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MALE Synthesis
MALE Synthesis
DR. ALEX DY
Preceptor
ID:PT, 34 y/o,
male, married, life
guard from Anislag, Pertinent Data:
Daraga Age: Age-specific diseases; sexually active
period; middle-adulthood period
Gender: Gender-specific diseases
Married: one partner? Multiple partner?
Partner in the last 3 months? Sexual activity?
Work: Nature of work? Shifting? Hygienic
practices?
OPQRST
Onset? When did it started? How frequent
CC: Penile was it? Is it continuous or intermittent?
Discharge of 2 Palliative and provocative factors? When
does it gets worst?
weeks duration What are the characteristics of the penile
discharge? What is its color, composition,
appearance and odor?
DDx: Is it painful? If yes, does it radiate to any
part of your body? Are there any
Urethritis or related
associated symptoms?
diseases (STD)
In a pain scale, how will you rate the pain?
When did it started? Did it start abruptly
or in progression? During when does it
appear?
HPI
2 weeks: pain upon
urination;
clear to yellowish
penile discharge;
drinks 2-3 L of DDx
water
Urethritis and related
1 day: thick and diseases
yellowish to Gonorrhea
greenish discharge; Chlamydia
(-) testiclular pain
1 month: (+) dysuria; (-)
fever, flank
pain, tea colored
urine
Data Needed:
What are the symptoms
experienced in UTI last
2012?
PMH Hx of chilhood illnesses (eg,
mumps)?
(-) HPN, DM, BA Screening tests?
S/P tonsillectomy (2012) Hx of trauma or accidents?
adult? What age? Psych hx?
UTI (Jan 2012) Recurrent tonsilitis might
be a sign of infection (STD)
Family Hx Data Needed
(+) HPN, DM both sides Previous STD?
Contact with known STD?
Social Hx
Partners, need to be tested
(+) smoking 2-5/day x 5yrs = 1.25 Unprotected sex
pack years MSM
Occasional alcoholic beverage Sexual activities: oral,
drinker
genital, anal?
Lifeguard for 8 years
Married for 3 years Nature of work?
Several female sexual partners
(2016)
Denies relationship with same sex
Denies practice with oral sex
PE:
VS: BP: 120/80 HR: 86 Normal
RR: 16cpm Temp: 37.7 C
HEENT:
DDx:
(+) aphthous ulcer 5cm in diameter,
right buccal mucosa Syphilis
(+) penile discharge (thick yellowish) Gonorrhea
(+) scrotal tenderness
(+) palpable lymph nodes on the
inguinal area, bilateral
U/A:
INFECTION
Lt. yellow
Pus cells 10-15/hpf
RBC 0-13
Sp. Gravity 1.030
Protein none
DDx:
Grams stain of discharge:
- Gonorrhea
(+) gram negative diplococci
RPR & VDRL
- Awaiting result
Rx:
1. Ceftriaxone 250mg/IM as single dose
2. Azithromycin 500mg/cap, 1 cap OD x 3 doses
Sexually Transmitted
Diseases (STD)
Initial rate of spread of any STI Efforts to prevent and control STIs
within a population: aim to:
Chlamydia trachomatis
infection has been increasing
steadily (MSM and African
Americans)
MANAGEMENT OF COMMON SEXUALLY
TRANSMITTED DISEASE (STD) SYNDROME
1.Risk assessment
2.Clinical assessment
3.Diagnostic testing or screening
4.Treatment
5.Prevention
MANAGEMENT OF COMMON SEXUALLY
TRANSMITTED DISEASE (STD) SYNDROME
RISK ASSESSMENT
guides detection and interpretation of symptoms that could
reflect an STD
decisions on screening or prophylactic/preventive
treatment
risk reduction counseling and intervention (e.g., hepatitis B
vaccination)
treatment of partners of patients with known infections
MANAGEMENT OF COMMON SEXUALLY
TRANSMITTED DISEASE (STD) SYNDROME
CLINICAL ASSESSMENT
elicitation of information on specific current symptoms and signs of STDs
Confirmatory diagnostic tests
for persons with symptoms or signs
Screening tests
for those without symptoms or signs
MANAGEMENT OF COMMON SEXUALLY
TRANSMITTED DISEASE (STD) SYNDROME
CLINICAL ASSESSMENT Grams stain of
urethral discharge for
men with urethral
microscopic examination discharge
culture Rapid plasma reagin
antigen detection tests test for genital ulcer
nucleic acid amplification tests
(NAATs) 4 Cs of prevention and control:
Contact tracing
serology
Ensuring compliance with
therapy
All adults should be screened for Counseling on risk reduction
infection with HIV-1 at least once Condom promotion and provision
and more frequently
URETHRITIS IN MEN
URETHRITIS IN MEN
3. Evaluate for gonococcal and 4. Treat urethritis promptly while test results
are pending.
chlamydial infection.
Azithromycin or doxycyclin
Absence of typical gram- if Grams stain does not reveal gonococci,
urethritis is treated with a regimen effective
negative diplococci on Grams- for NGU
stained smear of urethral
exudate containing Parenteral cephalosporin therapy & oral
inflammatory cells azithromycin
If gonococci are demonstrated by Grams stain
warrants a preliminary or if no diagnostic tests are performed to
diagnosis of NGU exclude gonorrhea definitively
DIFFERENTIAL DIAGNOSIS
CHLAMYDIA GONORRHEA
SYPHILIS
Chlamydia
ETIOLOGIC AGENTS: Chlamydiae
Obligate intracellular bacteria: cannot reproduce outside their host cell
Lympogranuloma C. psittaci
Trachoma
venereum (LGV) C. felis
Occular
Infection of C. abortus
trachoma
Urogenital lymphatics
and lymph
infections
nodes
Chlamydia trachomatis INFECTIONS:
CLINICAL MANIFESTATION
NONGONOCOCCAL AND POSTGONOCOCCAL URETHRITIS
ASYMPTOMATIC/SYMPTOMATIC
NEUROSYPHILIS:
AQUEOUS PENICILLIN
Penicillin allergy:
ASYMPTOMATIC/SYM Penicillin G Benzathine: no detectable
Skin Testing
PTOMATIC concentrations in CSF and SHOULD NOT Desensitization
NEUROSYPHILIS: BE GIVEN FOR NEUROSYPHILIS Treatment w/
AQUEOUS
PENICILLIN AsymptomaticNeurosyphilis: may Penicillin
relapse--higher in pts w/ HIV
Menigeal Syphilis: treatment w/ penicillin
is good but if w/ existing parenchymal
damage, arrest dse progression
Ceftriaxone may be used
DIFFERENTIAL DIAGNOSIS
CHLAMYDIA GONORRHEA
SYPHILIS