Last updated on 14 May 2020 at 1:04 PM (ID08)

Dysuria
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.

 

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
Pharmacology of gentamicinfluconazoleciprofloxacinnitrofurantion 

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