New England Training Curriculum in Sexually Transmitted Infections

A 35-year-old man presents with a one day history of whitish discharge from his penis. He also has mildly uncomfortable urination.

A 27-year-old male presents with a whitish mucopurulent urethral discharge. Three days ago, the patient began to have pain when urinating.

A 32-year-old male presents with complaints of persistent dysuria. The patient reports that symptoms began about four weeks ago. He reports a history of condomless vaginal sex with three partners in the last six months. He was treated presumptively for gonorrhea and chlamydia last month by his primary care provider with intramuscular ceftriaxone 250mg once and azithromycin 1gm orally. He reports that he has not engaged in any sexual activity since treatment completion. Symptoms did not improve or resolve despite treatment.

A 20-year-old female presents with complaints of vaginal itching and irritation for the past three days. Two weeks ago, she had streptococcal pharyngitis and was treated with amoxicillin. For the last year, she has had one male sex partner and she reports that they consistently use condoms. Pelvic examination reveals erythema of the vulva and vagina and the presence of a thick, whitish vaginal discharge. The pH of the discharge is 4.0.

A 25-year-old female presents with an abnormal, whitish vaginal discharge with a fishy odor for the past 10 days. She reports a history of condomless oral/vaginal sex with four male partners in the past year. She is currently in a relationship with a new male partner.

A 30-year-old female presents with a green vaginal discharge and vaginal itching for six days. She reports a history of condomless oral/vaginal sex with four male partners and two female partners in the past three months.

An 18-year-old male with no past medical history presents to the clinic reporting a four-day history of pruritis and erythema of the glans of the penis. He is not circumcised and has never been sexually active.

A 21-year-old male presents with a small raised and indurated ulceration of his penis. The lesion is non-painful. The patient has no other past medical history and does not take any other medications. He reports two anonymous male partners in the past month. He used condoms for anal sex but not for oral sex. Neither partner reported any symptoms. The patient does not have any other complaints.

A 32-year old female has itching and discomfort in the genital area and bleeding during sex. She denies any vaginal discharge. Physical exam reveals whitish lesions close together that appear as a cauliflower-like shape around the vagina. She reports having condomless sex with multiple male sexual partners in the past three months. She does not have any significant medical history and is not currently taking any medications.

A 26-year-old female presents with multiple, painful, vesicular genital lesions. She denies any abnormal vaginal discharge. The patient reports six sexual partners in the past three months, four men and two women. She normally uses condoms for vaginal sex but never for oral sex. Physical exam reveals five lesions on the labia majora and four lesions on the pubis.