Gonococcal urethritis in present times: Seek and find

Abstract

Sexually transmitted infections gained importance after the advent of human immunodeficiency virus infection in 1983. The global incidence of gonorrhea in 2008 was 106.1 million, in 2005 was 87.7 million, and in 1999 was 62 million. Laboratory diagnosis of gonorrhea is challenging due to poor facilities in smaller laboratories of developing countries. This along with nonsuspicion might lead to under-reporting of cases from such countries. We report two cases of gonococcal urethritis from a city in South India within a period of 1 year. Two young/middle-aged patients presented to the urology department with complaints of acute-onset painless urethral discharge. On suspicion of gonococcal urethritis, urethral pus was sent for Gram stain which revealed a plenty of polymorphonuclear neutrophils and a plenty of Gram-negative bean-shaped diplococci. The organism was isolated and identified as Neisseria gonorrhoeae. Contact tracing was not possible in both cases, so they were appropriately counseled and treated. Gonococcal urethritis could be under-reported in India. In the era of automation in microbiology and syndromic approach for diagnosis, simple techniques such as Gram stain and culture coupled with good clinical suspicion can clinch the diagnosis of gonococcal urethritis. Since there is a vast difference in antibiotics used for treating gonococcal and nongonococcal urethritis, it is important to diagnose the etiological agent at the earliest for targeted therapy.

Keywords

• ceftriaxone
• gonococcal urethritis
• gonococci
• gram stain
• neisseria gonorrhoeae
• sexually transmitted infection
• urethritis