Who you are:
You are FY2 doctor in GUM clinic,Who the patient is:
Mr. John Black, 34 years old, came with discharge from his penis a week ago. Gonorrhoea was confirmed and he has been started on antibiotics 2 days ago.
Nurse talked to him about contact tracing, but he refused.What you should do:
Talk to him, convince him and address his concerns.
Approach
D: I can see from my notes that you have been diagnosed with gonorrhoea and you are receiving treatment for it, how are you right now?
P: I am fine, thanks.
D: I also understand that the nurse talked to you about contact tracing and I am here to talk to you about your condition also. Before that do you have any questions about gonorrhoea?
P: No.
D: Do you mind if you walk me through your condition from the beginning?
P: I started to have this discharge from my penis 2 weeks ago when I was in Greece, after that it became more frequent and painful.
D: How much do you know about gonorrhoea?
(This is a condition which is usually transmitted by having unprotected sex. It is caused by a bug, it is not serious; however, if not treated it could be serious. )
Quick Hx as it already diagnosed
P1
- What made you come to the clinic in the first place, was it the discharge?
(Unusual Discharge)
Tell me more about it. - Anything else?
- Symptoms of gonorrhoea:
Pain while you are passing urine?
Pain in your testicles? - Symptoms of Other STIs:
Ulcers in your private area?
Diarrhoea? Weight loss?
P2
- Have you been tested for STIs before?
- Have you had this discharge before?
- Any medical conditions?
Sexual so important
D: Sorry, I need to ask you some questions that are quite personal and in depth, but they are related to your condition. If you feel uncomfortable and want me to stop just let me know. Are you sexually active?
P: Yes.
D: Are you in a stable relationship?
P: Yes.
D: Do you practice safe sex?
P: No.
D: By any chance, have you had sex with another partner in the past 6 months?
P: I had sex with a girl while being in Greece.
D: Did you use any method of protection, like condoms?
P: No.
D: Have you had this unusual discharge after this?
P: Yes.
D: Have you had unprotected sex with your partner after this?
P: Yes.
D: By any chance, is your partner experiencing the same symptoms as you?
P: She hasn’t mentioned anything about it.
Examination:
• Observation
• Throat (check for signs of infection)
• Private parts
• Abdominal (if patient is female as they can get PID)
Patient concerns:
P: Why do you want to tell my wife?
D: May I know why you don’t want to tell her?
P: This could ruin our marriage, it was only one time and I promised myself I wouldn’t do it again.
D: I really appreciate what are you feeling but you told me that you had
unprotected sex with her after having these symptoms and it’s highly likely that you have transmitted the infection to her. So we need to check and treat her because if only you get treated you will get the infection back again from her after.
P: She will leave me if she knows what I did
D: I am really sorry about that, but have you heard about the anonymous
notification program?
P: No.
D: Your partner will receive a letter or an e-email saying that she might have an STI and she needs to get tested without giving her any more details.
P: She doesn’t have any symptoms so why inform her?
D: Sometimes you have the infection without any symptoms, so we need to test her to exclude that because this could have an effect on her health and possibly her fertility.
You:
- You might get infected again if she has the infection.
Your partner
- She might have long term complications like chronic infection, and
infertility.
P: If I don’t give you my permission will you tell her?
D: Well, we would need you to give us her contact details to inform her but as I said we can do it anonymously and your name wouldn’t be mentioned.
Surely you love your wife, and you want to prevent any further harm to her health?
P: Can we have children in the future?
D: Do you have any children right now?
P: No.
D: If both of you are treated early on, then you should be able to have
children like anyone else.
Advice
Stop sexual intercourse till both of you have been treated.
Use condoms.
Refer to gum clinic
Offer leaflets
Safety netting
• Persisting discharge
• Testicular pain and swelling
• Fever
Arrange follow up