NAAT is key to diagnosis
Infection with genitourinary N gonorrhoeae can be detected in various ways, including gram staining of a male urethral specimen, culture, nucleic acid hybridization, and NAAT. NAAT, which we used with our patient, has the advantage of being approved for use with urine specimens from men and women, as well as with endocervical or urethral samples.
Diagnosis of nongenital infection (ie, pharynx, rectum) typically requires culture. Other diagnostic methods are not FDA-approved for use with specimens from nongenital sites and may yield false-positive results due to cross-reactivity with organisms other than N gonorrhoeae.14 Patients tested for gonorrhea should also be tested for other sexually transmitted infections, including chlamydia, syphilis, and human immunodeficiency virus.
Treat patients with ceftriaxone
Treatment for tysonitis is similar to treatment for gonococcal urethritis and centers on the use of appropriate antibiotics.15 Quinolone-resistant N gonorrhoeae is increasingly common; it is estimated that up to 40% of strains in Asia are now quinolone resistant.16 Because of this, the CDC recommends treatment with ceftriaxone and azithromycin.17 As with urethritis, presumptive treatment for chlamydia is warranted. For tysonitis, incision and drainage may also be necessary.18
A good outcome for our patient
This patient was treated with ceftriaxone 250 mg intramuscularly and azithromycin 1 g as a single oral dose. The abscess was incised and drained under local anesthesia, with 2 cc of pus obtained.
Five days after treatment, the patient reported feeling much better. He was told to call the clinic if he didn’t have complete resolution in 2 weeks. He did not report any further problems.
CORRESPONDENCE Andrew Schechtman, MD, San Jose-O’Connor Hospital Family Medicine Residency, 455 O’Connor Drive,#210, San Jose, CA 95128; aschecht@stanford.edu