A sexually active man presents with dysuria and purulent penile discharge. What is the most likely diagnosis?

A sexually active man presents with dysuria and purulent penile discharge. What is the most likely diagnosis?

• A. Gonorrhea
• B. Urethritis due to non-gonococcal infection
• C. Herpes simplex infection
• D. Cytomegalovirus urethritis

Answer: (A)

Purulent urethral discharge with dysuria in a sexually active man is most characteristic of gonorrheal urethritis caused by Neisseria gonorrhoeae. The infection typically produces a thick, purulent discharge and painful urination in men, which sets it apart from other causes of urethritis. Non-gonococcal urethritis, often due to Chlamydia, usually presents with milder symptoms and a mucoid or scant discharge rather than a purulent one. Herpes simplex infection tends to cause painful vesicular lesions or ulcers rather than a purulent urethral discharge. Cytomegalovirus urethritis is uncommon in this setting. Diagnosis is confirmed with nucleic acid amplification testing of urine or urethral swab, and Gram stain showing intracellular diplococci can support gonorrhea in the appropriate clinical context.

Purulent urethral discharge with dysuria in a sexually active man is most characteristic of gonorrheal urethritis caused by Neisseria gonorrhoeae. The infection typically produces a thick, purulent discharge and painful urination in men, which sets it apart from other causes of urethritis. Non-gonococcal urethritis, often due to Chlamydia, usually presents with milder symptoms and a mucoid or scant discharge rather than a purulent one. Herpes simplex infection tends to cause painful vesicular lesions or ulcers rather than a purulent urethral discharge. Cytomegalovirus urethritis is uncommon in this setting. Diagnosis is confirmed with nucleic acid amplification testing of urine or urethral swab, and Gram stain showing intracellular diplococci can support gonorrhea in the appropriate clinical context.