28 year old sexually active male with burningmicturition. On clinical examination no ulcer in the genitals. Urine examination shows 50 WBCs/HPF, no RBC's, leucocyte esterase positive, gonococcal culture negative. What could be the most probable causative organism '?
Chlamydia trachomatis The most common cause of urethritis in a young male is gonococcal infection Chlamydia is the next most common cause (the most common non gonococcal urethritis is chlamydia urethritis). So whenever a young male presents with urethritis, gonococcal or a chlamydial infection is suspected. Gram staining of a gonococcal urethritis reveals gram negative diplococci along with inflammatory cell. If the gram staining does not reveal gonococcus most probably it is a case of nongonococcal urethritis (chalamydial urethritis). The urethral specimen should then be tested for the presence of chlamydia. Cell culture is the best method for the diagnosis of chlamydia. Cell culture methods used for the diagnosis of chlamydia are - Mc coy cells - HI or HEp+2 cells Management of urethral discharge in men Usual causes Usual initial evaluation * Chlamydia Trachomatis * Demonstration of urethral discharge or pyuria * Neisseria Gonorrhoea * Exclusion of systemic or local complications * Ureaplasma urealyticum * Urethral gram's stain to confirm urethritis, detect gram negative diplococci. * Trichomonas vaginalis * Test for Neisseria, Gonorrhoea, chlamydia trachomatis. * Herpes simplex virus * Mycoplasma genitalium Initial treatment for patients and paners Treat Gonorrhoea (unless excluded) * Cefpodoxime * Ceftriaxone I.M. * Fluoroquinolone Plus Treat chalinydial infection Azithromycin or Doxycycline
Treponema pallidum
Neisseria
Chlamydia trachomatis
H. ducreyi