Married Female Patient’s Pap Smear Reveals Suspected STD – A Medical Case Study

Yesterday I watched again the TV series “The Doctor Under the Stars” with my children, and there was an impressive case: a 15-year-old girl underwent surgery for experimental acute appendicitis. Before the surgery, the internist helped the patient with a urinary catheter. rarely in pediatric surgery).

This episode reminds me of a case I encountered a long time ago. As pathologists, we often receive Pap smear samples from female patients. This is a regular checkup that adult women need to do. Pap smear examination can effectively identify cervical precancerous lesions and treat them early to reduce the chance of breast cancer. By examining cells under a microscope, as well as pre-cancerous lesions and cancerous cells, we can sometimes identify inflammation and diseases in the cervix, including some sexually transmitted diseases, such as genital herpes and trichomonas (Trichomonas vaginalis).

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That time it was a female patient almost sixty years old In her Pap smear sample, it was obvious that there was a “cytopathic effect” caused by the herpes virus: there were many nuclei in one cell, and the chromatin in the nucleus gathers towards the edges. In normal circumstances, we will make a diagnosis directly on the pathology report. However, with the patient’s age, whether he is too young or too old, doctors must be careful before diagnosing an STD. What is even worse is that the husband of the female patient happens to be someone everyone knows. Whether a husband is influencing his wife or there is a patient on the outside, it can cause a family crisis and it does not matter.

After speaking with my colleagues, I decided not to write this pathology report at this time. The patient’s attending doctor communicates with the patient alone first to understand the situation, and then ask a microbiology doctor to examine and confirm. After all, histopathology relies on visual diagnosis and cannot be 100% accurate for microbial infections, microscopic observation can only provide general guidance. Which virus, bacteria or parasite it is ultimately depends on various diagnostic microbiology technologies, such as inoculum, blood test, antibody test, polymerase chain reaction, etc., to make a diagnosis and appropriate treatment.

The full text was published in the Economic Daily, originally titled “Thoughtful diagnosis」

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