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Gram Stain Gonococcal Urethritis — SCE Infectious Diseases MCQ

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EasySTIsGram Stain Gonococcal UrethritisSCE Infectious Diseases

A 22-year-old man presents with a urethral discharge. Gram stain of the discharge shows Gram-negative intracellular diplococci within polymorphonuclear leucocytes. NAAT is pending. Based on the Gram stain alone, what is the presumptive diagnosis and should treatment be initiated immediately?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Presumptive gonococcal urethritis — yes, treat immediately with Ceftriaxone 1 g IM without waiting for NAAT confirmation

Gram-negative intracellular diplococci (GNID) within PMNs on urethral Gram stain have >95% sensitivity and >99% specificity for gonococcal urethritis in symptomatic men. This allows immediate presumptive treatment with Ceftriaxone 1 g IM without waiting for NAAT results. Concurrent treatment for Chlamydia (Doxycycline 100 mg BD for 7 days) should also be given as co-infection is common (~20–40%). NAAT should still be sent for confirmation and test of cure at 2 weeks. Gram stain is less reliable in women and at extra-genital sites.

Reference: BASHH 2019 – Gonorrhoea; NICE CKS 2024 – Gonorrhoea