Acute gonococcal urethritis

Abstract

Gonococcal urethritis is a sexually transmitted infection caused by obligate gram-negative diplococci, Neisseria gonorrhoeae. In a patient complaining of dysuria and urethral discharge, the diagnosis is typically confirmed by identifying the bacteria in mucosal secretions. Inadequately treated or untreated cases are at a risk of developing epididymo-orchitis, prostatitis and serious complications like disseminated gonococcal infection, meningitis, and endocarditis.

Case illustrated

A 24-year-old unmarried man presented with a four-day history of dysuria and urethral discharge. He was heterosexual and had engaged in unprotected intercourse with multiple partners. His most recent sexual contact occurred seven days before the symptoms began. When the urethra was gently milked, mucopus was noted at the urethral meatus, along with perimeatal erythema (Fig. 1A). The pus collected, when subjected to Gram staining, showed multiple Gram-negative diplococci within polymorphonuclear leukocytes (Fig. 1B), suggestive of infection with Neisseria gonorrhoeae. Our diagnosis of gonococcal urethritis was further confirmed by culturing the pus on GC agar. Our patient was administered an intramuscular injection of ceftriaxone 500 mg and took 100 mg of oral doxycycline twice daily for seven days.

Fig. 1.

(A) Mucopurulent urethral discharge with perimeatal erythema. (B) Gram stain of pus showing multiple Gram-negative diplococci and polymorphonuclear leukocytes.

Gonorrhea represents various genital and extragenital conditions caused by an infection with the sexually transmitted, obligate gram-negative diplococci, Neisseria gonorrhoeae [1]. Its growing incidence and associated morbidity make it a major public health concern worldwide. Depending on the type of exposure, N. gonorrhoeae can infect the urogenital, rectal, oropharyngeal or conjunctival mucosa. The clinical presentation may vary from an asymptomatic mucosal colonization to overt inflammatory disease, most commonly presenting as urethritis and cervicitis[2]. Men with acute urethritis usually experience dysuria and urethral discharge, as seen in our case. The diagnosis is established by demonstrating N. gonorrhoeae in mucosal secretions, through Gram staining, culture, and nucleic acid amplification test [2], [3]. Patients with gonococcal urethritis who have not been tested for co-infection with Chlamydia, should additionally receive treatment for chlamydial infection, as was done for our patient [3]. They are advised to abstain from sexual activity for seven days after treatment, and their sexual partners from the past 60 days should be tested and treated. Inadequately treated or untreated cases are at a risk of developing epididymo-orchitis, prostatitis and serious complications like disseminated gonococcal infection, meningitis, and endocarditis.

Ethical approval

Not applicable

Financial support

None.

Consent

Obtained.

CRediT authorship contribution statement

Shatikkulamin H: Conceptualization, Writing – original draft. Chandana Shajil: Writing – original draft, Writing – review & editing.

Declaration of Competing Interest

No conflict of interest.