Course 04: Respiratory Medicine and Infectious Disease
Lesson 13 of 14. Explore the diagnostic and management frameworks, work through the case, and finish the linked 10-question practice set. Urgent presentations require an emergency-care pathway and review of local professional scope.
STI assessment and patient-centred history
- Obtain a respectful sexual history relevant to symptoms, exposures, anatomical sites, pregnancy potential, prior testing and prevention; request permission and protect confidentiality.
- Use site-specific NAAT for chlamydia/gonorrhea and appropriate serology for HIV/syphilis; test relevant exposed anatomical sites.
- Do not rely on absence of symptoms to exclude infection; arrange screening based on risk, guidelines and shared decisions.
Treatment, follow-up and public health
- Follow current PHAC guidance for gonorrhea, chlamydia, syphilis and HIV exposure management; resistance patterns and recommended regimens can change.
- Partner management, public health reporting, repeat testing and test-of-cure vary by infection, pregnancy, exposure and local rules.
- Discuss barrier methods, appropriate vaccines and HIV pre/post-exposure prophylaxis where relevant, with timely referral if outside professional scope.
Travel and vector exposure reasoning
- Take travel timeline, destination, season, mosquito/tick/animal/freshwater exposure, prophylaxis and vaccine history.
- Fever after travel to a malaria-endemic region can be malaria and needs urgent same-day assessment, regardless of previous preventive medication use.
- Consider Lyme disease after relevant tick exposure and compatible clinical features; do not treat an isolated nonspecific symptom as confirmed Lyme disease.
Other systemic infection priorities
- New fever in severe neutropenia, severe headache with neck stiffness, pregnancy-associated infection or rapidly progressing rash requires urgent assessment.
- Interpret viral hepatitis and HIV test results in context of exposure windows; discuss repeat testing as indicated and avoid stigmatizing language.
- Check current local reportable-disease rules and public-health contact pathways rather than assuming national guidance replaces provincial law.
Applied clinical case
A 34-year-old returns from a malaria-endemic region with chills, fever, headache and thrombocytopenia despite reporting prophylaxis.
Show model clinical reasoning and disposition
Malaria is a potentially fatal diagnosis; arrange urgent same-day assessment and malaria testing (repeated if required by specialist/local protocol). Prophylaxis does not guarantee exclusion.
Clinical self-check
- Which anatomical sites should be tested for STIs?
- What changes partner management?
- What cannot be delayed in post-travel fever?
Current guidance and further learning
- PHAC: Sexually transmitted and blood-borne infection guides (external)
- Canadian Tuberculosis Standards, eighth edition (external)