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You are shadowing a physician in the emergency
roo m of an urban ho spital. The next patient on the
docket is a 15 -year-old male who was broug h t into
the e mergency roo m by his sister and is waiting in
curtain 3. Loo king pretty worried he rep orts a 24hou r hist ory of dysu ria and noted so me “pus -like”
drainage fro m the tip of his pen is.
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What is dysuria?
Should he be concer n ed?
Name at least three possibl e causes for the
observed proble m.
4. What follow -up questions do you and the
physician have for the
pati ent?
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He clai ms that have been sexually active with five or
six partners over the p ast 6 months.
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Do you and the physi cian have additional
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questions fo r the patient?
He clai ms that he and his partners have n ot had any
sexual trans mitted di seases (STDs).
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1. Do you and physi cian have additional
questions fo r the patient?
2. What is your next step?
According to the patient’s chart his temperature, blood
pressure and heart rate are all normal. The physician
puts on a pair of blue nitrile exam gloves and begins
examining the patient. The physician notes a yellow
urethral discharge and tenderness at the tip of the
penis.
7. Why does the physician use nitrile gloves and not
latex?
8. In one column list the symptoms for this patient and
in a second column list the signs.
9. What is your next step?
10. What culture media would you recommend?
Gram Stain of Urethral Discharge
Urinanalysis
• Urine clear upon gross examination.
• Sample positive for leuckocytes
esterase.
• Growth on SBA and EMB negative.
1. Are the urine results consistent with each other?
2. Why is the urine culture negative?
Growth on Thayer-Martin Agar
1. Why is the urine culture negative on SBA and EMB?
2. What is your diagnosis?
3. What virulence factors contribute to this disease?
5. What is the reservoir and mode of transmission for
this bacterium?
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Why did his partners have a negative history for
sexually transmitted diseases? For what complications
are his sexual partners at risk?
7. What is the recommended treatment?