Male urethral discharge


  • Candidate Instructions
  • Actor Instructions
  • Mark Sheet
  • Score

Location: You are an foundation year doctor in sexual health

Patient: 25 year old man has come into clinic and has indicated on his booking form he has discharge from his penis

Task:

  • Take a focused sexual history from the patient
  • Answer any questions that the patient may have
  • After 6 minutes you will be asked a series of questions by the examiner

Note to actor: Try to restrain yourself from volunteering too much information – you may do so when prompted (that is, by a specific question, not a general one). If a student is on the wrong line of clinical reasoning do not fuel this line of thinking, state no to the question as being ambiguous may prompt further questioning and does not allow the student to be appropriately tested. The aim of the exercise is to take a focused history; short answers are required.

You are a 26 year old man. You start the consultation by admitting to the doctor that you feel embarrassed as you have never been to a sexual health clinic before.

You have noticed some painful discharge from your penis over the past 3 days. It is a thick white / green colour. It has been collecting in your underwear. You find it very painful to pass urine and you feel like you need to go to the toilet more often.

If asked you have had some painful dedication and your stools have been a bit looser and whiter in colour.

Only give information if prompted – you last had sex 1 week ago with a male partner, this was a casual and was a one off. You had oral sex, anal both receptive and penetrative. This is the first and only time you have had unprotected anal intercourse. You are unsure if your partner has symptoms.

Parter before this was 2 weeks ago, it was a casual partner and you only had oral sex both giving and receiving.

You have had sex with 10 people in the past 3 months.

You have never had an STI screen or HIV test before. You have had not been vaccinated against hepatitis A or B.

You drink more than 10 double gin and tonics in a single evening more than 4 times a week. You occasionally take party drugs if you are offered by others.

If the candidate appears to have finished early remind them how long is left at the station and enquire if there is anything else they would like to ask, or whether they have finished. If they have finished, please remain silent and allow the candidate that time for reflection.

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Medical school / year / grade
Clarifies who they are talking to
Asks patient for preferred name


Introduction continued
Explains confidentiality
Asks if would like a chaperone


Male symptoms
Dysuria
Urethral discharge
Rectal discharge
Testicular pain


Previous partner
Last sexual contact
Male / female partner
Regular / casual
Length of relationship / one off contact


Previous partners extended
Type of sex
Use of condoms
Partner symptoms
Partner location


Previous partners extended
Records the details above for last 2 partners
Number of sexual partners in the last 3 months


HIV risk assessment
Previous HIV test
Partners from high risk countries
Same sex or bisexual partner
History of IVDU or partners with IVDU
History of paying or being paid for sex
History of HIV positive partners
History of unsafe blood transfusion.
History of sexual assault


History continued
Past medical history
Drug history and Allergies
History of sexually transmitted infections


Social history
Alcohol
Recreational drugs


Patient
Good rapport with patient
Active listening skills
Appropriate use of body language
Avoids medical jargon
Logical structure / does not jump around topics in consultation
Summarises and checks patient understanding


Question What investigations would you like to do in this patient?
Urethral swab
Oropharyngeal swab
Rectal swab
Venous blood
First pass urine


Question
Look at the following urethral swab under the microscope and comment on your findings

Gram-negative diplococcus
Likely Gonorrhoea


Question Given this patient has been diagnosed with gonorrhoea, how are you going to treat them?
Ceftriaxone 500mg IM STAT
With Azithromycin 1G PO STAT



Score