Let’s start with a fairly short one, that addresses a common urgent care issue, as well as an important principle of medical management that they don’t teach you in med school.
STIs (aka STDs) are one of the more common issues encountered by the urgent care provider. Part of this is due to simple convenience, of course… but part of this is also embarrassment. Many people would prefer someone other than their regular primary care doctor, who may also be treating family members, know all the dark secrets of their sexual history. Also, STDs often target younger people with no primary care provider to begin with. Here is one such case.
A 26 year old African American male presented with penile discharge for 3-4 days. He says the tip was slightly irritated, with slight burning when he urinated. He did confirm unprotected intercourse with multiple female partners. He also reported some vague fatigue and stress. He had no other issues on presentation. He denied any rash or other skin lesion, fever, flank pain, nausea, vomiting, joint pain, or other issues. He said he had a cold or flu a few weeks ago but no other past medical history. He took no medications. A basic dipstick into the patient’s urine was completely normal. The physical exam was unremarkable except for some large, soft, non-tender lymph nodes in the patient’s groin. No other rashes or lesions were noted in his genital region or elsewhere. I ordered a routine STI panel and put him on empiric therapy for what I considered the most likely diagnosis.
AT THIS POINT I DID NOT KNOW THE PRIMARY DIAGNOSIS… ALTHOUGH PERHAPS I SHOULD HAVE. WHAT IS YOUR GUESS? (scroll down when ready)