Diagnosis and Treatment of Sexually Transmitted Infections in Urgent Care -

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Publication Date: March 2023 (Volume 2, Number 3)

CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 03/01/2026.

Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 3 Pharmacology and 4 Infectious Disease CME credits, subject to your state and institutional requirements.

Urgent Care Update Author

Peer Reviewers

Charting & Coding Author

Abstract

Sexually transmitted infections (STIs) continue to be a growing threat to public health. Because they may be asymptomatic or feature nonspecific signs and symptoms, STIs often go underrecognized by patients and healthcare workers. Frontline clinicians in particular must remain vigilant, playing a critical role in combatting the rising tide of infections by obtaining a thorough but sensitive history, conducting an appropriate physical examination, ordering relevant laboratory tests, and, when necessary, prescribing antimicrobial treatments. This issue reviews the CDC's 2021updated guidelines for the diagnosis and treatment of STIs, focusing on efficient and safe strategies to promote health for all patients and their partners, regardless of their sex, gender, age, pregnancy status, or other demographic variables.

Case Presentations

A 32-year-old woman walks in reporting she has a urinary tract infection...

• Her vital signs are reassuring at triage: blood pressure, 120/63 mm Hg; heart rate, 71 beats/min; respiratory rate, 18 breaths/min; oxygen saturation,100% on room air; and temperature, 37°C (98.6°F).
• The intake note states: “Patient presents today with a 3-week history of dysuria, urinary frequency, and lower abdominal pain despite a full course of nitrofurantoin prescribed by another local urgent care clinic and a full course of ciprofloxacin prescribed by her primary care provider thereafter.”
• When you examine the patient, she advises she felt mild improvement in her symptoms 2 days prior, but now has persistent dysuria again.
• Her initial physical exam is positive only for mild suprapubic discomfort with palpation. Urinalysis shows small leukocyte esterase and negative nitrite. Her urine pregnancy test is negative.
• You wonder whether to prescribe a third antibiotic and send a urine culture, or if there is something else you should be considering…

A 50-year-old man and his wife present to clinic, clearly arguing with one another in hushed tones...

• While the man is being triaged, he says he has “bumps” on his penis. He reports that the lesions appeared 3 days ago and are itchy but not painful.
• He denies use of any new soaps, detergents, or other potential allergens. He states that he hasn’t noticed any bumps elsewhere and has never had a skin rash like this before.
• During the chaperoned physical exam, you note a small cluster of red bumps at the base of the penis. There is no drainage, crusting, or ulcerated tissue.
• As you consider the differential diagnosis for these bumps, you wonder how best to broach the possibility of genital herpes with this married couple, wishing to be both gentle but comprehensive in your evaluation...

A 19-year-old college student calls ahead, asking if any female providers are working that day...

• On arrival, the anxious but otherwise healthy young woman states that she was sexually assaulted at a party 2 nights ago. She does not know what happened but believes she was drugged by someone at the party and only remembers waking up in an empty hotel room.
• She does not want to go to the ED for a forensic exam but does ask to be treated for STIs.
• You recall that the CDC recently updated its guidelines for victims of sexual assault and return to your workstation to check the current recommendations…