Gonorrhea

The correct answer is B.

This patient has a gonorrhea infection. Gonorrhea is one of the most prevalent sexually transmitted diseases (STDs) in the United States. It is more common in patients of lower socioeconomic status, patients with multiple sexual partners, and in urban settings.

The causative organism is N. gonorrhoeae, a gram-negative aerobic diplococcus. Up to 80% of women that are infected with the organism will have no symptoms at all or only vague symptoms. Symptoms that are frequently noted are vaginal discharge, postcoital spotting, and urinary symptoms if the urethra is involved.

Examination may reveal a cervicitis, although this is not always present. A patient found to have gonorrhea should be treated with intramuscular ceftriaxone or oral cefixime, ofloxacin, or ciprofloxacin. These medications will effectively eradicate the gonococcus.

However, because Chlamydia trachomatis can be isolated in up to 50% of women with gonorrhea and because women treated for gonorrhea only may soon go on to develop Chlamydia or pelvic inflammatory disease (PID), any woman receiving treatment for gonorrhea should also be treated for Chlamydia. Treatment of Chlamydia is with azithromycin or doxycycline. It is also essential that this patient's partner be treated as well.

When treating a patient for gonorrhea, there is no need to treat the patient with metronidazole to treat bacterial vaginosis (choice A) as well, unless there is evidence of a bacterial vaginosis .

Herpes (choice C) often presents as painful vesicles and ulcers. Patients with gonorrhea do not need to be treated for herpes as well, unless there is evidence for herpes infection.

Patients with gonorrhea are at increased risk of having other sexually transmitted diseases, including syphilis (choice D). It would be prudent to check this patient for syphilis with a blood test. However, in the absence of a positive syphilis test, patients with gonorrhea do not need to be treated for syphilis.

Trichomoniasis (choice E) is treated with metronidazole. Again, as with bacterial vaginosis, herpes, and syphilis, unless there is evidence of Trichomonas infection, the patient does not needed to be treated for trichomoniasis.

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