UTI in a Transgenter

Casebank History
1

Who are you:
You are an FY2 in the GP clinic.

Who the patient is:
28 year old transman with the birth name of Samantha Mason who now goes by Peter Mason has come to see you with some urinary symptoms.

What you should do:
Talk to the patient, take relevant history and address his concerns.

Approach
From the beginning of the station, the patient tells you to call he/him with a name different than their apparent gender or their name in the scenario then you will understand that he/she is a transgender. In this case, you can add a question here:

I understand you are transitioning, but do you still have your periods?
If a female transitioning to a male) by any chance, can you be pregnant?
Do you practice safe sex?
If the patient did not give you any clues from the beginning that he/she is transitioning then continue normally as a UTI case then in the past medical history do the following:

  • Medical conditions?
  • Medications including over the counter or supplements?
    Here he/she can tell you ‘’ I am taking testosterone or estrogen’’
    may I ask you why? ‘’ I am transitioning ‘’ and
    how far are you in the transition process? And
    were these medications prescribed or did you have your gender identity clinic yet?
  • Afterwards, check mood.
    how are you coping?
    any stresses? Any abuse? Are you satisfied with the transitioning

Risk factors for UTI in transgender:
You do not necessarily have to ask these, but know them for your own knowledge.

  1. Transgender women (biologically male) tend to tuck in their penises in female underwear which makes them more prone to infection.
  2. Transgender men (biologically female) use testosterone which causes vaginal dryness and can predispose them to all kinds of infection.
  3. Both of them tend to hold their urine because they cannot easily find a suitable bathroom (unisex or mixed bathroom) which also increases likelihood of UTI.

History:

  • Pain? Frequency? Change in the colour or smell or urine?
  • Fever?
  • Blood in urine?
  • Tummy pain?
  • When was the last time you passed urine?
  • Concern?

P1: (ODIPARA)
Doctor: how can I help you?
Patient: I have a burning sensation.
D: Tell me more about that?
P: It burns when I pee.
D: Is it all the time or it comes and goes?
P: All the time.
D: Is there anything that makes it better or worse?
P: No.
D: Anything else?
P: I don’t think so.
D: Any pain anywhere else?
P: No.
D: Any fever?
P: I haven’t measure it but I feel warm.
D: Any change in colour of your urine?
P: No.
D: Any blood in your urine?
P: No.
D: Any tummy pain?
P: No.
D: When was the last time you passed urine?
P: This morning.
D: Anything else concerning you?
P: No.

P2:
D: Have you had this condition before?
P: No.
D: Do you have any medical condition?
P: No.

MAFTOSA+ Sexual Hx:
D: Are you taking any medications?
P: I am taking testosterone.
D: Can you tell me more about that?
P: I have been taking it for the past 3 months as I am transitioning.
D: Who prescribed it to you?
P: The doctor, and I am taking it as prescribed.
D: Are you happy with the transitioning process?
P: Yes.
D: Have you had any top or bottom surgery for it?
P: Not yet.
D: Are you facing any problems with transitioning?
P: it’s just embarrassing to go to a public toilet so I hold my urine in when I am not home.
D: Do you feel supported by your loved ones?
P: Yes
D: Are you sexually active?
P: No.
D: How is your mood?
P: It’s fine.

ICE

Examination:

  • Observations: Temp 38
  • Tummy
  • Urine dipstick test- to be done straight away and preferably sample should be taken midstream.

Diagnosis:
From the chat we had, you told me you have a burning sensation while passing urine and your urine dipstick test has come back positive, so it looks like you have a urinary tract infection, possibly from holding in your urine when you are out.
It is not dangerous, but we need to treat it before it gets worse or potentially spreads to your kidneys.

Treatment:

  • Investigations:
    – urine sample+/- culture
    – FBC
    – RFT
  • Medications: Nitrofurantoin 100 mg BD or 50mh QD
  • Advice: Drink plenty of water, do not hold in your urine.
  • Support: Give lots of emotional support.
  • Safety net: Persistence of the symptoms and mood
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