Sexual health

Question 1

If a 17 year old adolescent who presents with pain on urination, what history would you take from them?

Answer 1

Discharge, redness, rash, lesions. 
Sexual history 
MSM, drug use, condom use, receptive overseas sexual contact, paid sex work. 
Regular partner, HIV status. 
History of STI

Question 2

In a male who has sex with males, if they present with a red urethra, what is the diagnosis and what investigations might you consider?

Answer 2

Urethritis causes Chlamydia water discharge, Gonorrhoea purulent discharge.
Other causes include HSV, Mycoplasma, ureaplasma, trichomonas.
If discharge, then get swab PCR for meatus, pharynx and anus.
If no discharge, then get first pass urine PCR.
Also do standard STI screen.

Question 3

What is the management for gonococcal and non gonococcal urethritis?

Answer 3

Ceftriaxone 500mg with lignocaine 2ml of 1% lignocaine
plus 1g Azithromycin stat.
Contact tracing
Partner treatment
No sexual contact for 7 days post treatment
Condom advice
Retest in 3-6 months to check for reinfection for those with documented chlamydia or gonococcal infection.
Serial testing for HIV if high risk or known exposure.