Sexually transmitted infections (STIs) consist of infections spread by sexual contact. STIs are common occurrences, making screening, diagnosis, and treatment critical. National and state-level data reflect rising STI rates, requiring increased attention on behalf of medical providers. The following program will seek to improve awareness of STIs, efficiency and accuracy in testing, diagnosis, and treatment, and incorporation of sexual history into routine history and physical assessments. The following online case studies afford providers the opportunity to practice identifying, diagnosing, and treating common STIs.

This activity is intended for medical providers from internal medicine, primary care, pediatrics, OB/GYB and other providers who are delivering services pertaining to sexual health.

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    Case 1

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

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    Case 2

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

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    Case 3

    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.

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    Case 4

    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.

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    Case 5

    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.

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    Case 6

    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.

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    Case 7

    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.

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    Case 8

    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.

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    Case 9

    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.

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    Case 10

    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.

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    Case 11

    A 35-year-old male presents with a 1-2 cm painful ulcer at the dorsal aspect of his penis. The lesion appeared 10 days ago and the patient reports that the lesion looked like a pustule that progressed to an ulcer. On physical exam, his left inguinal lymph nodes are swollen. There are no signs of urethritis and no discharge from his penis. He reports recently engaging in sex with several female partners while vacationing in the Caribbean. Syphilis serologies are negative. A culture of the ulcer is negative for HSV-1/2.

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    Case 12

    A 29-year-old male presents with tenesmus (urge to defecate), painful bowel movements, rectal bleeding, and painful bilateral inguinal adenopathy. The patient reports having condomless anal sex with several male partners in the last few months. No rashes or genital ulcers are noted. Rectal swabs are positive for chlamydia by NAAT.

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    Case 13

    A 26-year-old male presents with a sore throat, fever, and myalgias for the past ten days. He reports having eight male sex partners in the past three months and using condoms occasionally for anal sex. Medical records show negative testing for HIV, syphilis, gonorrhea, and chlamydia six months ago.

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    Case 14

    A 35-year-old male presents to the clinic with multiple small papules in and around his fingers and also in his scrotum and pubic region. The rash is intensely pruritic. He is originally from Bolivia, currently unemployed, and lives in an apartment with five other friends. Two of his housemates have similar symptoms. He reports a history of condomless sex with three female partners in the past six months.

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    Case 15

    A 19-year-old female presents with postcoital bleeding, abnormal vaginal discharge, urinary frequency and pelvic pain. Over the past three months, the patient reports having vaginal sex with two male partners and sharing vaginally inserted sex toys with one cisgender female partner, with no condom use.

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    Case 16

    A 24-year-old male presents with abdominal cramps, gas, nausea, malaise, rectal pain, and diarrhea for the past week. Over the counter medications have been minimally effective. The patient denies the presence of blood or mucus in his stool.

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    Case 17

    A 19-year-old female college student presents with pruritis and irritated skin in the inguinal area, as well as a blotchy rash and small (pinpoint) bruises on the inner thighs. Upon further questioning, the patient reports that the itchiness worsens at night.

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    Case 18

    A 34-year-old male from Papua New Guinea presents with a several month history of painless ulcerated lesions on his penis, pubic area and scrotum. The patient reports that the lesions started as nodules and progressed to ulcerated lesions over about a month. He reports condomless sex with four female partners prior to developing symptoms. On exam, the lesions are visualized to be “beefy red” in appearance and bleed easily.

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    Case 19

    A 39-year-old male presents for routine testing and preventative care for sexually transmitted infections. He has no past medical history and takes no medications. He reports one longer term male partner, but occasional other male partners as well. He doesn’t use condoms with his longer-term partner but does with his other partners. He has no complaints on evaluation. He does not travel outside of the United States and currently works at a bank. He reports no prior hepatitis A or B vaccinations. The patient denies any past or current substance use.

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