Neisseria gonorrhoeae infection

A 47-year-old married man, Mike A., reported to a local clinic with complaints of slight chest pain, shortness of breath, dysuria (difficult and painful urination), and a milky-white urethral discharge. His previous medical history was significant for hypercholesterolemia and hypertension. These conditions were being managed with diet and exercise and continued to be monitored by his regular physician. Mike was proud to announce that he had lost 30 pounds over the past year and had been working out regularly at the gym. He mentioned that he had been feeling very well, "like I was 25 years old again," until 3 days ago, when the dysuria and discharge first started. He admitted that he did not want to visit his regular physician because of the nature of this problem but was starting to become increasingly anxious about his situation. Mike divulged further that he had been having an affair with a woman he met at the gym. They had been sexually intimate over the past 6 weeks, and they had unprotected intercourse a week ago.

A urethral specimen was collected for routine sexually transmitted disease (STD) workup, and Mike was treated empirically with antimicrobial agents.

Direct Gram's stain of the urethral discharge revealed many polymorphonuclear leukocytes and numerous intra- and extra-cellular kidney bean-shaped gram-negative diplococci.

1. Based on the Gram's stain results, what organism do you suspect is causing Mike's infection?

2. What considerations should be made for appropriate specimen transport for these types of specimens?

3. "Routine" STD workups may consist of molecular diagnostic techniques, conventional culture methods, or both. If the specimen is processed for conventional culture, what type(s) of media would be appropriate for recovery of the organism responsible for this man's infection? Be sure to mention the important components of the media and their purpose, as well as any specialized inoculation techniques and the appropriate atmosphere of incubation.

4. What subsequent testing would be appropriate for identification of the organism?
5. What are some of the key biochemical characteristics that are useful in identifying this organism?
6. Describe the molecular diagnostic techniques that may also be used to identify this organism and another etiologic agent in STDs.

7. What would be an advantage to using molecular diagnostic techniques in this situation?

8. What might be a disadvantage to using these techniques?

9. What does empiric mean?

10. What antimicrobial chemotherapy would be appropriate for Mike?

11. What should be done about the woman from the gym and Mike's wife?