A 15-year-old heterosexual male was brought to the
emergency room by his sister. He gave a 24-hour history of
and noted some ‘
-like’ drainage in his
underwear and the tip of his penis (Figure 1). Urine
appeared clear and urine culture was negative, although
urinalysis was positive for leukocyte esterase and multiple
white cells were seen on microscopic examination of
urine. He gave a history of being sexually active with five
or six partners in the past 6 months. He claimed that he
and his partners had not had any sexually transmitted
diseases. His physical exam was significant for a yellow
urethral discharge and tenderness at the tip of the penis. A
Gram stain of the discharge was performed in the
emergency room (Figure 2). He was given antimicrobial
agents and scheduled for a follow-up visit 1 week later. He
was asked to provide the names and addresses of his
sexual partners to the Health Department so that they
could be examined and treated if necessary. One of the
sexual partners, a 15-year-old female who reported having
had sexual relations with her boyfriend frequently over the
last 6 months, was asymptomatic until 2 days before
coming to the hospital when she developed fever, shaking
chills, and lower abdominal pain. Her symptoms worsened
and she presented with fever of 42
abdominal pain, and a swollen right knee, with blood
pressure 120/80 and pulse 150/min and regular. The date
of her last menstrual period, which was described as
normal, was 1 week before admission. The patient was
abdomen and rigidity, and decreased bowel sounds; the
right knee was red, hot, tender, and swollen. Pelvic
examination showed some white discharge of the cervical
os (Figure 3) A swab was obtained from her cervix for
culture (Figure 4). Her right knee was tapped.
hemoglobin: 12 g dl
white blood cell (WBC) count: 26000
differential: 70 PMN, 5 bands, 25 lymphocytes
urinalysis: specific gravity, 1.010; protein, 2+; sugar,
negative; WBC, 8–10 per HPF; no casts.
Figure 1 (top left).
infection in the male. Creamy
purulent discharge from the urinary
. In many cases infection is
asymptomatic, but may cause painful
urination or a purulent discharge, as
seen here. In severe cases it may also
cause inflammation of the testicles and
prostate gland, and infertility. Treatment
is with antibiotics.
Figure 2 (top right).
Gram stain of
penile discharge showing intracellular
Figure 3 (bottom left).
Figure 4 (bottom right).
Gram stain of
a cervical smear showing extracellular
and intracellular gram-negative
© Lydyard, Peter; Cole, Michael; Holton, John; Irving, Will; Porakishvili, Nino; Venkatesan, Pradhib; Ward, Kate, Jan 01, 201