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Simple cases
Case 27
A patient complains of burning on urination for 3 days.
History
I need to ask you a few questions which you may find awkward. How many different women have you slept with in the past month? Did you always use a condom?
I don't have a regular partner now. In the last 4 weeks, I have had intercourse with two different ladies who I really didn't know. Both times things were so spontaneous that I didn't have time for a condom.
You usually will not get such a clear answer on your first question, but must ask and ask.
Have you ever had any sexually transmitted diseases?
No, not that I know.
A positive history suggests risk-taking behavior.
Does anyone in your family have a history of urinary tract abnormalities?
No, not that I know of.
The patient clearly has a urinary tract infection. Even if he has a malformation as a predisposing factor, the family history doesn't help you.
Do you have any other problems?
No
Signs and symptoms of systemic disease could help you with the differential diagnosis.
Are you allergic to any medications?
I am allergic to penicillin, here is my allergy pass.
While drug reactions rarely cause urethritis, this is a crucial question for planning treatment.
Are you having discharge from your urethra?
Once in a while a few clear drops come out.
The nature of the urethral discharge also helps in the differential diagnosis.
Lesion
Choose the right efflorescences:
No defect is seen.
The patient has burning on urination.
No mention of itchy transient lesions.
There are no skin lesions.
Diagnosis
Choose the right diagnosis:
The discharge in gonorrhea is thick and foul-smelling and stains the underwear. This is why gonorrhea is known as the drip in the USA.
The discharge in gonorrhea is thick and foul-smelling and stains the underwear. This is why gonorrhea is known as the drip in the USA.
Scabies does not cause urethritis. The patient does not complain of pruritic skin lesions.
None of the porphyrias cause urethritis. Bad choice!
Therapy
Choose the right therapy(ies):
A possible regimen, which can be used during pregnancy.
Terrible choice - patient is allergic to penicillin, this is not approved for chlamydial infections, and the dosage is too low for almost anything.
Another suitable regimen. If possible, partners should be identified and treated. In this case, it was not possible.
The patient has an infection and needs antibiotic treatment.
