I wanted to share an experience with my fellow NPs here.
So I'm doing rounds the other day and had a young girl, 22yo, hospitalized with sore throat (weak admit btw). Anyway she was running fever 103, tachycardic 115s, 14k leukocytosis at time of admission, so she did meet sirs criteria. Anyway, the NP who did her H&P checked her for strep, mono, the usual work up. All of which was negative. Despite being on abx (unasyn) in the hospital and previously on amoxicillin for one week from an urgent care center, she had little to no improvement.
So I'm reading the H&P and can't find the sexual hx (was never asked). So I enter her room, do my usual exam, throat is quite erythematous, no pustules, no exudate. I obtained her sexual hx. New sex partner 2.5 weeks ago, + oral sex, unprotected.
We swab her throat for GC. Next day later she is + for gonorrhea. Given the hx I obtained from her I empirically treated her for gonorrhea anyway. I discharged her later that day and part of DC instruction was to dump the new boo, lol, and have him treated.
So the reason I'm sharing this is to encourage you all to really think about your differentials depending on your patients age and symptoms, especially the new NPs coming out of school. Sore throat in a young person has many differentials, which can easily be overlooked as an STD. Always do a thorough history and physical, like they say you can diagnose 80-90% of problems with a good H&P.
Having worked in an STD clinic for years, we routinely cultured throats and rectums for GC and CHL. We had many, many positives. It was the patient who became blind in one eye because of GC, that blew me away (no pun intended).
beckysue920
134 Posts
Having worked in an STD clinic for years, we routinely cultured throats and rectums for GC and CHL. We had many, many positives. It was the patient who became blind in one eye because of GC, that blew me away (no pun intended).