Chief Complaint:white milky discharge from penis

Ismael Parets. Main Post U11 D1
COLLAPSE
Chief Complaint:white milky discharge from penis

History of Present Illness: A 56-year-old male reports having white milky discharge from his penis for 4 days after having an unprotected sex and he is experiencing pain with urination.

PMH/Medical/Surgical History:HTN and Inguinal hernia. Medications include HCTZ.

Social History: nonsmoker, nondrinker, travels extensively and has never had this problem before.

Review of Symptoms:

Genitourinary: complaining of penile discharge and pain with urination.

Diagnostic Tests/Labs needed:

Gram stain
Culture of the penile discharge
Testing for chlamydia
Assessment: (Impression)Urethritis

Differential diagnoses: Trichomoniasis, chlamydia,gonorrhea

Plan of Care:

1) Urethritis is defined as infection-induced inflammation of the urethra (Manhart et al., 2016). The term is typically reserved to describe urethral inflammation caused by an STD, and the condition is normally categorized into either gonococcal urethritis (GU) or nongonococcal urethritis (NGU) (Buttaro, Trybulski, Bailey, & Sandberg, 2016).

Education: It is important to refrain from sex for one week after treatment showed results and symptoms resolved. Patient also needs education regarding protected sex to avoid future health issues.

Treatment:Antibiotic therapy should cover both gonococcal urethritis and nongonococcal urethritis (NGU). If concomitant treatment for NGU is not provided, the risk of postgonococcal urethritis is approximately 50%. The choice of antibiotics should be based on cost, adverse effects, effectiveness, and compliance. In most situations, optimal treatment is with single-dose therapy administered in the emergency department or the physician’s office. Antibiotics used in the treatment of urethritis include the following: Azithromycin, Ceftriaxone, Cefixime, Ciprofloxacin, Ofloxacin, and Doxycycline (Manhart et al., 2016).

Follow-up:return to clinic in 1 weeks for further follow up.

References

Buttaro, T. M., Trybulski, J. A., Bailey, P. B., & Sandberg, J. (2016). Primary Care. New York, N. Y.: Elsevier.

Manhart, L., Gillespie, C., Lowens, M., Khosropour, C., Colombara, D., Golden, M., . . . Totten, P. (2016). Standard treatment reigmens for nongonococcal urethritis have similar but declining cure rates: A randomized controlled trial. Clinical Infectious Diseases, 56, 934-942. doi:10.1093/cid/cis1022