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Chlamydia trachomatis
33%
6/18
Escherichia coli
6%
1/18
Neisseria gonorrhoeae
56%
10/18
Staphylococcus saprophyticus
0%
0/18
Trichomonas vaginalis
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This patient is presenting with a tender urethra with a discharge and a negative Gram stain suggesting a diagnosis of urethritis from Chlamydia trachomatis. Urethritis in men presents with dysuria and urethral discharge with numerous neutrophils on urethral swab. Urethritis in men is most commonly caused by 2 categories of sexually transmitted infections. In gonococcal urethritis, patients present with purulent discharge and gram-negative diplococci on Gram stain, with N. gonorrhoeae as the offending agent. In nongonococcal urethritis, patients present with watery discharge which shows no bacteria on Gram stain (it is intracellular). Chlamydia is the most common offending agent in nongonococcal urethritis and is the most common cause of urethritis overall. Azithromycin is a good choice for the treatment of nongonococcal urethritis because it covers Chlamydia and other common causative organisms. It is often given with ceftriaxone which offers double coverage for N. gonorrhoeae. Incorrect Answers Answer 2: Escherichia coli is the most common cause of cystitis which presents with dysuria and leukocytes, bacteria, and nitrites on urinalysis. TMP-SMX is a first-line agent for the treatment of uncomplicated cystitis. Answer 3: Neisseria gonorrhoeae is the most common cause of gonococcal urethritis which presents with a purulent urethral discharge and gram-negative diplococci on Gram stain. Ceftriaxone (a single injection) is the most common treatment for gonococcal urethritis. Ceftriaxone would be appropriate if the patient presented with purulent urethral discharge and a supportive Gram stain. Patients treated for gonococcal urethritis are generally treated for a Chlamydia trachomatis infection since there is a high rate of co-infection. Answer 4: Staphylococcus saprophyticus is a common cause of UTI in young and sexually active women. It is still less common a cause of a UTI when compared to Escherichia coli. Answer 5: Trichomonas vaginalis is a less common cause of male urethritis. It can present with pruritus but with less specific symptoms when compared to women with this condition. If the patient did not respond to antibiotics, this diagnosis could be suspected. Metronidazole is the treatment of choice. Bullet Summary: Chlamydia trachomatis can cause urethritis which presents with urethral discharge and a negative Gram stain.
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