skip to main content

Pharyngeal gonorrhea with a positive posttreatment NAAT — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

HardTest-of-CurePharyngeal gonorrhea with a positive posttreatment NAATABIM Board

A 32-year-old man underwent screening after a new male sexual partner. A pharyngeal nucleic acid amplification test (NAAT) was positive for Neisseria gonorrhoeae; urethral and rectal NAATs were negative. No culture was obtained. His weight is 182 lbs (83 kg), and he received directly observed ceftriaxone 500 mg intramuscularly. Chlamydial testing was negative. He abstained from sexual activity after treatment, and his recent partner was evaluated and treated. Eight days later, he remains asymptomatic and returns for the recommended pharyngeal test of cure. The repeat pharyngeal NAAT is positive. Which of the following is the most appropriate next step?

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

Reveal the answer and explanation

Correct answer: B — Obtain a pharyngeal culture with antimicrobial susceptibility testing before retreatment

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as E

Pharyngeal gonorrhea requires a test of cure 7–14 days after treatment regardless of the regimen because infection at this site is more difficult to eradicate. Testing near day 7 can yield a false-positive NAAT from residual nucleic acid. Therefore, a positive test-of-cure NAAT should be confirmed with culture before retreatment, particularly when no pretreatment culture was obtained. Any positive culture should undergo antimicrobial susceptibility testing. This patient's observed weight-appropriate ceftriaxone treatment, posttreatment abstinence, and treated partner make reinfection unlikely and heighten concern for treatment failure if viable gonococci are recovered. B is inappropriate because serial NAAT cannot establish organism viability or provide susceptibility data. C is tempting because suspected failures are commonly retreated with ceftriaxone, but administering antibiotics before culture may prevent recovery of an isolate needed to confirm failure and assess resistance. D confuses routine 3-month retesting for reinfection—which is still indicated later—with the site-specific test-of-cure requirement for pharyngeal disease. E uses the correct diagnostic method at the wrong anatomic site; gonococcal testing must sample the previously infected pharynx. If culture confirms persistent infection, expert/public-health consultation, reporting, and susceptibility-guided management are indicated.

Reference: Gonococcal Infections Among Adolescents and Adults (STI Treatment Guidelines 2021; last reviewed September 21, 2022) — https://www.cdc.gov/std/treatment-guidelines/gonorrhea-adults.htm STI Treatment Guidelines (Current CDC guidance; checked August 27, 2026) — https://www.cdc.gov/std/treatment-guidelines/default.htm