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Partner Therapy in Sexually Transmitted InfectionsA Teachable Moment

Educational Objective
To describe novel strategies for notification and treatment of patients' partners who have gonorrhea infection to help reverse the trend of rising gonococcal infection and resistance.
1 Credit CME

A previously healthy man in his 20s presented to an urgent care clinic after 5 days of urethral discharge and dysuria. He reported having a new female sexual partner for the past 4 weeks. He had had no other sexual partners in the past 6 months and did not report having sex with men or prior sexually transmitted infections. He had not experienced fevers, chills, joint pains, erythematous eruptions, or flank pain.

On examination, he was afebrile with a heart rate of 68 beats/min, blood pressure of 126/72 mm Hg, and a respiratory rate of 14 breaths/min. Spontaneous mucopurulent urethral discharge was noted. No suprapubic tenderness, inguinal lymphadenopathy, epididymal tenderness, or genital ulcers were present. A urine test result for Neisseria gonorrhoeae nucleic acid amplification testing was positive. Test results for human immunodeficiency virus (HIV) serology, rapid plasma reagin, and chlamydia testing were negative. He was diagnosed as having gonococcal urethritis and was treated with single doses of intramuscular ceftriaxone and oral azithromycin. The health department was not notified.

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Article Information

Corresponding Author: Arjun Gupta, MD, Department of Internal Medicine, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8852 (guptaarjun90@gmail.com).

Published Online: June 11, 2018. doi:10.1001/jamainternmed.2018.2406

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

Additional Information: Dr Keshvani was an internal medicine resident at the time of preparation and submission of this manuscript.

References
1.
Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.  Sexually Transmitted Disease Surveillance 2016. Atlanta, GA: Centers for Disease Control and Prevention; 2017.
2.
Workowski  KA, Bolan  GA; Centers for Disease Control and Prevention.  Sexually transmitted diseases treatment guidelines, 2015.  MMWR Recomm Rep. 2015;64(RR-03):1-137.PubMedGoogle Scholar
3.
Boyajian  AJ, Murray  M, Tucker  M, Neu  N.  Identifying variations in adherence to the CDC sexually transmitted disease treatment guidelines of Neisseria gonorrhoeae Public Health. 2016;136:161-165.PubMedGoogle ScholarCrossref
4.
Gursahaney  PR, Jeong  K, Dixon  BW, Wiesenfeld  HC.  Partner notification of sexually transmitted diseases: practices and preferences.  Sex Transm Dis. 2011;38(9):821-827.PubMedGoogle ScholarCrossref
5.
Golden  MR, Whittington  WL, Handsfield  HH,  et al.  Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection.  N Engl J Med. 2005;352(7):676-685.PubMedGoogle ScholarCrossref
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