Juliana Mirabelles - 25 yo female, 5'5", 135 lb, BMI 22.4

Juliana Mirabelles – 25 yo female, 5’5”, 135 lb, BMI 22.4 Temp – 37.1 (98.7) Pulse- 66 regular BP – left 116/64, right 118/66 Resp – 12 regular even unlabored SpO2 – 99% Last visit – 1 yr 1 month ago Pain with urination and urgency PMH – none Hospitalizations – none Meds – OCP- ethinyl estradiol/drospirenone, ibuprofen for menstrual cramps Allergies – none Preventative health – last Pap 1 yr afo, no Hx abnormal results, previous std screen, no HPV vaccination, thinks she is up to date with immunizations Fam Hx: mother – DM, father – HTN, CAD, HLD, older sister – alive and healthy Social Hx: works as a consultant, travels frequently, alcohol- 1 -2 times per week, 4 – 5 drinks per occasion, no other substances, previous smoker – 2 pack-year Hx HPI: JM is a 25-year-old female presenting complaints of with dysuria, frequency, and vaginal discharge. CC: “I have been having a burning when I pee. I was worried that I had another bladder infection, but these symptoms are a little different than the symptoms I had with my last UTI.” Pt reports dysuria started 3 days ago and feels like a severe burning pain that is worse when she starts to pee and maintains in severity. She denies aggravating factors besides urination, and reports soaking in a warm bath seems to help. She has not tried any treatments for her pain. She also notes frequency, urinating small amounts of urine every 10 – 20 minutes. She also notes mucousy, creamy vaginal discharge without smell that started 3 days ago. JM states she has had multiple male sexual partners in the past 6 months, most frequently one week ago. She does not use any STI protection with intercourse. Last menstrual period started 2.5 weeks ago. Multiple sexual partners without protection. Last sexual encounter 1 week ago. OCP for birth control. Last PAP 2 years ago- no abnormal history. No HPV vaccination. On exam, cervix was friable and mucopurulent discharge present from cervical os. No masses, lesions, ulcerations, or cervical motion tenderness. Reason for encounter – pain with urination, “I have been having a burning when I pee. I was worried that I had another bladder infection, but these symptoms are a little different than the symptoms I had with my last UTI.” Also has vaginal discharge that started at same time, denies vaginal itching HPI- pain with urination started 3 days afo, vaginal discharge is yellow, kind of mucousy, kind of creamy, not really too smelly, discharge started during third week of pill pack, constant, denies inserting foreign bodies into vagina, urine is normal, denies blood and pus, no urinary incontinence, feels like has to pee more often, 10 – 20 minutes but resists due to pain, small amounts of urine, denies urgency, no frothy no stones, No fevers, no change in hx or medications, last period started 2.5 weeks ago, does not vaginal douche, Sexually active with multiple male partners in past 6 months, not using STD protection, last sexual encounter 1 week ago, no partners have said they have similar problems Denies vaginal dryness and sores PMH: No change since last visit/none Medications: