A 17-year-old boy comes to the emergency department because of a 3-day history of pain in his left wrist. That morning the pain increased and he started to have chills and malaise. Last week he had self-resolving left knee pain. He is otherwise healthy and has not had any trauma to the wrist. He recently returned from a camping trip to Minnesota. He is sexually active with one female partner, who uses a diaphragm for contraception. His temperature is 38.7°C (101.7°F). Examination shows several painless violaceous vesiculopustular lesions on the dorsum of both wrists and hands; two lesions are present on the left palm. There is swelling and erythema of the left wrist with severe tenderness to palpation and passive movement. Which of the following strategies would most likely have prevented this patient's current condition?

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Eductional Objective: Neisseria gonorrhoeae is spread sexually by genitourinary secretions and can be prevented by the consistent use of condoms.  Genitourinary infections are often asymptomatic, which increases the risk of spread through the bloodstream, leading to disseminated gonococcal infection.  Patients with disseminated disease typically present with the triad of polyarthralgia, tenosynovitis, and dermatitis or purulent arthritis.

A 17-Year-Old Boy Comes to the Emergency Department Because of a 3-Day