A 28-year-old man from Delhi presents with purulent urethral discharge and dysuria for 3 days. On examination, there is urethral meatus inflammation and a positive urethral smear showing gram-negative intracellular diplococci. He is otherwise healthy with no systemic symptoms. What is the most appropriate next step in management?

Explanation

## Clinical Diagnosis and Management **Key Point:** Gram-negative intracellular diplococci on Gram stain of urethral smear is pathognomonic for *Neisseria gonorrhoeae*. This is a presumptive diagnosis sufficient to initiate treatment immediately without awaiting culture results. ### Why Immediate Treatment? **High-Yield:** Gonorrhea is a reportable STI with significant morbidity if untreated. Delayed treatment increases risk of: - Ascending infection (epididymitis, prostatitis) - Transmission to partners - Disseminated gonococcal infection (rare but serious) ### Current Treatment Guideline The WHO and CDC recommend **ceftriaxone 250 mg IM as a single dose** as first-line monotherapy for uncomplicated urogenital gonorrhea. This has replaced the older ceftriaxone + azithromycin combination due to emerging resistance patterns. **Clinical Pearl:** The presence of purulent discharge with positive Gram stain findings in a symptomatic patient warrants immediate empiric therapy. Culture and sensitivity can be done concurrently but should not delay treatment initiation. ### Partner Management Simultaneous steps include: - Notification and testing of sexual partners - Counseling on safe sex practices - Testing for other STIs (chlamydia, syphilis, HIV)