Case Study

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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 urethral irritation with occasional clear
  discharge.
• Q What could his symptoms be due to?

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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.

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Etiology

• STIs
• Infections cystitits, prostatitis
• Anatomic Congenital Abnormalities urethral
  stricture, phimosis
• Iatrogenic catheterization, instrumentation,
  other procedures
• Tumours
• Foreign Bodies

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Etiology

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

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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
• Chlamydia
• Trichomoniasis

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Gonnorhea

• 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
• 5 to 10 never have signs or symptoms

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Chlamydia

• 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.

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Gonorrhea VS. Chlamydia

• Urethritis caused by gonorrhea and chlamydia
  cannot be differentiated both have a 7- to
  21-day incubation period and cause dysuria.

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Gonorrhea VS. Chlamydia

• 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.

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Trichomoniasis

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

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Urethritis Prostatitis

• Mr. Ts urethral discharge and urethral
  irritation may be caused by urethritis or
  prostatitis.

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Urethritis

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

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Urethritis

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

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Prostatitis

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

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Prostatitis

• 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)

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Acute or Chronic Bacterial Prostatitis

• Causes Include
• Reflux of infected urine into ejaculatory and
  prostatic ducts
• Hematogenous
• Secondary to urethritis
• Urethral instrumentation
• Pseudomonas, e.coli, klebsiella, streptococcus,
  staphylococcous, chlamydia

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Non-Bacterial Prostatitis

• Causes Include
• Trichomonas, ureaplasma or other organism
• Prostatodynia pain/discomfort without other
  signs of infection and no identifiable causative
  factor

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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 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
• Trichomonas
• Urethritis (gonococcal or nongonococcal)

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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?

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References

• Lippincott Manuel of Nursing Practice (8th 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
  (2nd ed.). Lippincott, Williams Wilkins
  Philadelphia.