A Gay Man with Jaundice
Michael, a 19-year-old man, presents to his General Practitioner with a 7-day history of nausea, malaise, poor appetite, and discomfort in the right upper abdomen. Over the past few days he has noticed that his urine is darker than normal and that his stools are pale. His friends have told him that his skin looks yellowish. He drinks about 10 units of alcohol per week, but he does not use recreational drugs, and he is not receiving any medication. He has not traveled abroad in the past 2 years. He lives with his parents and a 16-year-old sister. For the past 3 months Michael has been in a regular sexual relationship with a 28-year-old man, but he has had no other partners in that time. He has insertive and receptive oral–genital, oral–anal, and peno-anal intercourse; condoms are used infrequently for anal intercourse and not at all for oral sex. What conditions may cause his symptoms?