<please read bottom cliffs (at least) before answering>
<This is all I remember from the question, sorry if history is spotty>
40 year old guy presents with tingling during urination that has lasted for 5 days now. He first noticed it after he had sex with a new female partner and he has never felt anything like this in his life. He describes it (when it first appeared about a week ago) as a small white sore on the dorsal side of the glans which was painfully sharp, but not bloody and purulent. He notes no change in urinary frequency, no blood in his urine, and no difficulty in urinating.
Past medical history significant for previous UTI treated with antibiotics, but no history of obstructive genitourinary pathology. Never had any STD tests. No major past surgical history. He takes no medications.
He works as a clerk at an accounting office and is single with no pets or recent foreign travel.
Sexual history significant for multiple partners who have never reported any STDs to him, and patient claims consistent usage of condoms before starting intercourse including this most recent encounter.
Family history is unremarkable.
On physical exam of the area, there is no inguinal, suprapubic, scrotal, or testicular tenderness, no inguinal lymphadenopathy, no lesions seen on glans or surrounding structures, no urethral discharge, and no evidence of prior lesions on dermal surface.
You collect urine sample and dipstick test shows no presence of glucose, protein, blood, WBCs, nitrites, or leukocyte esterase. You also collect blood and urethral swabs to test and culture for common STDs such as gonorrhea, Chlamydia, syphilis, HIV, and herpes, but results won't be back for 72 hours.
Now, do you treat empirically without knowing the viral vs bacterial cause and potentially add to the growing problem of multiple drug resistant bacteria and expose him to potential side effects and complications of antibiotics?
OR do you send him back into society without treatment, wait for the results to come back, tell him to abstain until you call him with the results, and treat him if he returns?
**CLIFFS**
Guy comes in with vague genitourinary symptoms after new sexual partner and recent sexual encounter with her where he used a condom.
Physical exam of area is essentially normal.
You do tests but have to wait 3 days for results.
Now what?
<This is all I remember from the question, sorry if history is spotty>
40 year old guy presents with tingling during urination that has lasted for 5 days now. He first noticed it after he had sex with a new female partner and he has never felt anything like this in his life. He describes it (when it first appeared about a week ago) as a small white sore on the dorsal side of the glans which was painfully sharp, but not bloody and purulent. He notes no change in urinary frequency, no blood in his urine, and no difficulty in urinating.
Past medical history significant for previous UTI treated with antibiotics, but no history of obstructive genitourinary pathology. Never had any STD tests. No major past surgical history. He takes no medications.
He works as a clerk at an accounting office and is single with no pets or recent foreign travel.
Sexual history significant for multiple partners who have never reported any STDs to him, and patient claims consistent usage of condoms before starting intercourse including this most recent encounter.
Family history is unremarkable.
On physical exam of the area, there is no inguinal, suprapubic, scrotal, or testicular tenderness, no inguinal lymphadenopathy, no lesions seen on glans or surrounding structures, no urethral discharge, and no evidence of prior lesions on dermal surface.
You collect urine sample and dipstick test shows no presence of glucose, protein, blood, WBCs, nitrites, or leukocyte esterase. You also collect blood and urethral swabs to test and culture for common STDs such as gonorrhea, Chlamydia, syphilis, HIV, and herpes, but results won't be back for 72 hours.
Now, do you treat empirically without knowing the viral vs bacterial cause and potentially add to the growing problem of multiple drug resistant bacteria and expose him to potential side effects and complications of antibiotics?
OR do you send him back into society without treatment, wait for the results to come back, tell him to abstain until you call him with the results, and treat him if he returns?
**CLIFFS**
Guy comes in with vague genitourinary symptoms after new sexual partner and recent sexual encounter with her where he used a condom.
Physical exam of area is essentially normal.
You do tests but have to wait 3 days for results.
Now what?
