Week 8, Block 3.3 College of Medicine Al-Ahsa, Saudi Arabia

1. Week 8
The Morning After The Week Before
Abdullatiff Sami Al-Rashed
Block 3.3
College of Medicine, King Faisal University
Al-Ahsa, Saudi Arabia

2. The Case
• John Peters, 19, an army recruit, comes to the Accident
& Emergency (A&E) department. He is on holiday on
Curacao. A week ago he met Tanga (20). One thing led
to another and they ended up having a one-night stand.
• Two days ago he starting having a burning sensation
when urinating and this morning while washing he also
saw a tiny drop of grey discharge which seemed to
originate in his urethra.

3. The Case
• He’s very worried. He had been so cautious and had
asked Tanga beforehand whether she has any diseases,
and she’s said she didn’t. But when he asked after
having sexual intercourse, Tanga told him she had had
some contact bleeding. That had concerned him

4. The Questions

5. 1.What possible diagnoses can
you think of here?

6. Case History
Male 19 years old
Burning
sensation when
urinating
Gray discharge
from the urethra
Had a sexual
intercourse a
week ago
(unprotected)
His partner had
contact bleeding
(Postcoital
Bleeding)

7. Deferential Diagnoses
✔

8. 2.What must you ask and
examine/test to reach a more
conclusive opinion ?

9. Taking History
• Full medical history.
• Sexual history for both partners includes:
• Sexual contact with at least one partner.
• Sexual contact with a partner infected with HSV.
• Multiple sexual partners.
• Sexual contact for someone with STI in past 60 days.
• History of STDs
• Ask about systemic symptoms:
• Fever
• Sore throat (pharyngitis)
• Arthritis
• Conjunctivitis
• Pneumonia
• Low back pain ( reactive arthritis)
• Rash

10. Examination
General
Examination
Local
Examination

11. Local Examination
Urethra: Examine lumen of the distal urethral meatus
for lesions, stricture, or obvious urethral discharge;
palpate along urethra for areas of fluctuance,
tenderness

12. Local Examination

13. References