Question

• A male 20 yr old 2nd year student had a urethral discharge and went to Student Health. • A smear of the discharge showed typical Gram negative intracellular diplococci and a sample was sent for culture • He was given ampicillin in a dose sufficient to eradicate most penicillin sensitive gonococci (Neisseria gonorrhoeae). • The discharge diminished and became less purulent, but a week later it was still present. The Patient: Poll Code: ZLV • The initial culture was positive for penicillin-susceptible gonococci • The subsequent culture taken on his second visit to the doctor was negative both in smear (Gram stain) and culture.

Was this a treatment failure?
A. Yes, he probably had a strain of N. gonorrhoeae that mutated and became penicillin-resistant
B. Yes his N. gonorrhoeae likely acquired a resistance gene by horizontal transmission (e.g. conjugation)
C. No because the second specimen was culture negative
D. No, he had post-infectious autoimmune reactions

Answer 1

The described case was not a treatment failure because the second culture for Neisseria gonorrhoeae was negative, indicating successful eradication of the infection. Persistent discharge might suggest other causes and requires further investigation for proper diagnosis and treatment.

Step-by-step explanation:

The question relates to the treatment of urethral discharge in a male patient initially diagnosed with penicillin-sensitive Neisseria gonorrhoeae. Since the second culture, taken after treatment with ampicillin, was negative for both smear (Gram stain) and culture, this would typically suggest that the treatment was successful in eradicating the N. gonorrhoeae infection. Therefore, the appropriate answer is C. No because the second specimen was culture-negative. However, the persistent symptom of discharge, despite the negative culture, could suggest alternative causes such as another bacterial infection like Chlamydia trachomatis or Mycoplasma genitalium, or even post-inflammatory or post-infectious symptoms. It is important to consider Nongonococcal Urethritis (NGU) and potentially coinfection with other sexually transmitted infections when assessing treatment outcomes and post-treatment symptoms.