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Simple cases
Case 9
53-year-old man with burning pain on urination for 2 days and yellow discharge.
History
Do you have any other complaints?
No, I feel fine.
Acute urethritis usually does not cause any systemic problems.
Have you have unprotected sexual intercourse in recent days?
No, I had sex 5 days ago but used a rubber.
Unprotected genital sexual contact is the usual way this infection is transmitted.
Did you have oral sex?
Yes, I had oral sex at the same time.
Sometimes the infection is transmitted by oral sexual contact.
Are you married or do you have a regular sexual partner?
I'm single and don't have a regular partner.
Important in identifying sources or infections and others who could have become infected.
Do you have a fair number of sexual partners?
I would say I have had intercourse with 12 women in the past 6 months, almost always protected.
Important for determining risk-taking behavior.
Have you ever had any type of venereal disease?
I had crabs in basic training; otherwise I've been lucky.
Important for determining risk-taking behavior.
Have you had an HIV or syphilis blood test?
No, never.
These two important diseases are usually sexually transmitted.
Lesion
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.
Diagnosis
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.
Therapy
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.
