ACOG District IV & VI Annual Meeting 2018 Stump The Professors Matthew Zuber, MD PGY-4

Disclosures I have no disclosures

Learning Objectives Develop a clinical approach to patients who are victims of sexual assault Expand the differential diagnosis for patients with sepsis Keep physical examination at the heart of guiding diagnostic testing

Case Report 18 yo nulligravida presents to the emergency department 8 days after a sexual assault She complains of malodorous urine, dysuria, vaginal bleeding less than menses, nausea, pelvic pain, decreased appetite, subjective fevers and chills

Case Report PMH includes osteogenesis imperfecta with history of multiple fractures, as well as systemic lupus erythematosus on no medications LMP 2 weeks ago, using patch for birth control

Vitals T 101F P 107 RR 29 BP 130/60 UPT negative

Physical Examination Mildly ill appearing, no evidence of physical trauma though she appears flushed, lungs clear, abdomen tender throughout without rebound or guarding, vagina with slightly malodorous clear discharge, cervix with scant blood and clear cervical mucous, cervix and uterus diffusely tender on bimanual examination, no palpable adnexal masses, no lymphadenopathy

Differential? How would you initially approach the diagnostic workup?

HD#2

Laboratory Diagnostic Tests were Performed

HD#4

HD#4

Diagnosis?

Diagnosis HSV-2 associated acute hepatitis

Herpes Simplex Virus Type 2 — Seroprevalence Among Non-Hispanic Whites and Non-Hispanic Blacks by Sex and Age Group, National Health and Nutrition Examination Survey (NHANES), 1988–1994, 1999–2002, 2003–2006, and 2007–2010 Overall, herpes simplex virus type 2 (HSV-2) seroprevalence decreased between 1988–1994 and 2007–2010, from 21.2% to 15.5%. Among non-Hispanic White females, HSV-2 seroprevalence significantly decreased from 19.5% in 1988–1994 to 15.3% in 2007–2010; HSV-2 seroprevalence remained stable among non-Hispanic Black females, from 52.5% during 1988–1994 to 49.9% during 2007–2010. Similar race/ethnicity differences were observed for males. These data, along with data from the National Health and Nutrition Examination Survey years 1976–1980, indicate that non-Hispanic Blacks had higher overall seroprevalence than non-Hispanic Whites in each survey period. NOTE: Error bars indicate 95% confidence interval. SOURCE: Fanfair RN, Zaidi A, Taylor LD, et al. Trends in Seroprevalence of Herpes Simplex Virus Type 2 Among Non-Hispanic Blacks and Non-Hispanic Whites Aged 14 to 49 Years — United States, 1988 to 2010. Sex Transm Dis 2013; 40(11):860–864.

Thank you! Questions?