Abid

1. Child & Adolescent
Health
Dr Abid Vatani
28 April 2011

2. • G, 14 yo F
• BIB mother on 14 March 2011
• Cyclic pelvic pain
• Shifting from right to left at times
• Pain before period starts
• Moderately painful periods

3. • Last time pain worse
• Bent over & cried due to the pain
• Pain subsided at the time of consultation

4. PMHx:
• Menarche at age 12
• Regular cycles
• Unremarkable medical history
• Not sexually active
• Not on any medication

5. Differential diagnosis:
• Ovulation pain
• UTI
• GI aetiology
• Ruptured ovarian cyst
• (Endometriosis)

6. Red flags:
• Infection (PID/STD)
• Ectopic pregnancy
• Appendicitis

7. Ovulation pain more
likely
• Common
• Also known as ‘mid cycle pain’ or
Mittleschmetz pain
• Usually harmless
• Usually resolves with age

8. Management:
• Urine m/c/s
• NSAID
(Naproxen250mg bd)
• Return for result and
follow up

9. Urine m/c/s 14/3/11
• PH 6.0 • epi cells <10
• Protein Trace • Culture No pathogen
• Glucose Nil
• Special Gravity 1.026
• Leucocytes 290 * 10*6/L
• Erythrocytes <10

10. • Returned with mother on 7 April 2011
• First intercourse 4/52 ago
• No protection
• C/o smelly d/c for 2/52
• No itch or soreness
• Feels a painful lump ‘down below’

11. • Hurts when wipes
• LNMP 2/52 ago
• Mother asking for HIV testing

12. O/e:
• Abdo: Mild pelvic pain, no palpable mass, BS
presented.
• PV: Inspection: no obvious erythema or
swelling . Palpation: no palpable mass, no
cervical excitation. Speculum examination:
white/grey d/c ++, whole vagina wall looked
lumpy, red and inflamed.
• HVS & chlamydia swob taken

13. Differential diagnosis:
• Thrush
• STD
• Vaginosis

14. Management:
• Trial of clotriamzole
• Review with the results

15. • 11 April 2011
• Phone call from Public Health Medical
Officer
• Chlamydia was detected
• Questioning child safety and child abuse
• Asked receptionist to call mother to come
in to discuss the results.

16. • Later on that day phone call from a
Supervisor at S&N
• Gonorrhea also detected
• Recommended adding on Trichomonas
• Advice on treating with Azithromycin and
Ceftriaxone +/- Doxycyclin
• Also to do bloods for HIV and Syphilis

17. • 12 April 2011
• Presented with mother
• Sx less severe after clotrimazole
• Results given
• Treatment plan explained
• Mother happy to cover with Doxycyclin

18. • Boy’s mobile obtained
• Reassured the confidentiality
• Blood form for syphilis and HIV given
• Return if any concern

19. • D/w my Supervisor

20. • 15 April 2011
• Trichomonas was negative
• Sexual partner contacted on his mobile and
notified about the STD and advised to see
his GP or Sexual Health Service.
• Appointment made for the following day

21. • NO show !