History of Present Illness:
A man in his mid-s0’s presents to the hospital with suprapubic pain on and off for 6 months following bilateral inguinal hernia repair. It has been worse for the past few days. There is no dysuria but pain is better after voiding. He is worried about STD’s as well.
Vital Signs & Physical Exam:
Awake and alert x 4. Lower abdominal tenderness with no palpable hernia and normal GU exam without discharge or rash.
Initial Diagnostic Testing:
- CBC: normal
- Chem-7: normal
- UA: normal except for moderated mucus. GC and chlamydia negative
- Imaging:
What is the most likely diagnosis?
- A) UTI
- B) herpes cystitis
- C) hernia
- D) prostatitis
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What is the most likely diagnosis?
- A) UTI – Good thought but urine culture negative
- B) herpes cystitis – CORRECT. He had a recent outbreak of genital herpes that resolved fully about 4 days prior. It was his third outbreak but the first one with these delayed symptoms
- C) hernia
- D) prostatitis
1-Minute Consult on this topic: Click HERE and scroll to the TOP of page 176.
CASE CONCLUSION: sent home on pyridium and Famvir. Urine culture and urine HSV sent. Urine culture was negative. Serum HSV negative. Urine HSV positive. Improved with Famvir