Rising third-year resident Dr Neil Keshvani published a Teachable Moment in the most recent issue of JAMA IM.
His case involved a patient who presented to the clinic with signs and symptoms of gonorrhea. He was successfully treated, however had the return of symptoms 3 weeks later, prompting a return to the clinic. Further history elucidated the symptoms were likely due to re-infection and illustrates the necessity for partner therapy to prevent re-infection.
Gonorrhea infections in the United States are increasing, with more than 468000 cases reported in 2016. Once an infection is identified, patients must be referred to the health department and an extensive history of all sexual partners within the last 60 days must be documented. Treatment is fairly simple, with dual ceftriaxone and azithromycin still recommended by the CDC. A test of cure should be performed within 3 months of completion of therapy. Novel strategies such as inSPOT to discretely notify possible infected partners and expedited partner therapy can potentially decrease the rates of re-infection. EPT in particular reduces rates of recurrent infection by 25% relative to asking the patient to refer partners.
The case can be viewed here.
Great work Neil!