Case Study: Gonococcal Urethritis in a Young Adult with Financial Barriers to Care

Case at a Glance

A 22-year-old male student presented with classic symptoms of a sexually transmitted infection (STI), but financial constraints were a significant barrier to seeking medical evaluation. This case highlights the role of public health resources in providing essential care.

Patient's Story

The patient is a 22-year-old male college student who presented with a several-day history of dysuria (a burning sensation during urination) and a purulent, yellow-green penile discharge. He was concerned about a potential STI but was hesitant to seek care due to being a student on a limited budget and was unsure about the potential costs of diagnosis and treatment.

Initial Assessment

Upon initial consultation, which was facilitated by a public health hotline, the patient's symptoms were highly suggestive of infectious urethritis. The primary differential diagnoses included Neisseria gonorrhoeae and Chlamydia trachomatis, which frequently present with these symptoms. Given the patient's demographic and reported symptoms, a sexually transmitted infection was the leading suspected cause.

The Diagnostic Journey

The patient was counseled on accessible and low-cost healthcare options. He was advised to contact his local county health department, which provides confidential STI testing and treatment services for free or on a sliding scale based on income. The patient followed this advice and was able to schedule a same-day appointment at a public health clinic. At the clinic, a physical examination confirmed the presence of purulent urethral discharge. A urethral swab and urine sample were collected for Nucleic Acid Amplification Testing (NAAT) to screen for both gonorrhea and chlamydia.

Final Diagnosis

The NAAT results returned positive for Neisseria gonorrhoeae and negative for Chlamydia trachomatis. The final diagnosis was uncomplicated gonococcal urethritis.

Treatment Plan

Following the current CDC guidelines for uncomplicated gonorrhea, the patient was treated with a single 500 mg intramuscular injection of ceftriaxone. He received extensive counseling regarding the importance of partner notification and treatment to prevent reinfection and community transmission. He was instructed to abstain from all sexual activity for at least seven days following the completion of his and his partner(s)' treatment.

Outcome and Follow-up

The patient's symptoms of dysuria and discharge resolved completely within three days of receiving treatment. He reported that he successfully informed his recent sexual partner, who also sought testing and care. The patient was advised to return for re-testing in three months to screen for reinfection, which is recommended for this population. This case successfully demonstrates the critical function of public health clinics in overcoming socioeconomic barriers to ensure timely and effective treatment of STIs.