A 16-year-old female comes to the physician because of an increased vaginal discharge. She developed this symptom 2 days ago. She also complains of dysuriA. She is sexually active with one paner and uses condoms intermittently. Examination reveals some erythema of the cervix but is otherwise unremarkable. A urine culture is sent which comes back negative. Sexually transmitted disease testing is performed and the patient is found to have gonorrheA. While treating this patient's gonorrhea infection, treatment must also be given for which of the following?

This patient has a gonorrhea infection.It is more common in patients of lower socioeconomic status, patients with multiple sexual paners, and in urban settings. The causative organism is N. gonorrhoeae, a gram-negative aerobic diplococcus. Up to 80% of women that are infected with the organism will have no symptoms at all or only vague symptoms. Symptoms that are frequently noted are vaginal discharge, postcoital spotting, and urinary symptoms if the urethra is involved. Examination may reveal a cervicitis, although this is not always present. A patient found to have gonorrhea should be treated with intramuscular ceftriaxone or oral cefixime, ofloxacin, or ciprofloxacin. These medications will ffectively eradicate the gonococcus. However, because Chlamydia trachomatis can be isolated in up to 50% of women with gonorrhea and because women treated for gonorrhea only may soon go on to develop Chlamydia or pelvic inflammatory disease (PID., any woman receiving treatment for gonorrhea should also be treated for ChlamydiA. Treatment of Chlamydia is with azithromycin or doxycycline. It is also essential that this patient's paner be treated as well. When treating a patient for gonorrhea, there is no need to treat the patient with metronidazole to treat bacterial vaginosis (Choice A) as well, unless there is evidence of a bacterial vaginosis . Herpes (Choice C) often presents as painful vesicles and ulcers. Patients with onorrhea do not need to be treated for herpes as well, unless there is evidence for herpes infection. Patients with gonorrhea are at increased risk of having other sexually transmitted diseases, including syphilis (Choice D). It would be prudent to check this patient for syphilis with a blood test. However, in the absence of a positive syphilis test, patients with gonorrhea do not need to be treated for syphilis.