A young adult male patient presents with painful urination and a purulent discharge from the urethra. A Gram-stain of the discharge shows Gram-negative, intracellular diplococci. What is the most likely causative organism?
Group of answer choices
- Chlamydia trachomatis
- Ureaplasma urealyticum
- Mycoplasma genitalium
- Neisseria gonorrhoeae
The correct answer is: Neisseria gonorrhoeae
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Explanation:
The patient’s symptoms (dysuria and purulent urethral discharge) along with the Gram-negative intracellular diplococci on microscopy are classic for gonococcal urethritis caused by:
- Neisseria gonorrhoeae – A Gram-negative diplococcus that is intracellular (often seen inside neutrophils).
Why Not the Others?
- Chlamydia trachomatis: Causes non-gonococcal urethritis (NGU) with mucoid/purulent discharge, but no organisms are seen on Gram stain (obligate intracellular, requires PCR/NAAT).
- Ureaplasma urealyticum & Mycoplasma genitalium: Also cause NGU but are too small to visualize on Gram stain (no cell wall).
Key Diagnostic Clue:
Gram-negative intracellular diplococci are pathognomonic for gonorrhea in this clinical context.
Thus, Neisseria gonorrhoeae is the definitive diagnosis.
