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Dysuria

Clinical Discipline(s)/Organ System(s)
General Practice, Genitourinary System, Infectious Diseases, Microbiology, Obstetrics & Gynaecology
Progress Test Topic(s)
Infectious disease
Description
An 18 year old European woman presents to the student health clinic with burning discomfort when she passes urine. She has recently started university and has a new boyfriend. They have been having sex without using condoms.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy and function of the female reproductive tract
   - Microbiology of sexually transmitted infections (STIs)
   - Pharmacology of acyclovir; interactions with contraceptives
   - Methods of contraception, including pharmacology of oral contraceptives
Clinical and Communication Skills 
   - Appropriate communication for a sensitive topic
   - History from a young woman with dysuria; sexual history and include risk factors for an STI
   - Conduct a HEADSS psychosocial assessment
   - Examine the abdomen and genitalia; pelvic examination using speculum and obtain cervical smears and swabs
   - Differential diagnosis of dysuria: urinary tract infection, sexually transmitted infection (STI), genital ulcers, malignancy
   - Clinical features of STIs
   - Investigation of STI and urinary tract infection
   - Interpret midstream urine, vaginal swabs, urethral swabs, urine dipstick, chlamydia swabs and urine antigen testing, viral swabs and pregnancy test
   - Management of urinary tract infection, gonorrhea, chlamydia, bacterial vaginosis, syphilis
   - Complications of untreated chlamydia, gonorrhea and syphilis
   - Counselling regarding chlamydia, condom usage and contraception advice; indications and appropriateness of contraceptives
   - Counselling regarding unplanned pregnancy
   - Prevention of STI including herpes simplex virus infection
   - Barriers to healthcare access for adolescents
   - Contact tracing
Personal and Professional Skills 
   - Intimate examination and use of chaperone
   - Ethical issues in consenting for health care and confidential health care
   - Awareness of the tension between family/whānau involvement in health care decision making and the need to talk to young people without parents present
   - Discussion of personal topics including sexual history and possibility of coercion
   - Awareness of own personal views about unprotected sex and unplanned pregnancy, and how this could affect communication
   - Awareness of own sexual health and behaviour
   - Be aware of ethical and legal issues regarding unplanned pregnancy
Hauora Māori 
   - Self-reflective competencies: awareness and ability to recognise ones own stereotypes and biases in relation to sexual activity
Population Health 
   - Notifiable infectious diseases
   - Epidemiology of STIs and urinary tract infections
   - Safe sex education
   - Human papilloma virus vaccination programme
   - Non-pharmacological methods of preventing urinary tract infections
Conditions to be considered relating to this scenario
Common
chlamydia, gonorrhoea, trichomonas, pregnancy, vaginitis, candidiasis, herpes simplex virus, genital warts
Less common but 'important not to miss'
cervical cancer, bladder cancer, hepatitis B, hepatitis C, HIV, syphilis
Uncommon
endometriosis, haemorrhagic cystitis
Related Scenarios
[Flank pain and dysuria]