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As you enter the treatment room, the patient appears anxious and uncomfortable. What additional history should you obtain from the patient?

Additional history I would like to obtain from this 22-year-old male patient is if he has had multiple sex partners and their gender, type of sexual contact including oral, vaginal, and anal, does he use any protection such as a condom during sexual intercourse, and if he has ever been diagnosed or treated for an STI in the past. Obtaining the sexual history of the patient with a nonjudgmental attitude is important. STI and HIV prevention counseling should be done with adults recently diagnosed with STIs, who have multiple partners, or sexually active adolescents (Klein et al., 2022).

What physical examination components are indicated for this presentation?

Physical exam components indicated for a male patient with this presentation include inspection of the penis, glans, urethra, scrotum, and anal area. The testes, epididymis, and lower abdomen should be palpated, and a digital rectal exam performed if prostatitis is suspected (Dunphy et al., 2022).

Based on the presentation and history, you recognize the need to screen for sexually transmitted infections (STIs). What are the most common STIs for this presentation?

This 22-year-old male presented with scrotal pain, swelling, urinary frequency, and purulent penile discharge, absent of fever. The most common STIs in patients experiencing urethral discharge, pain, and swelling of the testes are Chlamydia and gonorrhea (Dunphy et al., 2022).

After your assessment, all subjective and objective findings should be considered when developing differential diagnoses for scrotal pain and swelling with accompanying urinary complaints. What may be included on a differential list?

Differential diagnoses for scrotal pain, swelling, and accompanying urinary frequency include prostatitis, urinary tract infection, renal calculi, hydrocele, and epididymitis (Dunphy et al., 2022). However, given this patientâ€™s purulent drainage that is accompanying his scrotal pain, swelling, and urinary frequency, and his history of recent sexual activity, STI is more likely.

Name your priority diagnosis and provide the treatment plan. If you elect to treat with medications, provide full prescription details and follow up plan.

I would first recommend testing to confirm the diagnosis of STI. It may be necessary to screen for multiple STIs since co-infections are common (Dunphy et al., 2022). Testing for STIs includes microscopy, culture, and nucleic acid amplification testing (NAAT) which is approved for Chlamydia, gonorrhea, Trichomonas, HSV, HBV, HCV, HPV, and HIV (Dunphy et al., 2022). Symptoms in males of gonorrhea include inflammation of the urethra, discharge, and dysuria. Symptoms in males of Chlamydia include purulent urethral discharge, dysuria, and pain and swelling of the testicles (Dunphy et al., 2022). Given this patientâ€™s presenting symptoms, I suspect Chlamydia. Once the diagnosis is confirmed through swab and NAAT, the primary therapy for Chlamydia is Doxycycline 100mg PO BID for 7 days. Doxycycline is the first-line treatment for Chlamydia due to its effectiveness at the urethral, rectal, and pharyngeal sites (Klein et al., 2022). The patient should be asked about sexual partners for the past 60 days if being treated for Chlamydia or gonorrhea, and efforts must be made to ensure the treatment of those partners (Dunphy et al., 2022). If symptoms resolve, it is recommended that the patient be screened for reinfection 3 months following treatment. If symptoms persist, repeat testing is indicated at 4 weeks (Klein et al., 2022).

As the practitioner, you are required to report certain STIs to your state health department. Provide a list of the STIâ€™s that must reported in your state along with the information that needs to be included when reporting these.

I reside in the state of Texas. In Texas, HIV/Aids, Syphilis, Chlamydia, gonorrhea, Chancroid, and Hepatitis C must all be reported. For Chlamydia, gonorrhea, and Chancroid, a two-page STD27 form must be filled out and submitted within 7 days. The information on the form includes patient contact information, date of birth, patient age, sex, marital status, partner contact information, provider information, type of STI, test used to confirm, treatment provided, and date of last exposure with partner (Texas Department of State Health Services, 2024).

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