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Internal Medicine
The quantity and appearance of the discharge can be used to distinguish accurately gonococcal
and nongonococcal urethritis in about 75-80% of patients who have not urinated recently. It
can’t, of course, be used to diagnose dual infection with N.gonorrhea and C.trachomatis. Milking
of the urethra may be necessary to get a good amount of discharge sample.
Microscopy of urethral discharge stained with methylene blue or safranin or Gram’s
stain shows pus cells with characteristic intracellular coffee bean shaped diplococci
Æ N.gonorrhea.
Pus cells without intracellular diplococci = NGU.
When the accurate etiologic diagnosis is made
Gonococcal Urethritis:
Ceftriaxone 250mg IM stat
Ciprofloacin 500mg PO stat
Spectinomycin 2mg IM stat.
• NGU: Doxycycline 100mg PO BID for 7 days or Tetracycline 500mg PO QID for 7 days
OR Erythromycin 500mg PO QID for 7 days if the patent has contraindication for TTC..
When there is no Etiologic diagnosis: Treatment should cover both gonococccal and
chlamydial infections (combine the above treatments)
2. Vaginal Discharge:
1. N.gonorrhea
2. Chlamydia trachomatis
3. Trichomonas vaginalis,
4. Gardnerella vaginalis
5. Candida albicans
6. Vaginal anaerobes (“bacteria vaginosis”)
The first three are sexually acquired and the last three are endogenous infections.
The first two cause cervicitis while the last four cause vaginitis.