ACUTE VIRAL RETENTION SECONDARY GENITAL HERPES Swab, culture PCR of vesicles

22 YEAR OLD CAME TO YOUR GP COMPLAINING OF URINARY

RETENTION ASSOCIATED WITH BOWEL PAIN AND LOWER
ABDOMINAL PAIN
TASK: HISTORY, PE FROM EXAMINER
MANAGEMENT PLAN

Vesicles rupture
New boyfriend, on pill, no condom, Panadol

Due to genital herpes

Uterine prolapse
Oedema of the bladder neck
Fibroid (cervical)
Huge ovarian cys
Bladder polyp
Urethra foreign body
Urethrocoele
Urological
Neurological problem (flaccid bladder)

Are you ok to answer my questions or do you want me to

relieve the pain first?
How long have you had this problem?
When did you last urinate?
Before that did you have any problem with your
waterwork? Can you control your waterwork?
Are you on any medication? (narcotics)
Any associated discharge?
Any associated symptoms?
PAIN questions –
Ulcer – tell me more about it
Any problem like kidney stones?
Any trauma to the back?
Any prolonged constipation?

Sexual History: Active, stable partner? Does your partner

have the same symptoms

Is there any possibility of foreign body inside?

Is there a possibility of being pregnant?
When was your last menstrual period?
Do you practice safe sex? What form of contraception do
you use?
Was there any diagnosis of lumps or bumps in your
womb or problems with the ovary?
Do you have any history of previous STD?

PE: GA VS
Abdomen: mass dullness on percussion any tenderness
or desire to pass urine on palpation
Pelvic – take consent
Inspection, lesion how many? Redness? Skin vesicles or
blister
Speculum? Not done – very painful
SPC: suprapubic catherization, give painkiller, urine
send to lab
STD screening with patient consent
Ff up with result
MEDS : Acyclovir 400mg TID x 5d 1st attack