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most commonly caused by organisms associated with sexually transmitted infections.


Urethritis is inflammation of the urethra,




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Indication: gonococcal urethritis

Microscopic evidence of gonococcal urethritis (ie, gram-negative intracellular diplococci in the urethral exudate) or high clinical suspicion of gonococcal infection (eg, known or suspected N. gonorrhoeae exposure)

When microscopic evaluation of urethral specimens is not available, sexually active men with urethritis should be empirically treated for gonococcal urethritis.


The preferred regimen for gonococcal infections is a single intramuscular dose of ceftriaxone (250 mg) and a single oral dose of azithromycin (1 gram). This regimen will also treat chlamydia, but co-infection with chlamydia is no longer the only impetus for dual therapy.

Of note, oral cephalosporins are no longer a recommended regimen for gonococcal infection due to the decreasing susceptibility to these agents noted among N. gonorrhoeae isolates, as well as concerns about the efficacy of these agents for pharyngeal infection.

Indication: N. meningitidis is treated the same as gonococcal urethritis [1].




Complications of Injecting Drug Use

  • Local problems—Abscess (Figures 240-2 
    Image not available.

    A 32-year-old woman with type 1 diabetes developed large abscesses all over her body secondary to injection of cocaine and heroin. Her back shows the large scars remaining after the healing of these abscesses. (Courtesy of ­Richard P. Usatine, MD.)

    and 240-3; Abscess), cellulitis, septic thrombophlebitis, local induration, necrotizing fasciitis, gas gangrene, pyomyositis, mycotic aneurysm, compartmental syndromes, and foreign bodies (e.g., broken needle parts) in local areas.2
    • IDUs are at higher risk of getting methicillin-resistant Staphylococcus aureus(MRSA) skin infections that the patient may think are spider bites (Figure 240-4).
    • Some IDUs give up trying to inject into their veins and put the cocaine directly into the skin. This causes local skin necrosis that produces round atrophic scars (Figure 240-5).
  • IDUs are at risk for contracting systemic infections, including HIV and hepatitis B or hepatitis C.
    • Injecting drug users are at risk of endocarditis, osteomyelitis (Figures 240-6and 240-7), and an abscess of the epidural region. These infections can lead to long hospitalizations for intravenous antibiotics. The endocarditis that occurs in IDUs involves the right-sided heart valves (see Chapter 50, Bacterial Endocarditis).2 They are also at risk of septic emboli to the lungs, group A β-hemolytic streptococcal septicemia, septic arthritis, and candidal and other fungal infections.


Urethritis generally responds well to antibiotic treatment, but fertility-limiting complications in men and especially in women may result from untreated or incompletely treated infections

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Question 1 of 1

A 42-year-old African-American man has been diagnosed with hypertension for the past 10 years and treated with medication. One morning, he is found unresponsive by his wife. He is taken to the emergency department and pronounced dead by the physician. An autopsy revealed cardiac hypertrophy and a narrowing of the aorta just distal to the ligamentum arteriosum, with dilation of the intercostal artery's ostia. How could the death have possibly been prevented?