A 28-year-old man from Delhi presents with urethral discharge and dysuria for 5 days. NAAT confirms Neisseria gonorrhoeae. Regarding the clinical features, complications, and management of gonorrhea, all of the following statements are correct EXCEPT:

Explanation

## Clinical Management of Gonorrhea: Treatment Regimens ### Current Treatment Guidelines **High-Yield:** Ceftriaxone dosing and combination therapy have evolved due to rising antimicrobial resistance. The current recommended regimen is NOT ceftriaxone 500 mg alone. **Key Point:** The CDC and WHO now recommend **ceftriaxone 1 g IM single dose** (NOT 500 mg) for uncomplicated urethral gonorrhea. Many guidelines also recommend addition of azithromycin or doxycycline to cover concurrent Chlamydia, though azithromycin resistance is increasing. ### Recommended Gonorrhea Treatment Regimen (2023 Guidelines) | Regimen | Dose | Notes | |---------|------|-------| | **Ceftriaxone (preferred)** | **1 g IM single dose** | Higher dose (1 g, not 500 mg) to combat resistance | | + Azithromycin or Doxycycline | 1 g PO single dose OR 100 mg BD × 7 days | For concurrent chlamydial coverage | | Alternative (if cephalosporin allergy) | Fluoroquinolone (if susceptible) or spectinomycin | Increasingly limited due to resistance | **Warning:** Ceftriaxone 500 mg is INADEQUATE and is no longer recommended. The dose must be 1 g IM for uncomplicated urethral gonorrhea. ### Complications in Men **Clinical Pearl:** Untreated or inadequately treated gonorrhea can ascend to cause: - Epididymitis (most common complication) - Prostatitis - Urethral stricture (due to fibrosis and scarring) - Infertility (from testicular damage) ### Complications in Women **Key Point:** Pelvic inflammatory disease (PID) is the most serious upper genital tract complication, leading to: - Chronic pelvic pain - Ectopic pregnancy (tubal scarring) - Infertility (tubal adhesions) - Tubo-ovarian abscess ### Disseminated Gonococcal Infection (DGI) **High-Yield:** DGI occurs in 0.5–3% of untreated cases and presents in two phases: 1. **Bacteremic phase:** Migratory polyarthritis (knees, wrists, ankles), tenosynovitis, pustular rash (typically on trunk and extremities, often with central necrosis) 2. **Septic arthritis phase:** Monoarticular arthritis (often knee), with sterile synovial fluid culture but positive NAAT or culture from blood/skin lesions **Clinical Pearl:** The combination of migratory polyarthritis + pustular skin lesions is pathognomonic for DGI and is a medical emergency requiring IV ceftriaxone.