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Case Study Ms. T. does not know which partner she got chlamydia from and wonders if it could be her current partner. He has complained on and off of some.

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Presentation on theme: "Case Study Ms. T. does not know which partner she got chlamydia from and wonders if it could be her current partner. He has complained on and off of some."— Presentation transcript:

1 Case Study Ms. T. does not know which partner she got chlamydia from and wonders if it could be her current partner. He has complained on and off of some urethral irritation with occasional clear discharge. Q: What could his symptoms be due to?

2 Urethral Discharge & Irritation Urethral discharge (UD) is a common symptom with etiology varying from sexually transmitted infection (STI) to cancer. Urethral Irritation often accompanies UD.

3 Etiology STIs STIs Infections: cystitits, prostatitis Infections: cystitits, prostatitis Anatomic & Congenital Abnormalities: urethral stricture, phimosis Anatomic & Congenital Abnormalities: urethral stricture, phimosis Iatrogenic: catheterization, instrumentation, other procedures Iatrogenic: catheterization, instrumentation, other procedures Tumours Tumours Foreign Bodies Foreign Bodies

4 Etiology Substance Abuse: chronic use of amphetamines and stimulants produce serous discharge; caffeine, alcohol use Substance Abuse: chronic use of amphetamines and stimulants produce serous discharge; caffeine, alcohol use Miscellaneous Factors: sexual practices, masturbation, oral sex Miscellaneous Factors: sexual practices, masturbation, oral sex Unknown: no organisms may be found in up to 1/3 of patients Unknown: no organisms may be found in up to 1/3 of patients

5 Sexually Transmitted Infections Several STIs have UD as part of their clinical manifestations. Mr. T may have an STI. The following STIs are characterized by UD. Gonnorhea Gonnorhea Chlamydia Chlamydia Trichomoniasis Trichomoniasis

6 Gonnorhea 60% of men infected suddenly experience marked dysuria and spontaneous, profuse, mucopurulent discharge from the urethra. 60% of men infected suddenly experience marked dysuria and spontaneous, profuse, mucopurulent discharge from the urethra. some individuals have little discharge or urethral itching only some individuals have little discharge or urethral itching only 5% to 10% never have signs or symptoms 5% to 10% never have signs or symptoms

7 Chlamydia Chlamydial infection accounts for 50% to 60% of cases of NGU (Nongonococcal urethritis) in men. Chlamydial infection accounts for 50% to 60% of cases of NGU (Nongonococcal urethritis) in men. Men might note a clear, mucous discharge on rising in the morning; dry, clear discharge on their underwear; or mild burning with urination. Men might note a clear, mucous discharge on rising in the morning; dry, clear discharge on their underwear; or mild burning with urination.

8 Gonorrhea VS. Chlamydia Urethritis caused by gonorrhea and chlamydia cannot be differentiated: both have a 7- to 21-day incubation period and cause dysuria. Urethritis caused by gonorrhea and chlamydia cannot be differentiated: both have a 7- to 21-day incubation period and cause dysuria.

9 Gonorrhea VS. Chlamydia Chlamydial urethritis is generally milder than gonorrheal urethritis and more likely to be asymptomatic. Symptoms may be intermittent or unnoticeable. Chlamydial urethritis is generally milder than gonorrheal urethritis and more likely to be asymptomatic. Symptoms may be intermittent or unnoticeable. Urethral discharge in men may be similar in the two infections, chlamydial discharge tends to be more clear and gonococcus discharge more purulent. Urethral discharge in men may be similar in the two infections, chlamydial discharge tends to be more clear and gonococcus discharge more purulent.

10 Trichomoniasis Most men with trichomoniasis remain asymptomatic. Most men with trichomoniasis remain asymptomatic. Possible clinical manifestations include scant intermittent discharge, slight pruritus, and mild dysuria. Possible clinical manifestations include scant intermittent discharge, slight pruritus, and mild dysuria.

11 Urethritis & Prostatitis Mr. Ts urethral discharge and urethral irritation may be caused by urethritis or prostatitis.

12 Urethritis Inflammation of the urethra Inflammation of the urethra Ascending infection in men Ascending infection in men Associated with cystitis and vaginitis in women Associated with cystitis and vaginitis in women Usually asymptomatic Usually asymptomatic S&S: Itching, burning around urethra, UD (scant to profuse, thin, clear or mucoid, thick or purulent) dysuria and frequency, penile discomfort S&S: Itching, burning around urethra, UD (scant to profuse, thin, clear or mucoid, thick or purulent) dysuria and frequency, penile discomfort

13 Urethritis Causes Include: Nongonococcal urethritis Nongonococcal urethritis STI: gonnorrhea, chlamydia, trichomonas, HSV, STI: gonnorrhea, chlamydia, trichomonas, HSV, Bacterial urethritis r/t UTI Bacterial urethritis r/t UTI Trauma Trauma

14 Prostatitis Inflammation of the prostate gland Inflammation of the prostate gland Classified as acute or chronic bacterial prostatitis OR non-bacterial prostatitis Classified as acute or chronic bacterial prostatitis OR non-bacterial prostatitis

15 Prostatitis acute bacterial prostatitis: fever, chills, body aches acute bacterial prostatitis: fever, chills, body aches chronic and non-bacterial prostatitis: symptoms more subtle: bladder irritability (frequency, dysuria, nocturia, urgency, hesitancy, hematuria) pain (rectum, perineum, lower back and abdomen, penile head) chronic and non-bacterial prostatitis: symptoms more subtle: bladder irritability (frequency, dysuria, nocturia, urgency, hesitancy, hematuria) pain (rectum, perineum, lower back and abdomen, penile head)

16 Acute or Chronic Bacterial Prostatitis Causes Include: Reflux of infected urine into ejaculatory and prostatic ducts Reflux of infected urine into ejaculatory and prostatic ducts Hematogenous Hematogenous Secondary to urethritis Secondary to urethritis Urethral instrumentation Urethral instrumentation Pseudomonas, e.coli, klebsiella, streptococcus, staphylococcous, chlamydia Pseudomonas, e.coli, klebsiella, streptococcus, staphylococcous, chlamydia

17 Non-Bacterial Prostatitis Causes Include: Trichomonas, ureaplasma or other organism Trichomonas, ureaplasma or other organism Prostatodynia: pain/discomfort without other signs of infection and no identifiable causative factor Prostatodynia: pain/discomfort without other signs of infection and no identifiable causative factor

18 Case Study Ms. T. does not know which partner she got chlamydia from and wonders if it could be her current partner. He has complained on and off of some urethral irritation with occasional clear discharge. Q: What could his symptoms be due to?

19 Case Study Mr. Ts symptoms – urethral irritation with occasional clear discharge – are mostly likely due to: Chlamydia Chlamydia Trichomonas Trichomonas Urethritis (gonococcal or nongonococcal) Urethritis (gonococcal or nongonococcal)

20 Case Study How would you respond to Ms. T? If Mr. T was your client presenting with these complaints, what data would you collect? What investigations would you order?

21 References Lippincott Manuel of Nursing Practice (8 th ed.) (2006) S.M. Nettina (Ed.). Lippincott, Williams & Wilkins: Philadelphia. McCance, K.L., & Huether, S.E. (2006). Pathophysiology: The biological basis for disease in adults and children (5th ed.). St.Louis, MI: Elsevier Mosby. Samraj, G.P.N. (2006). Urethral Discharge. In Paulman, P.M., Paulman, A.A., & Harrison, J.D. (eds.), Taylor's 10-minute diagnosis manual: Symptoms and signs in the time-limited encounter (2 nd ed.). Lippincott, Williams & Wilkins: Philadelphia.


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