Respond to other student’s responses with substantive comments. The postings should be at least one paragraph (approximately 100 words) and include at least references.

1. References and citations should conform to the APA 6th edition.
2. Remember: Please respect the opinions of others, even if their views differ. In other words, disagree professionally and respectfully.Plagiarism is never acceptable – give credit when credit is due – cite your sources.

Kathleen's Response

(S) 56-year old male has a complaint of an initial white milky discharge from penile. The patient noticed the discharge four days ago with painful urination. He maintains a sociable lifestyle with extensive traveling. He also reported unprotected sexual activity with the opposite gender. Patient has an h/o HTN and an inguinal hernia.

Med Hx: Hydrochlorothiazide

Allergies: NKDA

Social Hx: denies tobacco use and ETOH

(O) Penile white milky discharge

(A)

Nongonococcal urethritis (NGU): an infection of the urethra

• Causes: Dysuria, Chlamydia trachomatis, Mycoplasma, Herpes Simplex Virus, Trichomonas vaginalis
• Symptoms: Urethral discharge, Dysuria

Differential Diagnosis:

• Dysuria
• Trichomonas: Highly consider diagnose if the issue has no response to Azithromycin, Doxycycline
• Chlamydia trachomati

(P)

• First-line of defense: Azithromycin 1 Gram for one time dose
• Doxycycline 100 MG orally. Twice daily for 7 days
• If persistent: Metronidazole 2 Grams. One time doses &
• Erythromycin 500MG PO. Four times per day for 7 days.

It is vital for primary care clinicians to perform a routine screening for sexually transmitted infections on each patient/client. CDC (2015), advises a nonjudgmental approach with an empathetic manner that is appropriate to the patient’s age group and culture.

References:

CDC (2015). Nongonococcal urethritis. Retrieved from: https://wwwn.cdc.gov/nndss/conditions/nongonococcal-urethritis/

Cleveland Clinic (2010). Diseases and conditions: Nongonococcal urethritis (NGU) in men. The Cleveland Clinic Foundation. Retrieved from: http://my.clevelandclinic.org/health/diseases_cond…

Brooke's Response

S: 56 yo male presents with complaints of a white milky discharge from his penis that started four days ago. He also is experiencing dysuria. Symptoms appeared after having unprotected sex with an unknown female while out of town.

Allergies: NKDA

Medications: HCTZ

PMHx: HTN and Inguinal hernia

Social Hx: Denies alcohol or tobacco use. Travels frequently.

O: 56 yo male with penile discharge

VS: Information not provided-would want this information and to know if the pt is febrile.

General appearance: Information not provided but would assess.

HEENT: Information not provided

CV: Information not provided but would assess.

RESP: Information not provided but would assess.

ABD: Information not provided-Assess for abdominal pain. Palpate for tenderness/mass.

GU: Milky white penile discharge, dysuria-Inspect for penile or scrotal lesions, tenderness, quality and quantity of discharge.

EXT: Information not provided

NEURO: Information not provided

A:

Possible Diagnoses:

1. Gonorrhea- This disease can cause both dysuria and penile discharge. Left untreated it can cause sterility in both men and the women they have intercourse with. A urine test or urethral swab can test for the bacteria that causes this disease, N. gonorrhoeae. The Center for Disease Control (CDC) recommends Ceftriaxone 250 mg IM and Azithromycin 1 gm PO x1 for the treatment of gonorrhea to ensure that even resistant strains are treated. Patients should be educated to abstain from sex for seven days following treatment and to seek follow-up if symptoms continue after treatment ("Gonococcal Infections – 2015 STD Treatment Guidelines", 2016).
2. Urethritis- This diagnosis refers to inflammation of the urethra that may be accompanied by discharge. It may be caused by infection or just inflammation. The bacteria that cause gonorrhea and chlamydia may also cause this condition. However, there is another bacteria known as Mycoplasma genitalium which is linked to 15-25% of all urethritis cases. Microscopic examination of urine samples and genital swabs can help identify which bacteria is responsible for causing the troublesome symptoms. The Center for Disease Control recommended that Azithromycin 1 gm PO x1 be used to treat this condition. Patients need educated that they should refrain from sexual activity for seven days after treatment and to follow-up if symptoms do not resolve with treatment ("Diseases Characterized by Urethritis and Cervicitis – 2015 STD Treatment Guidelines", 2016).

P: Obtain a urine sample to test for UTI. Obtain a sample via swab of the penile discharge to test for STD’s. Prescribe Doxycycline 100mg PO BID x 7days. Educate patient on safe sex practices. Inform patient that partner should also be treated if possible. Instruct pt to abstain from sexual intercourse for 7 days following treatment.

References

Diseases Characterized by Urethritis and Cervicitis – 2015 STD Treatment Guidelines. (2016).

Cdc.gov. Retrieved 22 July 2018, from http://www.cdc.gov/std/tg2015/urethritis-and-

cervicitis.htm

Gonococcal Infections – 2015 STD Treatment Guidelines. (2016). Cdc.gov. Retrieved 22 July

2018, from http://www.cdc.gov/std/tg2015/gonorrhea.htm