increased erythrocyte sedimentation rate of 46 mm/hr and C - reactive protein at 67 mg/L, denoting that the patient has an infection. 

Prostatitis, Infection and Systemic Reaction 

Prostatitis is a medical term that refers to the swelling and inflammation that occurs in the prostate gland, located just below the bladder in men. This condition occurs when the prostate gland gets infected by the bacteria from the urinary tract, or by direct extension or spread from the rectal area via the lymphatic system. Prostatitis can also be caused by several organisms which cause sexually transmitted infections (McCance & Huether, 2019). The cause of the body’s systemic response is usually an infectious or a non-infectious agent. Some of the causes of Systemic Inflammatory Response Syndrome (SIRS) include bacterial, viral and fungal agents. Other causes are parasitic infections like malaria, burns, ischemia, hemorrhage etc. (Low & Broutet, 2017). In the case of our patient, her husband would be at risk of prostatitis, with the main probable cause being the infectious agents causing the STD. 

Immune Thrombocytopenic Purpura and Splenectomy 

ITP is a disorder of bleeding in which a person’s immune system attacks and destroys platelets. The spleen functions to remove these damaged platelets. Splenectomy is therefore important in that it has the net effect of preserving more platelets within the circulation (McCance & Huether, 2019). Here, we meet a patient with thrombocytopenia as is shown by the Complete Blood Count. The most prudent action to take would be to investigate the cause of the thrombocytopenia which could be a viral infection e.g. Epstein-Barr, rubella or mumps, Aplastic Anemia or cancers such as leukemia or lymphomas. 

Anemia 

Anemia has been described as low levels of healthy erythrocytes or hemoglobin required for the transportation of oxygen to the body tissues. The commonest symptom of this disorder is fatigue. Other symptoms are chest pain, skin pallor, dizziness, tachycardia and shortness of breath. Types of anemia include Iron deficiency anemia, vitamin deficiency anemia, hemolytic anemia, sickle cell anemia and aplastic anemia. The two broad categories of anemia, based on the size of the erythrocytes, are microcytic and macrocytic anemia. The classification can also include the amount of hemoglobin in the red blood cells and consequently described as normochromic, hypochromic or hyperchromic. If erythrocytes are less than 80 femtoliters, it is called microcytic anemia. On the other hand, if they are larger than 100 femtoliters, it is called macrocytic anemia. Normocytic anemia is defined by RBCs in the range of 80-100 femtoliters (McCance & Huether, 2019). Our case study shows a patient whose hemoglobin count is slightly above the upper normal limit of 15.5g/dl for females. The patient in question is therefore not anemic. 

References 

Genz, N., Meincke, S., Carret, M., Corrêa, A., & Alves, C. (2018). Sexually Transmitted Diseases: Knowledge and Sexual Behavior of Adolescents . Retrieved 4 August 2020, from https://doi.org/10.1590/0104-07072017005100015. 

Low, N., & Broutet, N. (2017). Sexually transmitted infections—Research priorities for new challenges. PLOS Medicine , 14 (12), e1002481. https://doi.org/10.1371/journal.pmed.1002481 

McCance, K., & Huether, S. (2019). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th Ed.). Mosby. 

Sherrard, J., Wilson, J., Donders, G., Mendling, W., & Jensen, J. (2018). 2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge. International Journal of STD & AIDS , 29 (13), 1258-1272. https://doi.org/10.1177/0956462418785451 

Small, W., Bacon, M., Bajaj, A., Chuang, L., Fisher, B., & Harkenrider, M. et al. (2017). Cervical cancer: A global health crisis. Cancer , 123 (13), 2404-2412. https://doi.org/10.1002/cncr.30667 

Vander Borght, M., & Wyns, C. (2018). Fertility and infertility: Definition and epidemiology. Clinical Biochemistry , 62 , 2-10. https://doi.org/10.1016/j.clinbiochem.2018.03.012 

World Health Organization. (2018). Managing epidemics: Key facts about major deadly diseases . The World Health Organization.