Review Question - QID 107391

This patient has an uncomplicated gonorrheal urethritis that should be treated with an injection of ceftriaxone. Patients treated for gonorrhea should also be treated with azithromycin or doxycycline for chlamydial co-infection.

Gonorrhea is the second most common sexually transmitted infection (behind chlamydia), and is a common cause of urethritis in men or cervicitis in women. The causative organism is Neisseria gonorrhoeae, a gram-negative intracellular diplococcus. Patients typically present with purulent yellow-green discharge, dysuria, urinary frequency, and a solitary erythematous nodule on the penile shaft.

Mayor et al. review the diagnosis and treatment of gonococcal infections. They warn that gonorrhea in women is often asymptomatic and that, if left untreated, can progress to pelvic inflammatory disease or disseminated disease. They state that while Neisseria gonorrhoeae most commonly affects the urogenital area, it can also cause anorectal, pharyngeal, and conjunctival infections. Gram stain, urine nucleic amplification tests, or urine polymerase chain reaction testing (in men) can all be used for diagnosis and have similar sensitivity and specificity.

Meyers et al. review the U.S. Preventive Services Task Force's (USPSTF) screening recommendations for sexually transmitted infections. The USPSTF recommends screening all sexually active women younger than 25 years of age for chlamydia and gonorrhea. They further recommend screening for chlamydia, gonorrhea, HIV, and syphilis in women older than 25 years of age with risk factors for sexually transmitted infections, such as unprotected sexual intercourse, having a new sexual partner, having multiple sexual partners, exchanging sex for drugs or money, or engaging in sex while under the influence of drugs or alcohol. Women older than 25 years of age without risk factors should not be screened. The USPSTF recommends screening for HIV and syphilis only in men who are at high risk of infection.

Figure A demonstrates a gram stain from a patient with acute gonococcal urethritis. Neisseria gonorrhoeae, a gram-negative intracellular diplococci, is present.

Incorrect answers:
Answer 1: Doxycycline is used in the treatment of chlamydia, not gonorrhea.
Answer 2: Penicillin G is used in the treatment of syphilis, not gonorrhea.
Answer 3: Ceftriaxone is an appropriate treatment for gonorrheal urethritis, however, it should be combined with either azithromycin or doxycycline in order to treat chlamydial co-infection.
Answer 4: Azithromycin is used in the treatment of chlamydia, not gonorrhea.