Workplace Stress Management

Determining the HIP will require additional history from the patient. For example, the physician should seek to determine if the patient has pain during position change (pain better/worse when sitting, standing, raising the scrotum). Additional questions regard comorbidity, for example, if he has type 1 DM and a history of malignancies. The physician should also ask if the patient has a history of scrotum trauma and get to know the recent sexual activity (protected or unprotected).  The physical examination in this setting includes lymphadenopathy, check for ulcers in the genitals, and if the urethra has a discharge (Dunphy et al., 2019). Additionally, a scrotal exam should be used to examine its tenderness and skin color change. 

Based on history and presentation, there is a need to screen for STIs. The patient is facing epididymitis at the onset of an STI probably (Neisseria Gonorrhea or Chlamydia trachomatis). The reason is that the young man is sexually active, has a urethral discharge, dysuria, and has pain in the scrotum. Other differential diagnosis includes torsion, scrotal trauma, scrotal abscess, and cellulitis and Fournier’s gangrene (Leik, 2017). Fournier’s gangrene is unlikely since it’s associated with fever, which the patient doesn’t have it. In this case, the priority diagnosis is epididymitis at the onset of an STI (Neisseria Gonorrhea).

The standard treatment for this young man (less than 35 years) with epididymitis is a fluoroquinolone. A chlamydia infection may not adequately respond to ciprofloxacin; thus, azithromycin 1 gm PO once. He can also take doxycycline 100 mg PO twice daily for seven days should be used (Dunphy et al., 2019). Dual therapy for empiric treatment for co-infection with N. gonorrhea should be a consideration. NSAIDs should be used for analgesic control if the pain persists longer than the infection (Dunphy et al., 2019). For a follow-up, additional counseling is required using 4Cs (counseling, compliance, condoms, and contact treatment). The reportable STIs in the state include syphilis, Gonorrhea, Chlamydia, HIV infection, and Aids, among others, are reported.


Dunphy, L. M., Winland-Brown, J. E., Porter, B.O., & Thomas, D. J. (2019) Primary care: The art and science of advanced practice nursing-an interprofessional approach (5th ed.). Philadelphia: F.A. Davis. ISBN-13: 978-0-8036-3801-3

Leik, M. C. (2017). Family Nurse Practitioner Certification Intensive Review. New York: Springer Publishing Company. ISBN     9780826134288