Hello bright minds, I am a med student on my uro clinical and had this difficult Dx, any ideas?
30/m complaining of progressive urethral pain, no other major health problems, pain started 4 years ago as sporadic pain and progressed over time into constant “extremely painful” burning pain. 14 visits to clinic for same reason with no relief. Complains new joint pain in knees with burning throbbing pain their as well, itching and burning in penis, around penis, around anus, and newly attributed neurological pain in his fingers and hands. Patient claims pain started after unprotected sex with female 4 years ago and insists symptoms resemble or mimic exact symptoms of late stage syphilis.
- for STDs, - for 2 cystoscopies, - for Hep A, B, C, HIV, urine test normal xray for kidney stones negative..
- Treatment included rocephin shot, deoxy antib, cipro antib, given different times to eliminate variables (no + results, pain progressed).
Dx of attending thusfar
Chronic pros. as hunch, but really just out of process of elimination. Attending asked me for other Dx, causes of symptoms, and ideas for treatment.
All I can think of for causes Trauma to the urinary tract; PID, STDs, Chronic/acute bac or non bac prost., cancer, autoimmune disorders?
And for Tx:
I don’t know, seems like patient tried every antib with no positive change. Should I recommend trial of penicillin since every other STI seemed to be treated eventhough no + result shown? Other tests I really don’t know. Patient seems in extreme pain and to be honest I don’t think the Attending really knows what the exact Dx is and what the exact Tx should go from here.