Question

A man presents with a history of dysuria and urethral discharge after having unprotected sexual intercourse. Gram-staining of the purulent discharge is seen in the following image. What is the treatment of choice for this infection?

• A. Erythromycin
• B. Azithromycin
• C. Ceftriaxone
• D. Penicillin G

Answer 1

The Correct Option is C

This clinical scenario likely indicates a case of gonorrhea, caused by the bacterium Neisseria gonorrhoeae. The classic symptoms of gonorrhea in men include dysuria (painful urination) and purulent urethral discharge, often following unprotected sexual intercourse. Gram staining of the discharge typically reveals Gram-negative diplococci. The most effective treatment for gonorrhea is ceftriaxone, an extended-spectrum cephalosporin antibiotic that is effective against N. gonorrhoeae.

The treatment guidelines recommend:

• Ceftriaxone: This is considered the treatment of choice due to its efficacy in treating gonococcal infections, including strains that may have developed resistance to other antibiotics. Current guidelines often recommend a single intramuscular dose of 500 mg.

Let us briefly analyze why other options might not be the best choice:

• Erythromycin: An antibiotic that is not typically used for the treatment of gonorrhea due to resistance issues.
• Azithromycin: While effective against Chlamydia (often tested and treated concomitantly due to frequent coinfection), it is not the first-line treatment for gonorrhea.
• Penicillin G: Previously used but no longer effective due to widespread resistance among gonococcal strains.

Therefore, the appropriate treatment to address the infection described in this scenario is ceftriaxone.