20 Feb 2018


20 year-old female presented at ER with 4-day history of fever, chills, myalgia. Two days earlier she noted painful genital lesions. On the day of admission she developed headache, photophobia, and a stiff neck. Previously, she had been in good health. She admitted to being sexually active, but had no history of sexually transmitted diseases (STDs).

Physical exam showed patient alert and oriented with normal vital signs except for a temperature of 101.3˚F. Throat was clear with no lymphadenopathy. Pelvic exam revealed extensive vesicular and ulcerative lesions on the left labia minora and majora with marked edema. The cervix had exophytic (outward-growing) necrotic ulcerations.


General laboratory tests were unremarkable. VDRL was negative. Lumbar puncture was performed and showed a mild pleocytosis (increased cell count) with a leukocyte count of 41 per µl with 21% polymorphonuclear leukocytes and 79% mononuclear cells. CSF glucose was 41 mg/dl (normal 50-80 ml/dl) and protein of 68 mg/dl (normal 15-60 mg/dl).

Cultures from the genital lesions and CSF were received 2 days later. The patient had received 2 days of intravenous therapy by then and her condition had improved.

Which of the following could cause her symptoms (circle most probable; Hint: virology course)?

Human papillomavirus

Treponema pallidium

Herpes simplex virus Type 2

Chlamydia trachomatis

Haemophilus ducreyi

Which of the above organisms would be most likely to have caused her symptoms and why (which cultures were positive/why)?

Which complication of her underlying illness did she develop?

If she had been pregnant at the time of her infection, for what would her fetus be at risk?

Briefly describe the natural cycle of this infection.

Briefly describe the 2 serotypes of this infection (name, where infection occurs, how usually contracted).

please can you answer all the questions.

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Patrina Schowalter
Patrina SchowalterLv2
21 Feb 2018

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