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