Gonorrhea

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍symptoms suggestive of a STIurethral dischargevaginal dischargerectal discomfort

Symptoms include:

‍abnormal vaginal discharge, ‍clear, ‍thin, ‍withwithout fishy odor

‍penile discharge

‍burning on urination

‍genital itching

‍genital irritation

‍scrotal pain

‍lower abdominal pain

‍pelvic pain

‍rectal pain

‍bleeding between periods

‍bleeding after intercourse

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills



Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍unprotected sex

‍multiple sexual partners

‍recent sexual contact with someone with a STI

no history of: ‍chlamydia infection, ‍sexually transmitted infections, ‍HIV, ‍immunodeficiency





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia

Pelvic:

- External genitalia: ‍normal, ‍rashlesions, ‍inguinal lymphadenopathy

- Vagina: ‍normal, ‍lesions, discharge ‍normal, ‍foul-smelling

- Cervix: ‍normal, ‍, ‍IUD strings visualized

- Bimanual exam: ‍normal, uterus ‍tendernessmass, adnexa ‍tendernessmass ‍on righton left, ‍cervical motion tenderness

- Tests performed: ‍Pap smearHPV test, ‍vaginal culturechlamydia/gonorrhea screeningHSV sample, pH ‍< 4.5 (normal)> 4.5, KOH sniff test ‍negative

- ‍Pelvic exam performed with chaperone 





ASSESSMENT:

‍Gonorrhea ‍likelysuspectedpossible

DDx: gonorrhea, chlamydia, syphilis, trichomoniasis, herpes simplex virus infection, HIV, hepatitis B and C, mycoplasma genitalium infection, ureaplasma urealyticum infection, bacterial vaginosis, yeast infection, pelvic inflammatory disease, prostatitis, cystitis, pyelonephritis





PLAN:

Investigations:

- Throat swab

- Rectal swab

- Urinalysis and culture

- STI screening for chlamydia, syphilis, HIV, hepatitis B and C

- Blood work: ‍HIV, ‍Hepatitis B, ‍Hepatitis C, ‍RPR

Treatments:

- ‍Antibiotics until 7 days after treatment completion

- ‍Analgesics

- Sexual partner notification and treatment (last 2 months)

- Abstinence until treatment completed and symptoms resolved

- Counseling on safe sex practices

Further care:

- Notification to public health

- Referral to sexual health clinic

- Follow-up in ‍ ‍daysweeks 2-3 weeks recommended

- Return if symptoms worsen or if new symptoms develop