Case #14

Final Diagnosis

You prescribe doxycycline and cefixime, administer the first injections of the Hepatitis A and B vaccination protocol, and counsel the patient to have his sexual partner/s evaluated for treatment. You further explain that it may take two to four weeks for the pain and swelling to completely resolve, and you then send the patient home with instructions to call or return to the office if his symptoms worsen or fail to improve in the next few days. You also schedule a follow-up appointment in a few days to more thoroughly address the issues encountered in this case, to gain further insight into the health risks faced by this patient, and to counsel the patient accordingly.

The urethral culture results return two days later and confirm your suspicion of Neisseria gonorrhea. Because Gonorrhea and Chlamydia are reportable diseases, this patient’s infection should be reported to the State to help track the incidence and distribution of sexually transmitted diseases.

Fast fact: Although the list varies by state, the following STDs were designated as notifiable at the national level at the end of 1995:

  • AIDS
  • Chancroid
  • Chlamydia trachomatis, genital infection
  • Gonorrhea
  • Hepatitis A, B, C/non-A, non-B
  • HIV, pediatric (<13 yr. old)
  • Syphilis

For further information visit: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00044418.htm

References:

  1. Junnila, Jennifer and Patrick Lassen. "Testicular Masses." American Family Physician. Feb. 15, 1998. Volume 57, no. 4: 685-692.
  2. Brendler, Charles B. "Chapter 4: Evaluation of the Urologic Patient." Clinical Urology. J.B. Lippincott Co., Philadelphia: 1994.
  3. McAninch, Jack W. "Disorders of the Testis, Scrotum, and Spermatic Cord." Smith’s General Urology, 13th edition, Appleton and Lange, Norwalk, CT: 1992.
  4. Siroky, Mike B. and Robert J. Krane. "Chapter 74: The Scrotum and Testis: Clinical Presentation and Differential Diagnosis." Clinical Urology. J.B. Lippincott Company, Philadelphia: 1994.
  5. Robey, Edwin L. and Paul F. Schellhammer. "Chapter 88: Scrotal Cancer." Clinical Urology. J.B. Lippincott Company, Philadelphia: 1994.
  6. Centers for Disease Control and Prevention. 1998 Guidelines for the Treatment of Sexually Transmitted Diseases. MMWR 1998; 47 (No. RR-1): 1-118, http://www.cdc.gov/std/
  7. "Summary of Notifiable Diseases, United States, 1995." CDC: MMWR Weekly, Oct. 25, 1996/ 44(53); 1-87, http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00044418.htm
  8. Woodward, Carol, PharmD and Melanie Fisher, M.D. "Drug Treatment of Common STDs: Part 1. Herpes, Syphilis, Urethritis, Chlamydia and Gonorrhea." American Family Physician. Oct. 1, 1999, vol. 60, no. 5: 1387-1394.
  9. Donahue, Philip E. "Theoretic Aspects of Hernia, Chapter 3." Hernia, 4th ed. L.M. Nyhus and R.E. Condon, ed. J.B. Lippincott Company, Philadelphia: 1995.
  10. Holmes, K.K. and S. A. Morse. "Gonococcal Infections, Chapter 150." Harrison’s Principles of Internal Medicine, 14th ed. Fauci, Anthony et.al., ed. Mcgraw-Hill, New York: 1998.
  11. Stamm, Walter E. "Chlamydial Infections, Chapter 181." Harrison’s Principles of Internal Medicine, 14th ed. Fauci, Anthony et.al., ed. Mcgraw-Hill, New York: 1998.
  12. Goldfarb, Stanley and Fuad Ziyadeh. "Renal Diseases, Fluid and Electrolyte Disorders, and Hypertension, Chapter 6." NMS Medicine, 3rd ed. Allen R. Myers. Williams and Wilkins, Baltimore: 1997.
    13.

Authors:

Andrew R. Shorb
Class of 2001

Peter Lewis, M.D.
Assistance Professor
Family and community Medicine

Shou Ling Leong, M.D.
Assistant Professor
Department of Family & Community Medicine
Penn State University College of Medicine
To guide us in the development of case studies to meet your educational needs, please take a few minutes to complete a brief survey.  

Email Case



Penn State Milton S. Hershey Medical Center ©2004
This page was last updated on April 24, 2006
Contact Us