Male Health Case Study Assignment
Please review rubric prior to starting the assignment.
J.C., a 23-year-old male naval officer recently stationed in the Philippines, complains of dysuria, meatal pain, and a profuse yellow urethral discharge for 2 days. He admits to extramarital sex with a prostitute over the past week. He states that his wife, B.C is 8 weeks pregnant but she is asymptomatic. Intracellular Gram-negative diplococci were seen on the Gram\’s stain of J.C.\’s urethral exudates. J.C tells you that if this is a sexually transmitted disease then he does not want the wife to know about this diagnosis and the extramarital affair.
Use the questions below to formulate your answers, reflect and solve the health issue and ethical dilemma.
What are your differential diagnoses? What is the primary diagnosis?
What is the CDC\’s drug of choice for treating this condition and what are some alternates?
What additional therapy should be included and why?
Why has CDC removed amoxicillin and procaine penicillin from their recommended drugs?
J.C. tells you that he does not want the wife to know about this diagnosis; what is the best answer to this request?
Should B.C. (J.C.\’s pregnant wife) be treated? If so, with what?
Is this a reportable disease to public health? If so, how best can you report this?
Assignment
Comprehensive Case Write-up
Please use the attached instructions to complete this assignment. The rubric used to score the assignment is also attached.
Follow the format of https://meded.ucsd.edu/clinicalmed/write.htm. This assignment should be 6-8 pages single-spaced. This is a standardized rubric that will be utilized for all comprehensive write-ups grading throughout the program.
Common Acute Male Health Illnesses
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Common Acute Male Health Illnesses
Introduction
Sexually transmitted diseases (STDs) are also called sexually transmitted infections (STIs). They are infections that are passed from one individual to another through sexual contact. According, sexual contact may mean vaginal, anal, or oral sex. Some STIs may spread through mere physical contact during sexual intercourse (Szreter, 2019). The illnesses affect both men and women but it is believed that health problems might be more severe to women than men. Gonorrhea is one of the most common STIs. Symptoms of gonorrhea include painful urination, pus-like discharge from the tips of the penis, or vaginal discharge in women (Szreter, 2019). In that regard, this paper uses the provided case study to answer all the questions required to complete the assignment.
Primary Diagnosis
Gonorrhea
As indicated above, gonorrhea is a bacterial infection transmitted through sexual intercourse. It might affect the urethra, rectum, or through in both males and females. In most instances, the illness affects the genital tract of the infected individual (Unemo et al., 2019). Common signs and symptoms of gonorrhea include pain while urinating, discharge from the genitals parts (penis or vagina), dysuria, and meatal pain. In men, gonorrhea may also cause pain or swelling in one testicle (Szreter, 2019). Some of the risks for contracting gonorrhea include having a new sex partner, having a sex partner who has other sex partners, having more than one sex partner, and having previous gonorrhea or other STIs infections. Gonorrhea is caused by the bacterium Neisseria gonorrhea, also called gonococcus/gonococci (Unemo et al., 2019). The bacterium is a species of Gram-negative diplococci bacteria.
The patient has indicated everything that suggests the diagnosis is more likely to be gonorrhea. He experienced dysuria, meatal pain, and a profuse yellow urethral discharge for 2 days (Szreter, 2019). The patient admitted extramarital sex with a prostitute the previous week. The intracellular Gram-negative diplococci were seen on the Gram\’s stain of J.C.\’s urethral exudates. The information on the patient’s history puts him at a high risk of contracting gonorrhea (Unemo et al., 2019). The laboratory test result confirms that J.C. is suffering from gonorrhea when the gram-negative diplococci bacterium was spotted in his urethral samples.
Differential Diagnoses
Chlamydia
Chlamydia is a sexually transmitted disease (STD) caused by bacteria known as chlamydia trachomatis. It is passed through vaginal, oral, or anal sex. Chlamydia is asymptomatic in most cases and easily treatable by the use of antibiotics (Szreter, 2019). If not treated early, the disease can spread to other parts of the body, leading to further detrimental health effects. Symptoms of chlamydia include discharge from the vaginal or penis, pain during urination, pain during sex, and sometimes pain and swelling of the testicles (Szreter, 2019). However, the disease was ruled out due to the manifestation of Neisseria gonorrhea in the urethral exudates.
Candidiasis
Candidiasis is another differential diagnosis for the patient’s condition. It is a fungal infection caused by a yeast called candida. The most common type of yeast is called Candida albicans (Szreter, 2019). Candida often lives on the skin and inside the body, in places such as the mouth, throat, gut, and vagina, without causing any problems. Although fungal infections are not considered STIs, there is an increased risk of yeast infection during the first regular sexual activity (Szreter, 2019). Symptoms include dysuria, meatal pain, and urethral discharge.
CDC’s drug of choice for treating this condition and some alternates
CDC recommends a single 500 mg IM dose of ceftriaxone for the treatment of uncomplicated urogenital, rectal, or pharyngeal gonorrhea. If chlamydial infections have not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended (CDC, 2020). In this particular case, the patient should receive a single 500 mg IM dose of ceftriaxone and doxycycline (100 mg orally twice a day for 7 days) concurrently, to treat his condition because chlamydia has not been excluded. If the patient weighs ≥150 kg (300 lbs.), 1 g of IM ceftriaxone should be administered (CDC, 2020). Ceftriaxone is a cephalosporin antibiotic used to treat a broad range of infections caused by bacteria.
The first alternative treatment is a single 240 mg IM dose of gentamicin plus a single 2 g oral dose of azithromycin. Gentamicin is a broad-spectrum aminoglycoside antibiotic combined with other medications to treat illnesses caused by gram-negative and some gram-positive bacteria (CDC, 2020). Similarly, azithromycin treats a broad range of bacterial infections. The second alternative is a single 800 mg oral dose of cefixime (CDC, 2020). If using cefixime, and chlamydial infection has not been excluded, doxycycline 100 mg orally twice daily for 7 days should be used concurrently.
Additional therapy that should be included and rationale
Additional therapy that may be recommended in this case is expedited partner therapy (EPT). It is a harm reduction intervention/therapy involving couples (Szreter, 2019). It involves treating the sex partner of the person diagnosed with chlamydia or gonorrhea, who is unlikely or unable to seek timely medical care. The patient is given medications or prescriptions to take to his partner, without the health care provider having examined the partner (Szreter, 2019). Health workers should always perform expedited partner therapy unless prohibited by the law or any other regulations.
The EPT is recommended to treat the partner in case of infections. In three U.S. controlled trials, results indicated that many partners were treated when EPT was delivered. The therapy reduces the rates of reinfection among couples (Szreter, 2019). Due to the benefits of the expedited partner therapy, it should be recommended to improve the health outcomes of the couple and prevent the patient from experiencing reinfections.
Why has CDC removed amoxicillin and procaine penicillin from their recommended drugs?
The CDC removed amoxicillin and procaine penicillin from their recommended drugs due to increasing antibiotic-resistant gonorrhea. According to Unemo et al. (2019), antibiotic resistance is the ability of bacteria to resist the effects of drugs used to treat them. In such cases, the bacteria are no longer killed by the same medications that are used to kill them. Gonorrhea had developed resistance against most antibiotics, including amoxicillin and penicillin (Unemo et al., 2019). Doctors are currently down to cephalosporins, one last recommended and effective class of antibiotics to treat the condition. CDC is closely monitoring any early warning signs of resistance both to azithromycin and cephalosporins, the class of antibiotics that includes ceftriaxone. It is not clear for how long the combination of azithromycin and ceftriaxone will remain effective against gonorrhea (Unemo et al., 2019). The percentage of gonorrhea isolates with high susceptibility to azithromycin is decreasing slowly over time.
J.C. tells you that he does not want the wife to know about this diagnosis; what is the best answer to this request?
The best answer is to explain to the patient that his wife should know about the diagnosis so that they can be treated together. Both couples should receive treatment to avoid reinfection. Also, the patient’s wife is pregnant, and omitting this diagnosis may affect the unborn baby health-wise (Szreter, 2019). Both the healthcare provider and the patient must find the best way to talk to the partner and ensure she accepts to seek medical attention regarding the situation. The healthcare provider should assess whether or not J. C’s wife had received gonorrhea screening, which is recommended in early and late pregnancy in high-risk individuals. J.C may also be informed on the importance of expedited partner therapy to improve their outcomes (Szreter, 2019). In case the partner refuses to seek medical attention, which is unlikely, the health care worker may provide J.C. with some medications or prescriptions to take to his wife to protect her and the baby.
Should B.C. (J.C.\’s pregnant wife) be treated? If so, with what?
As stated above, J. C’s wife should receive treatment alongside her husband. The expedited partner therapy is recommended for the treatment of gonorrhea. The recommended treatment for J. C’s wife is ceftriaxone 125 mg intramuscularly or cefixime 400 mg orally (CDC, 2020). Treatment is important to prevent reinfection after the patient’s treatment. Additionally, infections during pregnancy affect both the mother and the child. Many infections have been associated with premature delivery and low birth weight as well as morbidity and mortality. As a result of these problems, the CDC recommends screening for some STIs (CDC, 2020). Untreated gonococcal infections have been liked to miscarriages, premature death, and low birth weight (CDC, 2020). Other problems associated with gonorrhea include premature rupture of membranes and chorioamnionitis.
Is this a reportable disease to public health? If so, how best can you report this?
This is indeed a reportable case to public health. According to 4, sexually transmitted infections syphilis, gonorrhea, chlamydia, and HIV/AIDS are reportable diseases in every state (CDC, 2021). Accurate and timely reporting of STIs is essential to public health efforts in understanding morbidity trends, assisting the government with information, and allocation of required resources. Requirements for reporting some STIs differ from one state to another, therefore, health workers must be cognizant of requirements applicable within their localities (CDC, 2021). Reporting the cases can be provider-based, laboratory bases, or both.
If the health worker is not aware of state and local reporting requirements, he/she might seek advice from state or local health departments dealing with STI programs. When reporting such information, the patient’s identity should be kept confidential. In many states, reporting STIs is protected by regulations or statutes (CDC, 2021). The public health officials must consult the patient’s care provider before doing a follow-up with the STI patient. They must verify the diagnosis as well as determine the type of treatment used.
Conclusion
Sexually transmitted infections are infections passed from one person to another through sexual activities. Gonorrhea is one of the most common STIs across the United States. In the case study, the primary diagnosis id gonorrhea. The differential diagnoses include chlamydia and candidiasis. A single 500 mg IM dose of ceftriaxone is the recommended treatment of gonorrhea. Expedited partner therapy (EPT) should be considered in this case. Gonorrhea has developed resistance against amoxicillin and procaine penicillin. It is important to inform the patient’s wife about the diagnosis. The disease should be reported to help in tracking morbidity trends.
References