Gonorrhea in the throat

[YoutubeTheNP]

Yuck! Sorry for the distasteful headline.

I wanted to share an experience with my fellow NPs here.

So I'm doing rounds the other day and had a young girl, 22yo, hospitalized with sore throat (weak admit btw). Anyway she was running fever 103, tachycardic 115s, 14k leukocytosis at time of admission, so she did meet sirs criteria. Anyway, the NP who did her H&P checked her for strep, mono, the usual work up. All of which was negative. Despite being on abx (unasyn) in the hospital and previously on amoxicillin for one week from an urgent care center, she had little to no improvement.

So I'm reading the H&P and can't find the sexual hx (was never asked). So I enter her room, do my usual exam, throat is quite erythematous, no pustules, no exudate. I obtained her sexual hx. New sex partner 2.5 weeks ago, + oral sex, unprotected.

We swab her throat for GC. Next day later she is + for gonorrhea. Given the hx I obtained from her I empirically treated her for gonorrhea anyway. I discharged her later that day and part of DC instruction was to dump the new boo, lol, and have him treated.

So the reason I'm sharing this is to encourage you all to really think about your differentials depending on your patients age and symptoms, especially the new NPs coming out of school. Sore throat in a young person has many differentials, which can easily be overlooked as an STD. Always do a thorough history and physical, like they say you can diagnose 80-90% of problems with a good H&P.

[EaglesWings21, ASN, RN]

Nice catch! But ew! Lol

[Salter444]

During clinicals I asked a lady in her 60s about her sexual history as part of an assignment. Her response, "that is none of your damn business!" It still comes to mind to this day every time I ask the question...and makes me smile a little.

[coughdrop.2.go, BSN, RN]

I'm an RN and I love this post. I volunteered at a Free Clinic and for every sore throat we asked about unprotected sex with a member (regardless of of how they identify their gender) as part of our protocol. Some people are shocked, but we get some pharyngeal GC/CT every so often.

[offlabel]

ughhh....some folks need a hobby....

[Goldenfox]

I'm an RN and I love this post. I volunteered at a Free Clinic and for every sore throat we asked about unprotected sex with a member (regardless of of how they identify their gender) as part of our protocol. Some people are shocked, but we get some pharyngeal GC/CT every so often.

Is there a reason why you limit the question only to memberes? I could tell you a couple of stories...

[YoutubeTheNP]

I'm an RN and I love this post. I volunteered at a Free Clinic and for every sore throat we asked about unprotected sex with a member (regardless of of how they identify their gender) as part of our protocol. Some people are shocked, but we get some pharyngeal GC/CT every so often.

You would think, right? That's Suburbia for ya in this case, the lightbulb doesn't always go on. lol.

[JellyDonut]

The moral of the story:

Be careful what you put in your mouth!!

[carolinapooh, BSN, RN]

I'm a military RN and I'm embarrassed to say this is somewhat common among young military members.

They grew up in a generation where they were taught strict abstinence and there was a permeating belief that oral isn't real sex (Bill, I'm looking at you, LOL!) and you can't get VD from it - and I know this, because they've told me.

[SnowShoeRN]

I have seen so many providers not take thorough sexual histories. So, good for you for actually doing so and figuring out what was going on. I always make sure to include oral sex and the use of flavored condoms in my safe sex chats. Especially with my patients who exchange sex for money, food, or drugs. I get some funny looks from teenagers, but after a short chat on how they don't want to end up with STD's in their throats they generally get the picture. Thanks for the post!

[Conqueror+, BSN, RN]

When I worked in corrections it happened more that I care to remember.

[MrChicagoRN, RN]

ughhh....some folks need a hobby....

For some folks, that IS their hobby.