Simple cases

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Case 9

53-year-old man with burning pain on urination for 2 days and yellow discharge.

No, I feel fine.

Acute urethritis usually does not cause any systemic problems.

No, I had sex 5 days ago but used a rubber.

Unprotected genital sexual contact is the usual way this infection is transmitted.

Yes, I had oral sex at the same time.

Sometimes the infection is transmitted by oral sexual contact.

I'm single and don't have a regular partner.

Important in identifying sources or infections and others who could have become infected.

I would say I have had intercourse with 12 women in the past 6 months, almost always protected.

Important for determining risk-taking behavior.

I had crabs in basic training; otherwise I've been lucky.

Important for determining risk-taking behavior.

No, never.

These two important diseases are usually sexually transmitted.

Choose the right efflorescences:

False. No vesicles are seen.

False. No erosions are seen

False. No hives are seen

Correct. There is no primary skin lesion, just an urethral discharge.

Choose the right diagnosis:

False. Herpes genitalis usually has burning vesicles on an erythematous base.

False. You are close, as it is an urethritis and chlamydial urethritis is the most important differential diagnostic consideration.

False. Chancroid presents with an ulcer.

Correct. The incubation for gonococcal urethritis is 3-5 days, much less than the 7-21 days for chlamydial urethritis.

Choose the right therapy(ies):

False. The darkfield examination identifies Treponema pallidum, the causative agent of syphilis.

False. Gonorrhea must be treated.

False. Biopsy is not needed.

False. This antibiotic is not the agent of choice because resistance is so common.

Correct. This is the recommended approach.

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