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      Alex Grange

      Age: 21 years old male

      Full Case

      Station List
      Patient
      Examiner

      Patient's Data

      Patient’s name: Alex Grange

      Age: 21 years old male

      Past medical history

      • Nil

      Drug history and Allergies

      • Nil

      Recent notes/consultation

      • Nil

      Patient booked routine appointment to discuss concerns

      Patient's Information

      You are Alex grange, a 21-year-old male. You have noticed burning sensation when you pass urine and getting a bit of discomfort around your penis.

      This has been ongoing for last 3 days. ONLY SAY BELOW IF ASKED.

      You had unprotected sex 10 days ago with a new partner you met on a dating site (Only volunteer this if asked).

      You are otherwise well. SAY NO TO ANY OTHER SYMPTOMS ASKED

      Social history: you do not smoke or drink alcohol or use illicit drugs. You work as a Software developer

      Ideas- You suspect a urine infection

      Expectations: You need antibiotics

      Questions for the doctor

      If you are asked to come in for a face-to-face consultation or drop in a urine sample;

      inform the doctor that you cannot come in and that You are due to travel to Dubai for an important tech meeting for your Job in the next 30mins and you are currently on your way to the airport. You will be back from Dubai in 2 weeks’ time.

      Marking Scheme

      History taking

      • Ask about onset of symptoms• Ask about other urinary symptoms, nocturia, dysuria, frequency, haematuria, urgency, hesitancy, straining to urinate, weak stream.
      • Ask about penile discharge
      • Ask about rectal pain/testicular pain, pelvic pain, low back pain
      • Ask about fever
      • Ask about joint pain, eye symptoms.
      • Ask about sexual history
      • Ask about social history –smoking, alcohol, drug abuse
      • Ask ICE
      • Make a diagnosis of STI (STI is more common in young men than UTI). Also note that prostatitis will occur with LUTS, rectal pain and pelvic pain.
      • Most common STI in UK is chlamydia

      Explain to patient; Alex, from everything you’ve described, including the burning sensation when passing urine and your history of a new sexual partner, it’s very likely that you have a sexually transmitted infection, or STI. This is something we can treat effectively, but it’s also important to confirm the diagnosis and check for other possible infections.

      Ideally, I would like you to come in so we can do a urine test and screen for other STIs.

      However, since you’re traveling to Dubai and won’t be able to come in right now, I will prescribe you an antibiotic called doxycycline. This should help treat the likely infection and manage your symptoms.

      While this is a good start, I strongly recommend that you get tested for other STIs as soon as you can. You could do this in Dubai if it’s convenient for you, or we can arrange it as soon as you return. Screening is really important to ensure your complete health and also to protect any current or future partners

      Management

      Management

      • Offer F2F to assess –urinalysis, swabs, vitals etc.
      • If unable to come in, treat empirically with doxycycline 100 mg twice daily for 7days.
      • Advise the person to present in GUM clinic- inform this is confidential, they will screen for all other STI’s and also do contact tracing.
      • Advise that sexual intercourse (including oral sex) should be avoided until theyand their partner(s) have completed treatment.
      • Educate on use of condoms.
      • Safety net re worsening symptoms-fever, discharge, unwell, then to seek urgent medical advice.
      •  Follow up in 2 weeks’ time to ask about resolution of symptoms and if patient visited GUM clinic.
      • Advise that he may need repeat testing for chlamydia—As per NICE, we should offer this to all people under the age of 25 years diagnosed with chlamydia 3–6 months after completion of treatment to check for re-infection.