Differential Diagnosis for Painful Urination, Burning, and Discharge
Single Most Likely Diagnosis
- Gonorrhea or Chlamydia: Given the patient's symptoms of painful urination, burning, and discharge, along with a new sexual partner, these sexually transmitted infections (STIs) are the most likely cause. The patient's HIV-positive status also increases the risk of acquiring other STIs.
Other Likely Diagnoses
- Urethritis due to other STIs (e.g., Mycoplasma genitalium, Trichomonas vaginalis): These pathogens can also cause urethritis, leading to symptoms of painful urination and discharge.
- Urinary Tract Infection (UTI): Although less common in men, UTIs can cause similar symptoms and should be considered, especially if the patient has underlying urological conditions.
- Herpes Simplex Virus (HSV): Genital herpes can cause painful urination, especially if there are lesions on the genital area that come into contact with the urinary tract.
Do Not Miss Diagnoses
- Syphilis: This STI can cause a wide range of symptoms, including genital ulcers, which can lead to painful urination if the ulcers are in contact with the urinary tract. Given the patient's HIV-positive status, syphilis is a critical diagnosis not to miss due to its potential for severe complications.
- Tuberculosis (TB) of the Genitourinary Tract: Although rare, TB can infect the genitourinary tract and cause symptoms similar to those described. The patient's HIV-positive status increases the risk of TB.
Rare Diagnoses
- Lymphogranuloma Venereum (LGV): This is a rare STI caused by certain strains of Chlamydia trachomatis. It can cause symptoms such as painful urination, discharge, and systemic symptoms like fever.
- Granuloma Inguinale (Donovanosis): A rare STI that can cause genital ulcers, which might lead to painful urination if the ulcers are in contact with the urinary tract.