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Based on clinical appearance, the family physician (FP) diagnosed gonococcal urethritis in this patient; a urine specimen was sent for testing to confirm the gonorrhea and to test for chlamydia.
Neisseria gonorrhoeae and Chlamydia trachomatis are the most common infectious causes of urethritis. Other infectious agents include Mycoplasma genitalium, Ureaplasma urealyticum, Trichomonas vaginalis, herpes simplex virus 1 and 2, adenovirus, and enteric bacteria. Noninfectious causes include trauma, foreign bodies, granulomas or unusual tumors, allergic reactions, or voiding dysfunction.
A nucleic acid amplification test is used to screen asymptomatic at-risk men and symptomatic men. Urine is a better specimen than urethral swab and does not hurt.
Centers for Disease Control and Prevention (CDC) recommendations (August 2012) call for uncomplicated gonococcal urethritis to be treated with combination therapy using ceftriaxone 250 mg IM plus either azithromycin 1 g orally or doxycycline 100 mg orally twice daily for 7 days. For patients with a severe allergy to cephalosporins, the CDC recommends a single 2-g dose of azithromycin orally. Avoid fluoroquinolones and cefixime, as drug resistance is high.
In this case, the clinical picture was so probable for gonorrhea that the FP initiated treatment with ceftriaxone 250 mg IM and 1 g oral azithromycin (which would also treat possible coexisting chlamydia). The patient was offered (and agreed to) testing for other sexually transmitted diseases. He was told to inform his partners of the diagnosis. He was also counseled about safe sex; drug rehabilitation was recommended.
On his one-week follow-up visit, his symptoms were gone and he had no further discharge. His gonorrhea nucleic acid amplification test was positive; his chlamydia, rapid plasma reagin, and human immunodeficiency virus tests were negative. His FP reported the case to the Health Department for contact tracing.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Chumley H. Gonococcal urethritis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:921-923.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link:
Based on clinical appearance, the family physician (FP) diagnosed gonococcal urethritis in this patient; a urine specimen was sent for testing to confirm the gonorrhea and to test for chlamydia.
Neisseria gonorrhoeae and Chlamydia trachomatis are the most common infectious causes of urethritis. Other infectious agents include Mycoplasma genitalium, Ureaplasma urealyticum, Trichomonas vaginalis, herpes simplex virus 1 and 2, adenovirus, and enteric bacteria. Noninfectious causes include trauma, foreign bodies, granulomas or unusual tumors, allergic reactions, or voiding dysfunction.
A nucleic acid amplification test is used to screen asymptomatic at-risk men and symptomatic men. Urine is a better specimen than urethral swab and does not hurt.
Centers for Disease Control and Prevention (CDC) recommendations (August 2012) call for uncomplicated gonococcal urethritis to be treated with combination therapy using ceftriaxone 250 mg IM plus either azithromycin 1 g orally or doxycycline 100 mg orally twice daily for 7 days. For patients with a severe allergy to cephalosporins, the CDC recommends a single 2-g dose of azithromycin orally. Avoid fluoroquinolones and cefixime, as drug resistance is high.
In this case, the clinical picture was so probable for gonorrhea that the FP initiated treatment with ceftriaxone 250 mg IM and 1 g oral azithromycin (which would also treat possible coexisting chlamydia). The patient was offered (and agreed to) testing for other sexually transmitted diseases. He was told to inform his partners of the diagnosis. He was also counseled about safe sex; drug rehabilitation was recommended.
On his one-week follow-up visit, his symptoms were gone and he had no further discharge. His gonorrhea nucleic acid amplification test was positive; his chlamydia, rapid plasma reagin, and human immunodeficiency virus tests were negative. His FP reported the case to the Health Department for contact tracing.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Chumley H. Gonococcal urethritis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:921-923.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link:
Based on clinical appearance, the family physician (FP) diagnosed gonococcal urethritis in this patient; a urine specimen was sent for testing to confirm the gonorrhea and to test for chlamydia.
Neisseria gonorrhoeae and Chlamydia trachomatis are the most common infectious causes of urethritis. Other infectious agents include Mycoplasma genitalium, Ureaplasma urealyticum, Trichomonas vaginalis, herpes simplex virus 1 and 2, adenovirus, and enteric bacteria. Noninfectious causes include trauma, foreign bodies, granulomas or unusual tumors, allergic reactions, or voiding dysfunction.
A nucleic acid amplification test is used to screen asymptomatic at-risk men and symptomatic men. Urine is a better specimen than urethral swab and does not hurt.
Centers for Disease Control and Prevention (CDC) recommendations (August 2012) call for uncomplicated gonococcal urethritis to be treated with combination therapy using ceftriaxone 250 mg IM plus either azithromycin 1 g orally or doxycycline 100 mg orally twice daily for 7 days. For patients with a severe allergy to cephalosporins, the CDC recommends a single 2-g dose of azithromycin orally. Avoid fluoroquinolones and cefixime, as drug resistance is high.
In this case, the clinical picture was so probable for gonorrhea that the FP initiated treatment with ceftriaxone 250 mg IM and 1 g oral azithromycin (which would also treat possible coexisting chlamydia). The patient was offered (and agreed to) testing for other sexually transmitted diseases. He was told to inform his partners of the diagnosis. He was also counseled about safe sex; drug rehabilitation was recommended.
On his one-week follow-up visit, his symptoms were gone and he had no further discharge. His gonorrhea nucleic acid amplification test was positive; his chlamydia, rapid plasma reagin, and human immunodeficiency virus tests were negative. His FP reported the case to the Health Department for contact tracing.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Chumley H. Gonococcal urethritis. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:921-923.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link: