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Question

Difficulty: EasyInfectious Diseases

Match each patient's clinical presentation with the most appropriate first-line pharmacotherapy.

  • A 24-year-old man with a painless penile ulcer with indurated margins and non-tender inguinal lymphadenopathy.Intramuscular penicillin G benzathine
  • A 22-year-old woman with a frothy, yellow-green vaginal discharge and punctate cervical hemorrhages.Oral metronidazole
  • A 26-year-old man with purulent urethral discharge; Gram stain shows intracellular Gram-negative diplococci.Intramuscular ceftriaxone
  • A 21-year-old woman with mucopurulent cervicitis; nucleic acid amplification testing (NAAT) is positive for an obligate intracellular bacterium.Oral doxycycline

Answer

The correct pairings are: Primary syphilis with Intramuscular penicillin G benzathine; Trichomoniasis with Oral metronidazole; Gonorrhea with Intramuscular ceftriaxone; Chlamydia with Oral doxycycline.
Each classic presentation of a sexually transmitted infection uniquely matches with its standard, guideline-directed monotherapy. Recognizing the hallmark signs (e.g., painless ulcer for syphilis, intracellular diplococci for gonorrhea) allows for the direct selection of the appropriate antibiotic.

Step-by-Step Solution

1
Identify the underlying infectious etiology for the first clinical presentation.
A painless penile ulcer indicates primary syphilis.
Syphilis classically presents as a painless chancre, requiring penicillin therapy.
2
Identify the underlying infectious etiology for the second clinical presentation.
Frothy, yellow-green discharge and punctate cervical hemorrhages ('strawberry cervix') indicate Trichomonas vaginalis infection.
These are the classic hallmark findings for trichomoniasis, which is treated with antiprotozoal agents.
3
Identify the underlying infectious etiology for the third clinical presentation.
Purulent discharge with intracellular Gram-negative diplococci indicates Neisseria gonorrhoeae infection.
Gonococcus uniquely appears as Gram-negative diplococci inside polymorphonuclear leukocytes.
4
Identify the underlying infectious etiology for the fourth clinical presentation.
Mucopurulent cervicitis caused by an obligate intracellular bacterium indicates Chlamydia trachomatis.
Chlamydia cannot synthesize its own ATP and relies on the host cell, requiring targeted antibiotic therapy.
5
Match each identified pathogen to its guideline-directed medical therapy.
Syphilis -> Penicillin G; Trichomonas -> Metronidazole; Gonorrhea -> Ceftriaxone; Chlamydia -> Doxycycline.
Applying standard pharmacological guidelines ensures appropriate antimicrobial coverage and stewardship.

Key Concept

First-line pharmacotherapy for common sexually transmitted infections (STIs)
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Topics

Infectious Diseases

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