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Urethritis, Gonococcal


Step 1: View clinicals

A 26 year old man presents with dysuria, frequency and a copious urethral discharge for 3 days. He has a regular sexual partner with whom his last contact was 1 week ago, and also a casual partner whom he was last exposed to around 3 months ago. His medical history is unremarkable.

Step 2: Order all relevant investigations

Urethral swab & Gram stain

Gram negative intracellular diplococci are noted. There are ~10 WBC per oil immersion field


Pus cells: field full/hpf RBC: nil/hpf

Chlamydial + Gonococcal NAAT

Negative for C. trachomatis Positive for N. gonorrhoeae

Culture + ABST for N. gonorrhoeae

Cultures are positive for N. gonorrhoeae. Sensitivity testing shows that the strain is susceptible to Ceftriaxone and Azithromycin

Step 3: Select appropriate management

IM Ceftriaxone
Oral Azithromycin
Treat casual partner
Test 3 months after Rx

Score: ★★☆