Question

A 15 -year-old girl comes to the clinic for dyspareunia and a vaginal discharge. On speculum examination you find she has cervicitis. The pregnancy test is negative. The infection is modest and there is no emergency. Which of the following is the most appropriate action to take? a. Ceftriaxone/azithromycin now in a single dose. b. Make at least a "good faith" effort to notify her parents and treat her. c. Wait to inform at least one parent. d. Treat only if the patient agrees to inform her parents. e. Treat her now and inform the parents later. 

    A 15 -year-old girl comes to the clinic for dyspareunia and a vaginal discharge. On speculum examination you find she has cervicitis. The pregnancy test is negative. The infection is modest and there is no emergency.
Which of the following is the most appropriate action to take?
a. Ceftriaxone/azithromycin now in a single dose.
b. Make at least a "good faith" effort to notify her parents and treat her.
c. Wait to inform at least one parent.
d. Treat only if the patient agrees to inform her parents.
e. Treat her now and inform the parents later.
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Medical Ethics for the Boards
Medical Ethics for the Boards
Conrad Fischer 3rd Edition
Chapter 1, Problem 60 ↓

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The 15-year-old girl has dyspareunia, vaginal discharge, and cervicitis, indicating a possible sexually transmitted infection (STI). The pregnancy test is negative, and the infection is described as modest with no emergency.  Show more…

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A 15 -year-old girl comes to the clinic for dyspareunia and a vaginal discharge. On speculum examination you find she has cervicitis. The pregnancy test is negative. The infection is modest and there is no emergency. Which of the following is the most appropriate action to take? a. Ceftriaxone/azithromycin now in a single dose. b. Make at least a "good faith" effort to notify her parents and treat her. c. Wait to inform at least one parent. d. Treat only if the patient agrees to inform her parents. e. Treat her now and inform the parents later.
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Key Concepts

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Confidentiality in Adolescent Health Care
This concept emphasizes that adolescents have the legal right to seek sexual and reproductive health services, including treatment for sexually transmitted infections, without requiring parental notification or consent. Laws protecting minor confidentiality are designed to encourage timely medical care while maintaining trust between the patient and healthcare provider.
Management of Sexually Transmitted Infections
This concept involves the use of appropriate, evidence-based medical treatments to address infections such as those causing cervicitis. It includes selecting proper antibiotic regimens—like the combination of ceftriaxone and azithromycin—to effectively treat common pathogens such as Neisseria gonorrhoeae and Chlamydia trachomatis, ensuring prompt intervention and preventing complications.
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Case Number: 2 An otherwise healthy 22-year old man came to the emergency department with a history of urethral pain and purulent discharge that developed after he had sexual contact with a prostitute. Gram stain of the discharge revealed abundant gram-negative diplococci resembling Neisseria gonorrhoeae. The patient was treated with ceftriaxone and sent home. Two days later, the patient returned to the emergency room with a complaint of persistent, watery urethral discharge. Abundant white blood cells but no organisms were observed on Gram stain of the discharge. Culture of the discharge was negative for N. gonorrhoeae. 6. What is the most likely cause of his current complaint? a. Neisseria gonorrhoeae b. Chlamydia trachomatis c. Syphilis d. Chancroid e. HPV 7. What is the source of the infection? a. A toilet seat b. Improperly cooked food c. His own normal flora d. His sexual partner e. Deep puncture from stepping on a nail 8. Why did the ceftriaxone treatment fail? a. His strain of N. gonorrhoeae was producing beta-lactamase b. He hadn't taken his medication long enough c. He initially had a duel infection, and the ceftriaxone only killed the N. gonorrhoeae d. The drug given to him had degraded and was ineffective e. It just hasn't had time to work yet 9. Which laboratory test should be ordered to confirm the diagnosis? a. A nucleic acid test b. A serological test c. A routine culture d. A repeat Gram Stain e. A drug susceptibility test on the organism recovered two days ago. 10. What drug may be used to effectively treat this patient? a. More ceftriaxone b. Penicillin c. Azithromycin d. Rifampin e. Clindamycin
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