A sexually active young adult presents with a clear urethral discharge and dysuria. A Gram-stain of the discharge reveals numerous white blood cells but no organisms. Which organism is most likely responsible for these symptoms?
Group of answer choices
- Mycoplasma genitalium
- Ureaplasma urealyticum
- Neisseria gonorrhoeae
- Chlamydia trachomatis
The correct answer is: Chlamydia trachomatis
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Explanation:
The patient’s symptoms (clear urethral discharge, dysuria) and Gram stain findings (WBCs but no organisms) are classic for non-gonococcal urethritis (NGU), most commonly caused by:
- Chlamydia trachomatis (obligate intracellular bacterium, not visible on Gram stain).
- Mycoplasma genitalium is another cause but is less common than Chlamydia.
Why Not the Others?
- Neisseria gonorrhoeae:
- Causes purulent discharge with Gram-negative intracellular diplococci on Gram stain.
- Ureaplasma urealyticum:
- A rare cause of NGU but not as common as Chlamydia.
- Mycoplasma genitalium:
- Increasingly recognized but still less prevalent than Chlamydia in NGU.
Key Diagnostic Approach:
- NAAT (PCR) testing is the gold standard to confirm Chlamydia or Mycoplasma.
- Empirical treatment for NGU:
- Azithromycin 1g single dose (covers Chlamydia) or
- Doxycycline 100mg BID x 7 days (also covers Mycoplasma).
Thus, Chlamydia trachomatis is the most likely cause.
