A young man who is sexually active is evaluated in the clinic for clinical features that suggest gonorrhea.

Explanation

Core Concept: Gonorrhea is a sexually transmitted infection caused by the Gram-negative intracellular diplococcus Neisseria gonorrhoeae. In men, it typically presents as acute purulent urethritis.

Clinical Presentation:

• Profuse purulent urethral discharge, severe dysuria, and urethral pruritus.
• Complications: Epididymitis, prostatitis, urethral stricture, and disseminated gonococcal infection (arthritis-dermatitis syndrome).

Diagnosis:

• First-line tool: Nucleic Acid Amplification Test (NAAT) on a first-catch urine sample or urethral swab.
• Gold standard: Bacterial culture on Thayer-Martin agar from a urethral swab, which allows for definitive identification and crucial antimicrobial susceptibility testing due to rising global resistance.

Management:

• Acute: Empiric dual therapy (typically Ceftriaxone IM single dose, plus Doxycycline if Chlamydia is not ruled out) based on current CDC guidelines.
• Long-term/Definitive: Treat sexual partners simultaneously (expedited partner therapy) to prevent reinfection, and retest in 3 months.