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

2. Disclosures
I have no disclosures

3. 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

4. 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

5. 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

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

7. 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

8. Differential?
How would you initially approach the diagnostic workup?

9. HD#2

10. Laboratory
Diagnostic Tests were Performed

11. HD#4

12. HD#4

13. Diagnosis?

14. Diagnosis
HSV-2 associated acute hepatitis

15. 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 Sex Transm Dis 2013; 40(11):860–864.

16. Thank you!
Questions?