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Case of the Month - July 2019

Authors
Remco P.H. Peters1-3, Jan Henk Dubbink2

Affiliations
  • Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
  • Anova Health Institute, Johannesburg, South Africa
  • Department of Medical Microbiology, School of Public Health & Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
Keywords
Trichomonas vaginalis, male urethritis syndrome, vaginal discharge syndrome, metronidazole

Correspondence
Prof R.P.H. Peters
Department of Medical Microbiology
Pathology Building; Room 3-11
Faculty of Health Sciences
University of Pretoria
Pretoria
South Africa
Tel.: 076 3920858
Email: rph.peters@gmail.com

Case Presentation
We conducted a research study at primary healthcare facilities in rural Mopani District whereby individuals with genital discharge and/or dysuria were mobilised for treatment by an expert clinical team using community-strategies [1]. A 62-years old man presented to the study team with a nine months’ history of dysuria. He had received treatment three times over the prior months, but his symptoms had remained. He brought pill packages that showed that he had received amoxicillin, ciprofloxacin and flucloxacillin over that period. Upon presentation, the patient reported painful urination, but no frequency, urge or difficulty in urinating; he had not observed any blood in his urine. The patient did not report any genital discharge, itch, abdominal pain or abnormal defaecation. He had been married for many years and denied having sexual partners other than his wife. He did not know if his wife had any symptoms of discharge.

Upon examination the patient was afebrile (37.2 °C); there was no inguinal lymphadenopathy. Genital examination did not reveal any scrotal or penile abnormalities nor was there any abdominal pain or signs of prostatitis. Milking of the urethra expelled a tiny volume of discharge. Urine dipstick was done and showed traces of protein and leukocytes; nitrite was negative. Urine specimens were collected for microscopy, culture and susceptibility (MCS) testing as well as for molecular testing for sexually transmitted infections (STIs). The rapid HIV test after counselling was negative.


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