Manifestations of Gonorrhea and Chlamydial Infection Bernard M. Karnath, MD Choose the single best answer to each question. 1. A 25-year-old man develops a purulent urethral discharge and dysuria 5 days after having unprotected sexual intercourse with a new female partner. What will Gram staining of the purulent urethral discharge likely reveal? Gram-positive diplococci Gram-negative diplococci Gram-positive bacilli Gram-negative bacilli No organisms Click here to compare your answer. 2. A 21-year-old previously healthy college student presents with new onset of dysuria. He is sexually active with several partners. On physical examination, the patient is afebrile. Examination is normal except for a purulent urethral discharge. Once the diagnosis is established, which of the following is the best management for this patient? One dose of oral ofloxacin One-time intramuscular (IM) injection of ceftriaxone One-time IM injection of ceftriaxone and oral azithromycin One-time IM injection of ceftriaxone and a 7-day course of doxycycline Trimethoprim-sulfamethoxazole for 3 days Click here to compare your answer. 3. A 23-year-old woman presents with a 1-week history of joint pains, fevers, and scattered pustules on her skin. Her left knee is red, warm, and tender to palpation and painful when moved. Her right ankle is also very tender to palpation. Pelvic examination reveals a purulent cervical discharge. The cervical discharge is swabbed and sent for Gram stain and culture. What is the most likely sexually transmitted disease in this case? Chancroid Chlamydia Gonorrhea Herpes Syphilis Click here to compare your answer. 4. A 25-year-old man develops a urethral discharge and dysuria 5 days after having unprotected sexual intercourse with a new partner. The urethral discharge is clear and nonpurulent. The patient is treated with IM ceftriaxone. Two weeks later, the patient returns reporting the same clear urethral discharge. Which of the following is the most likely causative organism for this patient’s symptoms? Chlamydia trachomatis Haemophilus ducreyi Klebsiella granulomatis Neisseria gonorrhoeae Treponema pallidum Click here to compare your answer. 5. A 25-year-old man presents with a 2-week history of arthritis, conjunctivitis, and a clear urethral discharge. He admits to having unprotected sexual intercourse with a new female partner about 3 weeks ago. What is the best treatment option? Acyclovir Azithromycin Ceftriaxone Penicillin Click here to compare your answer. 6. A 24-year-old woman presents to the emergency department with excruciating abdominal pain. Her symptoms began approximately 4 weeks earlier with pain in the right upper quadrant associated with hiccups. The abdominal pain has progressed to the point where she is unable to walk. Physical examination reveals and temperature of 102.4°F, respiratory rate of 32 breaths/min and shallow, heart rate of 119 bpm, and blood pressure of 85/60 mm Hg. Sclerae are anicteric. The abdomen is tense with guarding and rebound tenderness, and bowel sounds are diminished. Pelvic examination reveals no external lesions and cervical motion tenderness. The patient reports a recent purulent urethral discharge. What is the most likely infection in this patient? Chancroid Chlamydia Gonorrhea Herpes Syphilis Click here to compare your answer. Click here to read more about Manifestations of Gonorrhea and Chlamydial Infection (Requires Adobe Acrobat Reader) Check our archives to test your knowledge in other clinical signs: If you do not already have Acrobat Reader, simply click on the icon below, scroll down to the "Get the Free Acrobat Reader" heading and follow the instructions to install the program. Acrobat enables you to convert any document into an Adobe Portable Document Format (PDF) file for easy viewing. Download Adobe Acrobat Reader   Hospital Physician     JCOM     Seminars in Medical Practice Hospital Physician Board Review Manuals About TWC    Subscribe    Contact TWC    Home    Search   Site Map Copyright © 2009, Turner White Communications Updated 6/19/09 • nvf