A 16-year-old boy comes to the office due to 3 days of burning with urination and yellow penile discharge. The patient is sexually active with one female partner; they engage in vaginal intercourse and do not use condoms. He has no other medical conditions, takes no medications, and has no allergies. Urine nucleic acid amplification test results are pending, and urethral Gram stain is shown in the exhibit.

Appropriate treatment of this patient's condition involves antibiotics from which of the following drug classes?

Question

A 16-year-old boy comes to the office due to 3 days of burning with urination and yellow penile discharge. The patient is sexually active with one female partner; they engage in vaginal intercourse and do not use condoms. He has no other medical conditions, takes no medications, and has no allergies. Urine nucleic acid amplification test results are pending, and urethral Gram stain is shown in the exhibit.

Appropriate treatment of this patient's condition involves antibiotics from which of the following drug classes?

Quizplus · Accepted Answer

11ec160b_3c00_5a09_9249_8398fd163b41_MD0001_00 This patient with dysuria and penile discharge likely has infectious urethritis due to sexually transmitted infection. Most cases are caused by Neisseria gonorrhoeae, Chlamydia trachomatis, or Mycoplasma genitalium. The underlying pathogen is typically identified with nucleic acid amplification testing (NAAT) of urine, vaginal, or endocervical swab. However, light microscopy with Gram stain can be performed to rapidly identify N gonorrhoeae while awaiting NAAT results, as follows: Patients with gonococcal urethritis who have coinfection with C trachomatis or uncertain C trachomatis status (as in this patient whose NAAT results are pending) require a third-generation cephalosporin (eg, ceftriaxone) and a tetracycline (eg, doxycycline) to cover gonococcus and possible C trachomatis coinfection. Patients with gonococcal urethritis who have negative C trachomatis NAAT should be treated with third-generation cephalosporin (eg, ceftriaxone) alone (Choice F). Patients with nongonococcal urethritis should be treated with macrolide (eg, azithromycin) or tetracycline (eg, doxycycline) monotherapy (Choice C). (Choices A and B) N gonorrhoeae is largely resistant to fluoroquinolones (eg, ciprofloxacin, levofloxacin), so this class of medication is not recommended. (Choice D) Penicillin is the treatment of choice for syphilis. However, empiric treatment is not recommended unless a chancre is present. Other stages of syphilis should only be treated when serology (eg, rapid plasma reagin, VDRL) is positive or the organism is otherwise identified. Educational objective: Infectious urethritis in men is typically caused by Neisseria gonorrhoeae, Chlamydia trachomatis, or Mycoplasma genitalium. Diagnosis is generally made by nucleic acid amplification testing, but microscopy with Gram stain can be used to quickly diagnose gonococcal infection. Patients with gonorrhea and positive or uncertain Chlamydia status require ceftriaxone and doxycycline; ceftriaxone alone can be used in those who do not have Chlamydia coinfection. __________ References: Management of gonorrhea in adolescents and adults in the United States. (http://www.ncbi.nlm.nih.gov/pubmed/26602618)

A 16-Year-Old Boy Comes to the Office Due to 3